Metabolic Complications Of Diabetes Mellitus Research Articles

The significance of precise diabetes diagnosis: a case of euglycemic diabetic ketoacidosis induced by the introduction of empagliflozin with simultaneous reduction of insulin dosage

Euglycemic diabetic ketoacidosis (euDKA) is a rare but severe metabolic complication of diabetes mellitus characterised by elevated anion gap metabolic acidosis despite normal or mildly elevated blood glucose levels. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as effective antidiabetic medications, yet their use is associated with an increased risk of euDKA, especially when coupled with insulin dose reduction. We present the case of a 50-year-old male with a 20-year history of diabetes mellitus, initially managed with insulin and metformin, who developed euDKA following the introduction of empagliflozin and sitagliptin alongside a reduction in insulin therapy. Despite normoglycaemia the patient exhibited symptoms of ketoacidosis, including chronic fatigue, polydipsia, and polyuria. Diagnostic workup revealed metabolic acidosis, elevated inflammatory markers, acute kidney injury and ketonuria. Subsequent specialised laboratory tests confirmed type 1 diabetes mellitus (T1DM) with the presence of anti-glutamic acid decarboxylase (anti-GAD) antibodies and the absence of C-peptide secretion. Management involved fluid therapy, intravenous insulin and glucose administration. This case underscores the diagnostic challenges of euDKA and emphasises the importance of differentiating between T1DM and T2DM, as management strategies vary significantly. Patient education on insulin therapy and injection techniques is crucial to prevent complications such as improper insulin delivery and dose reduction, which can precipitate euDKA. In conclusion, clinicians should be vigilant for euDKA in patients on SGLT2 inhibitors, particularly when insulin dose reduction is involved. Comprehensive patient education and accurate differentiation between diabetes types are essential for timely diagnosis and optimal management, thereby reducing the risk of severe complications.

Ketoacidosis and SGLT2 Inhibitors: A Narrative Review.

An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors.

Choice of p-fox inhibitor as actual therapeutic strategy in correction of cardiometabolic disorders

In the modern world, there is a steady increase in the number of patients with diseases pathogenetically associated with insulin resistance and metabolic syndrome, which represent a springboard for the development of not only cardiovascular, but also other socially significant chronic non-communicable diseases. The study of the pathogenetic interaction of numerous humoral and physical factors in the development and progression of vascular-metabolic disorders is the most relevant area of modern clinical research. Over the past decades, there has been a surge of interest in the scientific literature and a detailed discussion of current trends in the development of diseases and conditions associated with insulin resistance and metabolic syndrome, as well as their associated complications in various fields of medicine. Models of the interaction of neurohumoral, metabolic, vascular and other factors proposed by experts are important for understanding the processes leading to an increase in the prevalence of conditions associated with insulin resistance. Carrying out reciprocal interaction with the developing vascular and metabolic complications of diabetes mellitus and obesity, cellular metabolic disorders should become a new therapeutic target for improving the condition and prognosis of patients. A promising direction in the correction of intracellular metabolic disorders is the use of drugs that block the partial oxidation of free fatty acids in mitochondria (partial fatty and oxidation inhibitors) – p-fox inhibitors, which include the most commonly used in modern clinical practice trimetazidine and meldonium. A wide range of comorbid conditions and various chronic diseases in most patients dictates the need for a detailed study of the mechanisms and features of action, as well as drug-drug interactions of these drugs. There is also a need to discuss the possible risks of side effects that may limit the use of some p-fox inhibitors. This review provides a discussion of these issues in relation to trimetazidine and meldonium, as well as an assessment of various options for their safe clinical use.

