Absolute deficiency of insulin no longer is considered the principal cause of ketoacidosis. A combination of pathogenic mechanisms includes (1) relative insulin deficiency, (2) stress hormone excess, (3) fasting, and (4) dehydration. Prevention of any one or more of these mechanisms will reverse or lessen the rate of metabolic decompensation. Several important metabolic parameters must be monitored at frequent intervals to permit rational, preventive therapy. The flow sheet to be maintained by the patient should include body weight, temperature, respiratory rate, level of consciousness, degree of ketonuria, and degree of glycosuria. If the patient exhibits decreased mental status, more than 5% loss of body weight, or respirations more than 36/min, hospitalization is indicated.
(JAMA 242:2455-2458, 1979)