Background: Patients with diabetes who are hospitalized with COVID-19 have been found to have increased lengths of stay and greater intensive care unit utilization compared to those without diabetes. Diabetic ketoacidosis (DKA) is an acute diabetes emergency that accounts for a high number of hospitalizations, hospital readmissions, and healthcare utilization. Our study aims to evaluate [...]

Background: Diabetic Ketoacidosis (DKA) is the most common severe acute complication of diabetes, and has shown to be worsened by COVID-191. Several studies have found an association between COVID-19 and worsened outcomes from diabetic ketoacidosis (DKA).2 Vaccination against COVID-19 has led to substantial declines in the frequency, severity, and mortality from acute infection, but little [...]

Background: At our urban, academic hospital, use of outdated protocols and unnecessary variations in the care of DKA patients treated with ICU requiring IV insulin protocols have led to multiple safety events, delays in care with associated increased costs, and overtreatment of hyperglycemia with ketosis frequently resulting in unnecessary ICU utilization. After multi-disciplinary stakeholder development [...]

Case Presentation: Mr. O is a 28 year old Navy cadet with no significant past medical history who presented to the Emergency Department with three days of malaise, nausea, polyuria, and polydipsia in the setting of recent steroids for a new rash. On presentation, Mr. O’s glucose returned at 624 mg/dL, pH was 7.28 and [...]

Case Presentation: A 74 -year-old male with a past medical history of hypertension, hyperlipidemia, benign prostatic hyperplasia, renal cell carcinoma status post right nephrectomy, and peripheral arterial disease, presented to the Emergency Room with 20 days of progressive weakness, shortness of breath, nausea, vomiting, polyuria, polydipsia, and abdominal pain. The patient was vaccinated but not [...]

Case Presentation: A 62 YO woman with PMHx significant for type 2 DM, HTN, CAD with a previous MI, and OSA was recovering as expected from elective decompressive laminectomy. On POD 4 she developed nausea, confusion, and lethargy. The hospitalist service was consulted, prompting a metabolic work-up that suggested anion gap metabolic acidosis. There were [...]

Case Presentation: A 54 year-old woman with a past medical history of hypertension and Type 2 diabetes mellitus treated with metformin and canagliflozin presented to the hospital with lethargy and malaise. She reported that her blood glucose was stable over the past 2 weeks with fingerstick glucoses ranging from 100-130mg/ dL. She had been vomiting [...]

Case Presentation: A 60-year-old female with poorly controlled type 2 diabetes mellitus (A1c 11.8%) on insulin and previous stress cardiomyopathy during an episode of DKA with subsequently recovered systolic function presented with chest pain, nausea and vomiting following four days of cough and sore throat. On arrival, laboratory findings included: glucose 634 mg/dL, beta hydroxybutyrate [...]

Case Presentation: A 46-year-old male with Type 2 DM presented with 2 weeks of malaise, 3 days of cough, dyspnea, and fatigue. His wife noted his breath smelt different over the last 2 weeks. He had a thyroidectomy for multinodular goiter 2 weeks prior and started a ketogenic, intermittent fasting diet after. Medications include empagliflozin [...]

Case Presentation: A 58-year-old man with a history of hypertension, type 2 diabetes with non-adherence to insulin, GERD, and daily alcohol use presented to the emergency department for three days of epigastric abdominal pain and vomiting. He had previously experienced two months of worsening nausea and epigastric fullness with eating accompanied by a 30-pound unintentional [...]