Non-ketotic hyperglycemia and diabetic striatopathy – a rare presentation with hemichorea-hemiballismus

Introduction and aim. Non-ketotic hyperglycemia (NKHG), also known as hyperosmolar hyperglycemic state (HHS) is a serious metabolic complication of diabetes mellitus (DM).The mortality rate can be up to 20% and this is much more higher than that of diabetic ketoacidosis (DKA). It is usually precipitated by an event such as pulmonary/urinary infection, myocardial infarction (MI) or stroke. In this state of metabolic derangements, central nervous system (CNS) manifestations including altered mental status with or without focal neurological deficits are prominent clinical presentations. On the other hand, HHS may also be complicated with various other CNS events. Herein, a quite rare presentation of HHS with hemichorea ‒ hemiballismus in a 71 year old female patient with type 2 DM is presented. Description of the case. A 71-year-old female patient type 2 DM presented to our emergency department with progressive involuntary movements on the right upper and lower extremities accompanied by semiconsciousness during the last 24 hours. On neurological examination, cranial nerves and cerebellar signs were found to be normal, as the deep tendon reflexes. However, involuntary non-rhythmic writhing movements at rest were present on her right sided extremities. The fingerstick evaluation showed marked hyperglycemia (HG). The laboratory findings were characterized with high blood glucose level without obvious acidosis compatible with HHS. In urine analysis, glucosuria without significant ketonuria was detected. On head CT, subtle hyperdensity was noted in the left neostriatal regions without any mass effect or perilesional edema, compatible with left sided diabetic striatopathy (DS). Conclusion. Diabetic striatopathy is a quite rare presentation of HHS with hemichorea – hemiballismus. The characteristic computed tomograhy (CT) findings of associated striatopathy should be differentiated from vascular lesions that may also present with unilateral findings in the course of HHS and should not be overlooked in diabetic patients to recognise the ongoing HHS before the coma precedes.

Reversible supraventricular tachycardia complicating diabetic ketoacidosis in an adult patient: A case report

Diabetic ketoacidosis (DKA) is a commonly encountered serious acute metabolic complication of diabetes mellitus (DM) in adolescents and young adults. It is traditionally associated with poorly treated or newly diagnosed type 1 DM, however, in the setting of type 2 DM, inadequate insulin treatment, non-compliance to treatment, newly diagnosed DM, acute illnesses, drugs, and extreme stress can precipitate DKA. We report the case of a 42-year-old known diabetic of 7 years duration with a family history of DM who presented with a two-week history of difficulty in breathing, polyuria, and vomiting. On further examination, pulse rate was 220 beats per minute, respiratory rate 40 cycles per minute, temperature 38.4’C. Random blood sugar was 18.1mmol/l with ketonuria ++. Severe acidosis and mild hypokalemia were noted with her electrocardiogram (ECG) showing supraventricular tachycardia. She was managed and discharged in stable condition with a normal ECG after 20 days on admission to continue basal and pre-meal insulin at home. Adequate diabetic education was conducted and follow-up with endocrinology and cardiology units was advised.

Factors Associated to the Acute Metabolic Decompensation of Diabetes in Lome

The purpose of the study was to define basic factors of the acute metabolic decompensations of diabetes mellitus at the medical emergency units at the CHU-SO of Lome. The question is about a prospective study carried on along 12 months from 1st January, to December 31, 2013. It implicated 83 diabetes patients known or unknown admitted at the casualty department for an acute metabolic complication. In total the frequency of acute metabolic complications of diabetes mellitus that have been essentially done through the ketoacidosis model (73.49%) and hypoglycaemic (26.5%) is of 23.38%. Majority of diabetes patients were of type 2 (68.66%) and aged 50 and over with a sex-ratio of 0.76. The ketoacidosis revealed the disease in 43.37% cases. The main factors of ketoacidosis decompensations were infections, treatment termination and myocarditis ischaemia. Hypoglycemia decompensation factors were due to the absence or deficiency of food, the overdosage. Metabolic complications of diabetes then remain frequent. Infection and treatment termination are the major factors of ketoacidosis decompensation whereas those of the absence or deficiency of food are that of hypoglycemia. The prevention is compulsory through early screening of the disease and high treatment awareness of diabetes patients.

