Drug burden of type 2 diabetes mellitus population in the Bay of Plenty region, New Zealand

Abstract

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) remain two of the most commonly encountered metabolic emergencies. They are both potentially life-threatening when not managed correctly. DKA occurs most frequently (but not exclusively) in people with type 1 diabetes mellitus, who are absolutely insulin-deficient. HHS (formerly known as hyperosmolar non-ketotic state) occurs most frequently (but not exclusively) in older people with type 2 diabetes, who have insufficient insulin concentration to lower blood glucose, but enough to prevent ketone production. Diabetes can present for the first time as DKA or less commonly as HHS; however, these occur more frequently in people known to have diabetes, with the most common causes being infection and other intercurrent illness, or non-concordance with medication. The treatment of DKA and HHS differs because the conditions are biochemically dissimilar. In DKA the emphasis of treatment has changed: with increasing access to bedside plasma ketone monitors, β-hydroxybutyrate concentration rather than blood glucose is often used to guide therapy. In HHS, glucose-lowering should be undertaken predominantly using fluid rehydration, with insulin being gently introduced only when the rate of glucose-lowering has stabilized.