Abstract

Diabetic ketoacidosis (DKA) and its complications are the most common cause of hospitalization, morbidity and mortality in children and adolescents with established diagnosis of type 1 diabetes mellitus (T1DM). The overall incidence of recurrent DKA episodes is estimated as 8 per 100 patient years. Interestingly, almost 60% of recurrent DKA episodes occur in 5% of patients. Precipitating causes of DKA are infectious diseases, non-infectious diseases, and poor adherence to insulin therapy. Even mild infections, such as a cold or sore throat, can lead to DKA in patients with long standing poor glycaemic control. Poor glycaemic control is common during adolescence, secondary to poor compliance, fear of hypoglycemia or intentional insulin omission as a weight loss strategy. We present a case of DKA in a teenage girl with established T1DM and a step-by-step investigation process leading to diagnosis of intentional insulin omission. The identification of intentional insulin omission and the establishment of a comprehensive treatment are extremely important since it may reduce the rate of recurrent DKA as well as the long term complications associated with this disorder.

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