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Approximately 20–34% of hospitalized patients have a diagnosis of diabetes, while many others experience stress hyperglycaemia, both increasing the occurrence of dysglycaemia in the hospital.1 Hyperglycaemia is associated with increased infection rates and higher mortality rates. Conversely, hypoglycaemia can lead to adverse neurological outcomes, prolonged hospital stays, as well as increased mortality.1 In spite of current guidelines […]

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CE/CME accredited

Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

Topics Covered:
Diabetes
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Tutorial

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Poll

Which of the following key symptoms is most frequently missed in DKA?

Submit your answer to see the results and continue the video
Nausea/vomiting
   
Kussmaul breathing
   
Acetone breath
   
Other
   

Tutorial

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Poll

Which of the following risk factors is most common in DKA in your experience?

Submit your answer to see the results and continue the video
Previous DKA
   
SGLT2 inhibitor use
   
Elevated HbA1c
   
Other
   

Tutorial

These icons indicate there is something to be interacted with. Click it when you see it.

Poll

What is the biggest barrier to ketone monitoring in your patients?

Submit your answer to see the results and continue the video
Need for in-date test strips
   
Need for finger pricks
   
Need to remember to take test
   
Other
   
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Videos

Impact of DKA on individuals with diabetes

Prof. Jennifer Sherr covers the clinical features and aetiology of DKA and considers the impact DKA has upon individuals living with diabetes.
Duration: 7:50

Pathophysiology and management of DKA

Prof. Jennifer Sherr explains the pathophysiology and management of DKA, covering risk factors, common triggers, metabolic pathways and pillars of management.
Duration: 8:59

Prevention and monitoring of DKA

Prof. Jennifer Sherr delves into prevention strategies, highlighting the critical role of patient education. Her discussion extends to ketone monitoring, where she outlines its advantages, drawbacks and recent breakthroughs.
Duration: 10:33

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Associated slides for this activity are available under the Downloads tab.
A practice aid for this activity is available under the Downloads tab.

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Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

0.75 CE/CME credit

Question 1 of 5

You are having an initial consultation with a 7-year-old who was recently diagnosed with T1D. You are discussing the risk of DKA and the importance of monitoring and prevention. What symptoms would you advise the child’s parents to look out for?

DKA, diabetic ketoacidosis; T1D, type 1 diabetes

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Key presenting symptoms of DKA include acetone or fruity smelling breath, polyuria, polydipsia, abdominal pain, nausea/vomiting, altered sensorium and Kussmaul breathing.1,2

Abbreviation

DKA, diabetic ketoacidosis.

References

  1. Ahuja W, at al. Cureus. 2019;11:e4798.
  2. Shahid W, et al. Cureus. 2020;12:e10792.
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Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

0.75 CE/CME credit

Question 2 of 5

Which of the following risk factors are commonly associated with DKA?

DKA, diabetic ketoacidosis; GLP-1; glucagon-like peptide-1

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Non-modifiable risk factors for DKA include adolescent age, female sex, low socioeconomic status and ethnicity or migration.1 Modifiable risk factors include a previous episode of DKA, SGLT2 inhibitor use, elevated HbA1c, treatment non-adherence, alcohol or substance abuse, quality of care, poor mental health and somatic comorbidities, e.g. infection, trauma and pancreatitis.1,2

Abbreviations

DKA, diabetes ketoacidosis; HbA1c, glycated haemoglobin; SGLT2, sodium-glucose co-transporter-2.

References

  1. Ehrmann D, et al. Lancet Diabetes Endocrinol. 2020;8:436–46.
  2. Umpierrez GE, et al. Diabetes Care. 2024;47:1257–75.
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Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

0.75 CE/CME credit

Question 3 of 5

You have a 47-year-old with diabetes who presents to the emergency department with Kussmaul breathing, nausea and vomiting with an altered sensorium. Blood tests reveal a blood glucose of 230 mg/dL, an arterial pH of 7.1 and β-hydroxybutyrate concentration of 5.2 mmol/L. You diagnose moderate DKA. Which of the following would be your aim for treatment in this patient?

