Abstract
IntroductionHE are common acute complications of diabetes mellitus (DM) and include diabetic ketoacidosis (DKA), normo-osmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS). They contribute a lot to the mortality and morbidity of DM. The clinical features include dehydration, hyperglycemia, altered mental status and ketosis. The basic mechanism of HE is a reduction in the net effective action of circulating insulin, resulting in hyperglycemia and ketonemia (in DKA) causing osmotic diuresis and electrolytes loss. Infection is a common precipitating factor.Measurement of serum C-peptide provides an accurate assessment of residual β-cell function and is a marker of insulin secretion in DM patients.Aim and objectivesTo assess the level of pancreatic beta cell function in HE patients, using the serum C-peptide.MethodologyThe biodata and clinical characteristics of the 99 subjects were collated using a questionnaire. All subjects had their serum C-peptide, glucose, electrolytes, urea, creatinine levels, urine ketones determined at admission. Results of statistical analysis were expressed as mean ± standard deviation (SD). A p value <0.05 was regarded statistically significant. Correlation between levels of serum C-peptide and admission blood glucose levels and the duration of DM respectively was done.ResultsThe mean age of the subjects was 51 (SD ± 16) years and comparable in both sexes. Mean duration of DM was 6.3 (SD ± 7.1) years, with 35% newly diagnosed at admission.The types of HE in this study are: DKA (24.7%), NHS (36.1%), and HHS (39.2%). Mean blood glucose in this study was 685 mg/dL, significantly highest in HHS and lowest in NHS. Mean serum C-peptide level was 1.6 ng/dL. It was 0.9 ng/dL in subjects with DKA and NHS while 2.7 ng/dL in HHS (p>0.05).Main precipitating factors were poor drug compliance, new-onset of DM and infection.ConclusionMost (70%) of subjects had poor pancreatic beta cell function, this may be a contributory factor to developing HE. Most subjects with high C-peptide levels had HHS.Electronic supplementary materialThe online version of this article (doi:10.1186/1755-7682-7-50) contains supplementary material, which is available to authorized users.
Highlights
hyperglycemic emergencies (HE) are common acute complications of diabetes mellitus (DM) and include diabetic ketoacidosis (DKA), normo-osmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS)
Of these patients 23.7% were less than 40 years of age, 45.4% were between the ages of 40 and 60 years and the rest were older than 60 years
Most of the patients (65.1%) who had a previous history of DM were on oral hypoglycemic agents (OHA), 11.1% were on insulin alone, 9.5% on a combination of insulin and Oral hypoglycemic agents (OHA)
Summary
HE are common acute complications of diabetes mellitus (DM) and include diabetic ketoacidosis (DKA), normo-osmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS) They contribute a lot to the mortality and morbidity of DM. Definition of diabetes mellitus and hyperglycemic emergencies Diabetes mellitus (DM) is a complex metabolic disorder that has multiple etiologies and is characterized by chronic hyperglycemia as a result of defects in insulin secretion, insulin action, or both. Hyperglycemic emergencies (HE) are common acute complications of DM and include diabetic ketoacidosis (DKA), normoosmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS) They are lifethreatening conditions, even if managed properly and either type can fall anywhere along the disease continuum of diabetic metabolic derangements, only differing in the time of onset, the degree of dehydration, and the severity of ketosis. It has been established that the basic underlying mechanism for both DKA and HHS is a reduction in the net effective action of circulating insulin [5]
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