GEM - ketonuria at time of diagnosis of type 2 diabetes

• even in cases of suspected type 2 diabetes, ketonuria at the time of diagnosis should be a prompt for hospital assessment (1)
  • ketonuria is prevalent in untreated adults with apparent Type 2 diabetes presenting acutely (2)
    • severity of ketonuria in Type 2 diabetes might indicate vulnerability to ketoacidosis
    • in this study higher hemoglobin A1c, low HDL-cholesterol, younger age, and a past history of alcohol or illicit drug use were associated with ketonuria in Type 2 diabetes
    • occasionally older patients will present and there will be diagnostic concern whether the patient is really a type 1 diabetic and be requiring insulin treatment from diagnosis
    • patients with type 2 diabetes who have latent autoimmune diabetes of adulthood (LADA) also may require insulin treatment as an early treatment option. These patients are also more likely to respond to an insulin secretogogue rather the traditional first line therapy of metformin

Reference:

1. Personal Communication (October 12th 2006). Aresh Anwar, Consultant Diabetologist, University Hospitals Coventry and Warwickshire.
2. Kazlauskaite R. Ethnic differences predicting ketonuria in patients with Type 2 diabetes. J Diabetes Complications. 2005 Sep-Oct;19(5):284-90.