DKA, diabetic ketoacidosis.

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Treatment for DKA should aim to correct acidaemia and normalize blood glucose concentrations, acid-base disturbances and circulatory volume. These aims can be achieved with three main pillars of treatment, fluid resuscitation, insulin therapy and electrolyte replacement.

Abbreviation

DKA, diabetic ketoacidosis.

Reference

Dhatariya KK, et al. Nat Rev Dis Primers. 2020;6:40.

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Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

0.75 CE/CME credit

Question 4 of 5

How frequently should you discuss DKA mitigation with individuals with diabetes?

DKA, diabetic ketoacidosis; HbA1c, glycated haemoglobin.

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ISPAD guidelines state that structured diabetes education, including on DKA prevention, identification and management, should be available to all persons with diabetes at the time of diagnosis, and be reinforced with regular teaching sessions at least annually or more frequently depending on the outcomes of formal, individual assessments of need.

Abbreviations

DKA, diabetic ketoacidosis; IPSAD, International Society for Pediatric and Adolescent Diabetes.

Reference

Lindholm Olinder A, et al. Pediatr Diabetes. 2022;23:1229–42.

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Mastering DKA management: From pathophysiology to prevention and ketone monitoring strategies

0.75 CE/CME credit

Question 5 of 5

How may continuous ketone monitoring address some of the limitations of the currently available monitoring systems?

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Recent studies have shown that continuous ketone monitoring via interstitial fluid is a feasible method.1 These monitors work by using a sensor which is inserted subcutaneously and then employing an enzymatic electrochemical reaction.1 An ideal ketone monitor would measure ketones over a relevant dynamic range and would not require the user to initiate a measurement.1 Data presented at the ADA Congress 2025 suggest that CKM is able to produce acceptable accuracy with a mean average difference between CKM and capillary ketone readings of 0.2 mmol/L.2

Abbreviations

ADA, American Diabetes Association; CKM, continuous ketone monitoring.

References

  1. Kong YW, et al. Diabetes Obes Metab. 2024;26:47–58.
  2. Sabelli N, et al. Diabetes. 2024;74(Suppl. 1):229-OR.
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Videos

Impact of DKA on individuals with diabetes

Prof. Jennifer Sherr covers the clinical features and aetiology of DKA and considers the impact DKA has upon individuals living with diabetes.
Duration: 7:50

Pathophysiology and management of DKA

Prof. Jennifer Sherr explains the pathophysiology and management of DKA, covering risk factors, common triggers, metabolic pathways and pillars of management.
Duration: 8:59

Prevention and monitoring of DKA

Prof. Jennifer Sherr delves into prevention strategies, highlighting the critical role of patient education. Her discussion extends to ketone monitoring, where she outlines its advantages, drawbacks and recent breakthroughs.
Duration: 10:33

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Learning Objectives & Overview

Faculty & Disclosures

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Learning Objectives

After watching this activity, participants should be better able to:

  • Explain the impact of DKA on patients and the importance of preventing the condition
  • Describe the risk factors for developing DKA and its associated pathogenesis
  • Discuss available and emerging tools and strategies for preventing DKA, including ketone monitoring

Overview

In this activity, Prof. Jennifer Sherr addresses the clinical and physiological aspects of diabetic ketoacidosis (DKA), including its impact on patients, risk factors and pathogenesis, and the importance of prevention. The discussion includes metabolic pathways and core management strategies, as well as current and emerging tools for prevention, such as ketone monitoring and continuous glucose monitoring, with a focus on patient education and early intervention.

This activity is jointly provided by USF Health and touchIME.

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Target Audience

This activity has been designed to meet the educational needs of endocrinologists, diabetologists, primary care physicians as well as pharmacists and diabetes nurse specialists involved in DKA management

USF Accreditation

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Jennifer Sherr discloses: Advisory board or panel fees from Abbott, Cecelia Health, Insulet, Mannkind Corp, Medtronic Diabetes, StartUp Health T1D Moonshot, Vertex Pharmaceuticals. Consultancy fees from Abbott, Insulet, Medtronic Diabetes, Vertex Pharmaceuticals, Ypsomed. Grants/research support fees from Abbott, Breakthrough T1D/formerly JDRF, Dexcom, Insulet, Medtronic, Provention Bio.

