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Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

There is increasing recognition of a group of patients with type 2 diabetes who can present with ketoacidosis. Most reports have been of patients of African descent; however, the condition has been reported in other groups. This is a case of a Caucasian patient who has had three presentations with ketoacidosis and whose diabetes is not usually insulin-dependent. A patient, aged 48 years, presented with diabetic ketoacidosis (DKA) in a semi-comatose condition. She had a 3-day history of vomiting and loss of appetite. In the previous weeks she had undergone radiotherapy for metastatic squamous cell carcinoma (skin primary). The patient had two similar episodes of DKA, one 20 months and another 3 months earlier. Two of the patient’s brothers had type 2 diabetes. The patient was not abusing alcohol and did not have a history of pancreatitis. Three years prior to this admission the patient had been diagnosed elsewhere with type 2 diabetes, for which she had been on metformin and a small dose of insulin glargine. Two months after stopping her insulin glargine she developed her first episode of DKA while visiting our town. DKA, was diagnosed on the basis of arterial pH 7.03, blood gluco Continue reading >>

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Popular Questions

  1. amsmith

    I understand that the guidelines state "uncontrolled" should be coded as hyperglycemia. What about the DKA type 2 portion? We have 2 opinions in our office and I am just looking for the correct way to code it.
    I suspect for my scenario E11.65, E11.69 and E87.2. Please help.
    There really should be an E11.1X...LOL!!
    Thank you,
    Anna

  2. mitchellde

    Ketoacidosis is actually rare in a type 2 diabetic so that may be the reason for no specific code for it. So use the E11.69 with the E87.2

  3. amsmith

    Oddly, our physician's document it frequently. I will check with one of them to find out why we tend to have a higher volume.

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