Testing the urine for sugar and ketones is very sensitive and enables the diagnosis to be confirmed on the spot. Ketonuria as the time of presentation, however is less common than it used to be. A decision must them be made about the initial management. If ketoacidosis is present, immediate admission to hospital is required. Disasters have occurred because outpatient blood tests have been ordered, thus delaying admission, or because admission has been postponed to the following day.
Vomiting is an especially serious symptom in ketoacidosis.
Wherever or not patients with type I diabetes without ketoacidosis, are admitted to hospital will depend on a number of factors, among them severity of disease, age of patient, family factors, and experience of the physician. Type II diabetes may also present with loss of weight, thirst and fatigue. Frequently, however, the presenting symptoms are those of the complications of diabetes. Skin sepsis boils, carbuncles, whitlows, cellulitis, and infected eczema. Balanitis the importance of balanitis as a presenting symptoms is not widely appreciated, although is mentioned by Osler.