Akutkomplikationen des Diabetes mellitus – Schulungsinhalte richtig vermitteln

Die Insulintherapie des Diabetes ist gekennzeichnet durch das stetige Spannungsfeld zwischen zu niedrigen und zu hohen Glukosewerten. Die Akutkomplikationen Hypoglykämie und Ketose oder Ketoazidose sind daher ein Dauerbrenner in jeder Diabetesschulung. Neue Technologien haben den Umgang mit diesen Akutkomplikationen entscheidend verändert, aber eine gute Schulung ist immer noch die Basis eines sicheren Diabetes-Managements.

Abstract

The incidence and mortality of diabetic ketoacidosis (DKA) have hardly changed in recent years. Recurrent DKA in particular is characterised by a high mortality rate of about 23%. Young people with type 1 diabetes are more often hospitalised for DKA than for severe hypoglycaemia. COVID-19 probably leads to a higher incidence of DKA – especially in people with type 2 diabetes. Major risk factors for recurrent DKA include female gender, age between 13 and 25 years, higher HbA_1c, migrant background and mental illness. Education on DKA should create awareness of the dangers of DKA and develop a concrete plan of action in case of emergency.

Hypoglycaemia is the limiting factor of insulin therapy and is associated with increased diabetes-related distress and increased risk of cardiovascular events. The incidence of severe hypoglycaemia over 12 months is around 8%. The effective use of diabetes technologies should be an integral part of diabetes education. The most important technology-related education content includes alarm setting limits, the correct use of trend arrows, training in pattern recognition in the ambulatory glucose profile (AGP) and knowledge of automatic (predictive) low glucose suspend functions in automated insulin delivery (AID) systems. Hypoglycaemia unawareness occurs when the body becomes accustomed to low glucose levels and the autonomic response to low glucose levels weakens. The basis of hypoglycaemia-awareness training is systematic self-observation of one’s own physical symptoms at different glucose levels.

Kernaussagen

• Die Inzidenz und die Mortalität der diabetischen Ketoazidose (DKA) haben sich in den letzten Jahren kaum verändert. Besonders rezidivierende DKA sind durch eine hohe Sterberate von ca. 23% gekennzeichnet.

• Junge Menschen mit Typ-1-Diabetes werden häufiger wegen DKA ins Krankenhaus eingewiesen als aufgrund von schwerer Hypoglykämie.

• COVID-19 führt wahrscheinlich zu einer höheren Inzidenz der DKA – vor allem bei Menschen mit Typ-2-Diabetes.

• Zu den wichtigsten Risikofaktoren für rezidivierende DKA gehören das weibliche Geschlecht, Alter zwischen 13 und 25 Jahren, höheres HbA_1c, Migrationshintergrund und psychische Erkrankungen.

• Die Schulungen zur DKA sollten ein Bewusstsein für die Gefährlichkeit der DKA schaffen und einen konkreten Handlungsplan für den Notfall erarbeiten.

• Hypoglykämien sind der limitierende Faktor der Insulintherapie und gehen mit erhöhten diabetesbezogenen Belastungen und einem erhöhten Risiko für kardiovaskuläre Ereignisse einher.

• Die Inzidenz schwerer Hypoglykämien bezogen auf 12 Monate beträgt rund 8%.

• Der effektive Umgang mit Diabetestechnologien sollte fester Bestandteil der Diabetesschulung sein. Zu den wichtigsten technikrelevanten Schulungsinhalten gehören das Einstellen der Alarmgrenzen, der richtige Umgang mit Trendpfeilen, das Training der Mustererkennung im ambulanten Glukoseprofil (AGP) sowie das Wissen um die automatische (trendgesteuerte) Hypoglykämieabschaltung bei AID-Systemen.

• Hypoglykämiewahrnehmungsstörungen entstehen dann, wenn sich der Körper an niedrige Glukosewerte gewöhnt und die autonome Reaktion auf niedrige Glukosewerte schwächer wird.

• Basis der Schulung zur Hypoglykämiewahrnehmung ist die systematische Selbstbeobachtung der eigenen körperlichen Symptome bei verschiedenen Glukosewerten.

Schlüsselwörter

Diabetische Ketoazidose - Hypoglykämie - Diabetes-Schulung

Keywords

Diabetic ketoacidosis - hypoglycaemia - diabetes education

Publication History

Article published online:
05 August 2022

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