Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic.

: During the early stages of the COVID-19 pandemic, hospitals in London, the UK epicentre, reported an unusually high number of people presenting with COVID-19 disease developing diabetic ketoacidosis, hyperosmolar hyperglycaemic state, or a combination of both. Very high doses of insulin were often needed to manage the hyperglycaemia. It has been proposed that these metabolic disturbances may result from severe insulin resistance combined with decreased insulin secretion due to beta cell dysfunction.