Effective treatment of diabetic acidosis is based on three important prerequisites: 1. systematic efforts at prevention; 2. accuracy of diagnosis; 3. correct appraisal of severity.
Prevention succeeds when both patient and physician are aware of the causes of acidosis and avoid them. Some of the most common are omission or delay in daily insulin administration; reduction in insulin dosage because food cannot be taken during illness; increased insulin need during acute infection and trauma; failure to test urine for ketones when heavy glycosuria exists; disdain toward warning symptoms, especially thirst, polyuria and nausea; complacent attitudes toward poor routine control of diabetes.
Precise diagnosis often reveals a cause for acute illness in diabetes other than acidosis, even when glycosuria with some ketonemia, ketonuria, and lowered alkali reserve are present. A diabetic in coma is not necessarily in diabetic coma. Some of the sources of confusion are insulin shock; cerebral trauma, hemorrhage,