Management of Acute Complications of Diabetes Mellitus

Abstract

Hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS) are serious acute complications of diabetes mellitus and diabetic emergencies that require prompt recognition, diagnosis, and treatment. Hypoglycemia is a frequent adverse effect of antidiabetic treatment. The occurrence of hypoglycemic events can negate the beneficial effects of intensive glycemic control and is associated with adverse clinical outcomes, including cardiovascular morbidity and mortality, in patients with diabetes mellitus. Hypoglycemia requires immediate management, depending on its severity. DKA and HHS are hyperglycemic crises that result from absolute or relative insulin deficiency accompanied by increased counterregulatory hormones. The two conditions differ in the degree of hyperglycemia, acidosis, and volume depletion. It has been reported that mortality in patients with HHS is about 10 times higher than that with DKA. The prognosis of DKA and HHS is determined by age, the severity of volume depletion, and the presence of comorbidities. The mainstays of treatment of both DKA and HHS are restoration of volume depletion, insulin therapy, correction of fluid and electrolyte imbalance, and resolution of precipitating causes. Most cases of these three diabetic emergencies can be prevented or limited through patient education and careful clinical surveillance. In this chapter, we describe the pathophysiology, clinical presentation, precipitating factors, diagnosis, treatment, and prevention of hypoglycemia, DKA, and HHS.