Effectiveness of Gum Arabic With and Without Insulin on the Relieve of Some metabolic Complications of Diabetes Mellitus in Sprague-Dawley Rats

Effectiveness of Gum Arabic With and Without Insulin on the Relieve of Some metabolic Complications of Diabetes Mellitus in Sprague-Dawley Rats

Sodium-glucose Cotransporter 2 Inhibitors and the Risk of Diabetic Ketoacidosis; from Pathophysiology to Clinical Practice.

SGLT-2 inhibitors are a novel class of antidiabetic drugs, recently approved for the treatment of patients with T2DM. Their cardioprotective and renoprotective action, along with their beneficial effects on metabolic parameters, makes them an attractive therapeutic option. Since 2015, when the US FDA issued warning regarding the increased risk of euDKA in the setting of SGLT-2 inhibitors administration, a vivid discussion upon the direct connection between this novel class and the major metabolic complication of diabetes mellitus is still ongoing. To present the underlying pathophysiology, associating SGLT-2 inhibitors and euDKA, and clinical data both in T1DM and in T2DM patients, in order to understand the clinical background which favors the development of euDKA. We conducted a comprehensive research of the relevant literature regarding the association between SGLT-2 inhibitors in clinical practice and the events of diabetic ketoacidosis, mainly euglycemic. Randomized controlled trials, meta-analyses, case series and case reports shed light on this possible connection, the background that favors euDKA, and the mediating pathophysiologic mechanisms. Many of those euDKA events developed in patients with T1DM, due to off-label use of SGLT-2 inhibitors, or in patients previously misdiagnosed as having T2DM, who in fact suffered from LADA. SGLT-2 inhibitors certainly predispose to euDKA, but it is unclear if, as certain precipitating factors are usually recognized on the background, DKA would also occur in the absence of an SGLT-2 inhibitor. Further investigation is required in order to establish or not SGLT- 2 inhibitors as causative factors of euDKA.

The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal.

BackgroundDiabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal.MethodsA retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients’ demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.ResultsOne hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.ConclusionThe prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM.

Osteoporosis knowledge and beliefs in diabetic patients: a cross sectional study from Palestine

BackgroundOsteoporosis is a potential metabolic complication of diabetes mellitus (DM). Therefore, patients with DM should have adequate osteoporosis knowledge and beliefs in order to get engaged in osteoporosis preventive behaviors. The objective of this study was to assess osteoporosis knowledge and beliefs among diabetic patients.MethodsThis was a cross sectional study carried out at Al-Makhfiah governmental primary healthcare unit in Nablus, Palestine from September 2016 to December 2016. The tools used to assess knowledge and beliefs were Osteoporosis Health Belief Scale (OHBS) and the Osteoporosis Knowledge Test (OKT) respectively.ResultsThree hundred diabetic patients were interviewed regarding their knowledge and belief about osteoporosis. The study sample included 192 (64.0%) females. Mean ± standard deviation (SD) of the participants was 58.5 ± 9.3 years. Regarding co-morbidities, 229 (76.3%) had at least one co-morbidity other than DM. The majority of participants incorrectly answered 19 out of 32 questions of OKT scale. The mean OKT score was 13.5 ± 4.2 indicating poor osteoporosis – related knowledge. Females had significantly higher nutrition (p = 0.037), exercise (p = 0.043), and OKT score (p = 0.021) than males. Regarding OHBS, female participants had significantly higher belief score of susceptibility (p < 0.01) and seriousness (p < 0.01) of osteoporosis compared to males.ConclusionsDiabetic patients had poor osteoporosis knowledge and moderate perception of susceptibility and seriousness of osteoporosis. These results require implementation of awareness programs among DM patients to increase their practices regarding preventive measures of osteoporosis such as calcium intake and exercise.