Content reviewer

Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

TouchIME Medical Contributor

Judah Issa has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 26 August 2025. Date credits expire: 26 August 2026.

If you have any questions regarding credit, please contact cpdsupport@usf.edu

EBAC® Accreditation

touchIME is an EBAC® accredited provider since 2023.

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 41 minutes of effective education time.

EBAC® holds an agreement on mutual recognition of substantive equivalency with the US Accreditation Council for CME (ACCME) and the Royal College of Physicians and Surgeons of Canada, respectively.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) and the American Medical Association, physicians may convert EBAC® External CME credits to AMA PRA Category 1 CreditTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

EBAC® is a member of the International Academy for CPD Accreditation (IACPDA) and a partner member of the International Association of Medical Regulatory Authorities (IAMRA).

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

Date of original release: 26 August 2025. Date credits expire: 26 August 2027.

Time to Complete: 41 minutes

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org  

 

Faculty Members

Prof. Jennifer Sherr

Yale School of Medicine
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Prof. Jennifer Sherr

Yale School of Medicine

Medical director of paediatric diabetes and professor in the Department of Pediatrics

New Haven, CT, USA

Biography

Prof. Jennifer Sherr is medical director of paediatric diabetes and professor in the Department of Pediatrics at Yale School of Medicine, CT, USA.

read more

Prof. Jennifer Sherr was determined to become a paediatric endocrinologist since the time of her diagnosis with type 1 diabetes in 1987. While she always wanted to care for those with T1D, her eyes were opened to the meaningful impact that clinical research has.

She has been devoted to clinical research for over 15 years and focuses on ways to improve the lives of all people living with diabetes, including new technologies and therapeutics.

Disclosures

Prof. Jennifer Sherr discloses: Advisory board or panel fees from Abbott, Cecelia Health, Insulet, Mannkind Corp, Medtronic Diabetes, StartUp Health T1D Moonshot, Vertex Pharmaceuticals. Consultancy fees from Abbott, Insulet, Medtronic Diabetes, Vertex Pharmaceuticals, Ypsomed. Grants/research support fees from Abbott, Breakthrough T1D/formerly JDRF, Dexcom, Insulet, Medtronic, Provention Bio.

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Videos

Impact of DKA on individuals with diabetes

Prof. Jennifer Sherr covers the clinical features and aetiology of DKA and considers the impact DKA has upon individuals living with diabetes.
Duration: 7:50

Pathophysiology and management of DKA

Prof. Jennifer Sherr explains the pathophysiology and management of DKA, covering risk factors, common triggers, metabolic pathways and pillars of management.
Duration: 8:59

Prevention and monitoring of DKA

Prof. Jennifer Sherr delves into prevention strategies, highlighting the critical role of patient education. Her discussion extends to ketone monitoring, where she outlines its advantages, drawbacks and recent breakthroughs.
Duration: 10:33

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This activity is for healthcare professionals outside of the UK only

This activity is funded by an independent medical education grant from Abbott Diabetes Care Inc.

This activity is jointly provided by USF Health and touchIME.
touchIME is an EBAC® accredited provider.

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This Activity Is Funded By:

An independent medical education grant from Abbott Diabetes Care Inc.

The activity is jointly provided by USF Health and touchIME.
touchIME is an EBAC® accredited provider.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Date of original release: 26 August 2025. Date credits expire: 26 August 2026

EBAC® 

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

touchIME is an EBAC® accredited provider since 2023.

This content is intended for healthcare professionals outside the UK.

Date of original release: 26 August 2025. Date credits expire: 26 August 2027

Time to complete: 41 minutes

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

 

 

AMA PRA Category 1 Credits â„¢ expire: 26 August 2026
EBAC Credits expire: 26 August 2027

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