الفهرس 
Evidence based medicineOnly 14 pages are availabe for public view
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Abstract
EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care. DKA diagnostic criteria include serum glucose >250 mg/dl, arterial pH <7.3, serum bicarbonate <15 mEq/l, moderate ketonuria and,or ketonemia. Accumulation of ketoacids usually results in an increased anion gap metabolicacidosis. HHS diagnostic criteria include marked elevations in blood glucose greater than 600 mg/dl and serum osmolarity greater than 320 mOsm /l, with apH level greater than 7.30 , serum bicarbonate >15 mEq/l and mild or absent ketonemia. The use of rapid-acting insulin analogs (lispro and aspart) by the subcutaneous route in general wards every 1 or 2 h (in mild or moderate uncomplicated DKA) is as effective as the use of regular insulin by the IV route in the ICU. Both DKA and HHS are considered a preventable metabolic complications of diabetes mellitus as the most common leading causes of DKA and HHS are infection 57%, poor compliance with therapy 21% ,and psychological stress, can be easily prevented by better access to medical care, proper patient education, and effective communication with a health care provider during an intercurrent illness.