Correlation between the outcomes and severity of diabetic ketoacidosis: A retrospective pilot study.

Introduction:Diabetic ketoacidosis (DKA) is a serious acute metabolic complication of diabetes mellitus (DM). It is classified into mild, moderate, and severe based on severity as per the American Diabetes Association (ADA) guidelines. There are limited data on the correlation between the severity of DKA and its outcomes using this classification system. The aim is to study the correlation between the outcomes and severity of DKA in a tertiary care center in India.Methodology:In this retrospective pilot study, 1527 patients with DM were identified over a span of 3 years, of which 63 had a discharge diagnosis of DKA and 37 fulfilled the ADA criteria for DKA. Following inclusion details on clinical parameters and outcomes of patients with mild, moderate, and severe DKA were compared.Results:Mild, moderate, and severe DKA accounted for 8%, 41%, and 51% of the patients, respectively. Intensive Care Unit (ICU) care was required in 6.7% and 47.4% of those with moderate and severe DKA, respectively. Invasive ventilation (IV) was required in 47% (9) of those with severe DKA only. The mortality rates were 13.3% and 26% among those with moderate and severe DKA. The mean expenditure was ₹29,000, ₹30,000, and ₹64,000 among those with mild, moderate, and severe DKA, respectively.Conclusions:The ADA classification of severity of DKA correlates well with the duration of inhospital stay, costs of care, requirement of ICU care, need for IV or non-IV, and mortality. This suggests that this classification system could be a valuable tool in predicting outcomes.

Acute metabolic complications of diabetes mellitus in a tertiary care center

Background:Diabetes mellitus (DM) is a chronic medical disorder characterized by hyperglycemia. It arises due to inability of pancreas to produce insulin, either because of impaired insulin secretion, impaired action or both. Most of the untreated or inadequately treated patients develop acute metabolic complications. These complications are associated with high mortality and morbidity. Most common among the acute metabolic complications are diabetic ketoacidosis (DKA), hyperglycemic, hyperosmolar, non-ketotic state (HHNKS), Lactic acidosis (LA) and hypoglycemia. Early diagnosis and management of DM helps in preventing these complications. This study was aimed to determine the incidence of acute metabolic complications in DM and to determine the distribution of age and sex in different metabolic complications of diabetes mellitus.Methods: A prospective study was conducted on all cases presenting to Emergency Medicine department for a period of one year from April 2014 to March 2015.Results:Out of the 1211 cases 632 were Diabetic ketoacidosis, 329 cases were hypoglycemia, 201 cases were hyperglycemic hyperosmolar nonketotic state, 12 cases were lactic acidosis. The other 37 cases had findings which were overlapping with more than one type of acute metabolic complications related to diabetes mellitus. Two cases of HHNKS were associated with attacks of hypoglycemia. In this study, diabetic ketoacidosis was the common acute metabolic complication affecting Males aged less than 15 years.Conclusions:Hypoglycemia is the commonest iatrogenic acute metabolic complications India diabetes mellitus. HHNKS affects patients aged more than 45 years. In some cases, there is considerable overlap of diabetic ketoacidosis, lactic acidosis, hypoglycemia and HHNKS.

Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital.

Diabetic ketoacidosis, a well-known and major acute metabolic complication classically occurs in young patients with type 1 diabetes. However, it may occur in patients with type 2 Diabetes Mellitus too. Aim of this study was to look into the clinical profile, precipitating factors and clinical outcome in the patients presenting with Diabetic ketoacidosis in the Emergency of a Tertiary care hospital. The study was a prospective study conducted over a period of two years in Kasturba Medical College, Manipal Karnataka, India. Clinical profile of 60 diabetic patients admitted in the Emergency with the diagnosis of Diabetic ketoacidosis were analysed. Out of 60 patients, 12 were of Type 1 and 48 were Type 2 Diabetes Mellitus. Mean duration of diabetes was 8.65 years. Only 14 (23.3%) patients were taking regular treatment for Diabetes Mellitus whereas 32 (53.33%) patients were on irregular treatment and eight (13.33%) were not on any treatment at all. Among 12 Type 1 Diabetic patients, six patients were freshly diagnosed to be diabetic when they presented with Diabetic ketoacidosis complication. Nausea and vomiting (63.33%) were the most common symptoms of these patients. Infections (73.33%) were the most common precipitating factor for Diabetic ketoacidosis. Mean fluid requirement on first day of therapy was 3.51 liters. Mortality of 10% was seen. Diabetic ketoacidosis is a fatal acute metabolic complication of Diabetes Mellitus with heterogeneous clinical presentation. Early diagnosis and treatment can avoid morbidity & mortality.

