**9. Prevention of recurrent DKA**

Home measurement of blood ß –OHB concentrations, when compared to urine ketone test‐ ing, decreases diabetes-related hospital visits (both emergency department visits and hospi‐ talizations) by the early identification and treatment of ketosis. Blood ß -OHB measurements may be especially valuable to prevent DKA in patients who use a pump because interrupted insulin delivery rapidly leads to ketosis. There may be dissociation between urine ketone (sodium nitroprusside only measures acetoacetate and acetone) and serum ß -OHB concen‐ trations, which may be increased to levels consistent with DKA when a urine ketone test is negative or shows only trace or small ketonuria [4].

A psychiatric social worker or clinical psychologist should be consulted to identify the psy‐ chosocial reason(s) contributing to development of DKA. Insulin omission can be prevented by schemes that provide education, psychosocial evaluation and treatment combined with adult supervision of insulin administration. Diabetes education of the child and his/her fam‐ ily is the cornerstone to prevent DKA occurrence and recurrence.
