Abnormal insulin treatment behaviour: a major cause of ketoacidosis in the young adult

Diabet Med. 1995 May;12(5):429-32. doi: 10.1111/j.1464-5491.1995.tb00508.x.


Diabetic ketoacidosis occurs more frequently in the young adult population than in any other age group. In a 3-year retrospective casenote review of all patients admitted with ketoacidosis to this hospital, we have defined the clinical characteristics of ketoacidosis in this age group. Young adults (< 25 years) had worse preceding glycaemic control (median HbA1 14.6 vs 10.1%, p = 0.0001) and more frequent episodes of ketoacidosis in the previous 5 years (3 vs 0, p = 0.0001) than older adults (> 25 years); on admission they had lower blood urea concentrations (p = 0.0001) and had a lower incidence of systolic hypotension (6% vs 32%, p = 0.007). There were fewer complications of ketoacidosis in the young adults, and the duration of hospital stay was less than that in the older age group (4 vs 8 days, p = 0.0003). Young adults were less likely to have a proven underlying infective or other organic precipitant for ketoacidosis, but were investigated and treated in a similar way to older adults. Insulin error or manipulation was identified in 42% of young adults; abnormal insulin treatment behaviour is likely to be the major cause of ketoacidosis in this age group.

MeSH terms

  • Adolescent
  • Adult
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / etiology*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypotension / epidemiology
  • Hypotension / etiology
  • Incidence
  • Insulin / therapeutic use*
  • Length of Stay
  • Male
  • Medication Errors
  • Patient Compliance*
  • Retrospective Studies


  • Glycated Hemoglobin A
  • Insulin