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Given the fact that patients with type 1 diabetes have a life-long predisposition to recurrences of diabetic ketoacidosis, it is remarkable that the approach to the management of this complication is taught in a fundamentally different way in paediatrics and in adult medicine. In the former, the primary aim is to eliminate ketonaemia and ketonuria expeditiously, using a fixed dose and evidence based insulin infusion, namely, 0.1 unit/kg/h,1 which is maintained as long as necessary even if it entails the risk of hypoglycaemia, the latter eventuality being circumvented through the infusion of intravenous glucose, given the fact that the resolution of acidaemia takes longer than the normalisation of blood glucose concentrations.2
The teaching in adult medicine, conveyed through the medium of the handbook most likely to be used by junior doctors, is that normalisation of blood glucose is paramount, hence the preoccupation with a sliding scale insulin regime targeted at the blood glucose,3 as opposed to a fixed dose regime targeted at ketonaemia and ketonuria.
What this means is that, in the transition from childhood to adulthood, a diabetic will encounter a change in emphasis during the management of recurrences of ketoacidosis. I am not sure that this is right.
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