Estimation of serum magnesium and zinc levels in type 2 diabetes mellitus

Diabetes mellitus is chronic disease characterized by defective insulin production or utilization. Type-2 diabetes mellitus has mainly peripheral insulin resistance as a cause with or without insulin secretary defects. In particular, type-2 diabetes mellitus has been shown to be associated with abnormalities in the metabolism of Zinc, Chromium, Magnesium and Manganese. The serum levels of Zinc and Magnesium are usually low in diabetic patients. The study finding may exhibit the extent of deficiencies of these two trace elements in relation to duration of the disease. It may be utilized to optimize the control of type-2 diabetes mellitus by supplementation of zinc and magnesium. By doing so the metabolic complications of diabetes mellitus can be delayed.

A Study of Adiponectin in Children with Diabetes Mellitus = دراسة الأديبونكتين في الأطفال الذين يعانون من مرض السكري

Adiponectin is a hormone produced by adipose tissue. It is secreted exclusively by adipocytes and appears to play a role in the pathophysiology of obesity, diabetes mellitus (DM), and its comorbidities. The aim of this study was to assess adiponectin levels in diabetic children with type 1 DM (T1DM) and type 2 DM (T2DM), and to detect its prognostic role in them. This study was undertaken from April to July 2011 at Minia University Children's Hospital, Egypt, and included 314 children aged 2-18 years divided into two patient groups. Group I consisted of 164 pre-diagnosed diabetic patients, further subdivided into Group Ia which included 142 patients with T1DM and Group Ib, 22 patients with T2DM; Group 2 included 150 apparently healthy children as a controls; they were age- and sex-matched to the diseased group. Patients were subjected to a thorough history taking, clinical examination, and laboratory investigations including assessment of HbA1c percentages, fasting C-peptide levels, lipid profiles and fasting serum adiponectin levels. Adiponectin levels did not differ significantly between patients with T1DM and T2DM, but it was significantly higher in diabetic patients than in the controls. In T1DM, adiponectin had positive significant correlations with the duration of the disease and waist circumference, while in T2DM, it had a positive significant correlation with the dose of insulin given and negative significant associations with diastolic blood pressure, cholesterol, and C-peptide levels. The results of the study suggest that adiponectin can play a protective role against the metabolic complications of DM.

Clinical Spectrum and Management of Diabetic Ketoacidosis: Experience in A Tertiary Care Hospital

Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus (DM). It may be the presenting feature in type 1 DM, but more commonly it complicates previously diagnosed diabetic patients, both type 1 and type 2. If not recognized early and treated in a judicious way the outcome is often fatal. Objectives: The objectives of this study was to see the common presenting features of DKA, their precipitating causes, patterns of electrolyte imbalance, treatment requirement in early hours and to see the outcome. Materials and methods: This cross sectional study was done in BIRDEM General Hospital on fifty adult patients who presented with DKA over a period of nine months (January 2007 to September 2007). Results: Total number of patients were 50, male were 24 and female were 26 (M:F =12:13). Mean age was 27.6 ± 3.7 years. The incidence of DKA was more in known diabetic patients (32, 64%), in comparison with new cases (18, 36%). Frequency was more in poor village people (31, 62%). Vomiting (24, 48%) was the most frequent complaint, followed by fever (19, 38%), nausea (16, 32%), abdominal pain (14, 28%), weakness (13, 26%), polyuria (12, 24%) and polydypsia ( 8, 16%). Infection (18, 36%) was the most common precipitating cause, closely followed by inadherence to insulin therapy (17, 34%). In 12 (24%) cases no cause could be identified. Glycaemic control was poor, HbA1c was &gt;7% in 98% cases. Severe acidosis (pH &lt; 7) was less common (4, 8%) and gross electrolyte imbalance was uncommon but all patients required potassium supplementation in course of treatment. Neutrophilic leukocytosis was present in 44 (88%) cases, irrespective of presence of infection. Mortality was low (3, 6%). Conclusion: Diagnosis and treatment of DKA is not difficult if recognized early. So, high index of suspicion is necessary, particularly in previously undiagnosed cases. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12380 Birdem Med J 2011; 1(1): 15-20

Trend analysis of the correlation of amino acid plasma profile with glycemic status in Saudi diabetic patients

The role of amino acids in diabetes mellitus and its metabolic traits have been suggested previously; however, studied to a very limited scale in the Saudi patient population. Patients diagnosed with diabetes mellitus were included in the current clinical study. Sample was representative and in accordance with the national population distribution. Blood samples were drawn and assayed for glucose, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein. General biochemical markers, such as alkaline phosphatase (ALP), creatinine kinase (CK), aspartate transaminase (AST), alanine transaminase (ALT) and blood urea nitrogen (BUN) were assessed. Serum amino acids of different categories (essential, semi-essential and metabolic indicator amino acids) were assessed. Correlation co-efficient between each amino acid and serum glucose level was calculated. The current study showed positive correlation between amino acid level and glucose serum concentration in male while it showed negative correlation in female Saudi diabetic patients. Male patients had significantly higher methionine concentration parallel to their glycemic status. Metabolic indicator amino acids significantly changed in concordance with the glycemic status of female patients more than in male patients. In conclusion, serum amino acid is positively correlated with glycemic status in Saudi male diabetic patients while negatively correlated in female patients. Yet, further study would be recommended to utilize serum amino acid profile as surrogate parameter for the metabolic complications of diabetes mellitus.

Metabolic acidosis in a patient with type 1 diabetes mellitus complicated by methanol and amitriptyline intoxication

Diabetic ketoacidosis (DKA) is a widely known acute metabolic complication of diabetes mellitus (DM), which can be potentially fatal. It is not difficult to diagnose when a patient with DM comes with symptoms such as coma, fruity breath, hyperglycemia, acidosis, and tachypnea. If the patient has not been diagnosed with DM before, then other sicknesses characterized by an increased anion gap should be considered. A 12-year-old boy with type 1 DM and repeated earlier admissions for DKA was admitted to the emergency department in another apparent case of DKA with coma, hyperglycemia, and profound metabolic acidosis. When his condition did not improve with initial treatment, intoxication was suspected as an alternate cause of his condition. Further laboratory tests detected methanol and amitriptyline. The patient underwent hemodialysis and recovered completely. This case illustrates that a seemingly obvious medical condition can mask serious intoxication. This report is the only publication on two different entities characterized by an increased anion gap and at the end the patient has been cured completely without any complications.

Inpatient management of diabetes: survey in a tertiary care centre

Aims: Good glycaemic control in hospitalised patients with diabetes mellitus improves wellbeing and aids recovery. This survey aimed to: (1) assess glycaemic control in patients with diabetes admitted to hospital...

DIABETIC KETOACIDOSIS AND HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) are life-threatening acute metabolic complications of diabetes mellitus. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar. Each of these complications can be seen in type 1 or type 2 diabetes, although DKA is usually seen in patients with type 1 diabetes and HHNS in patients with type 2 disease. The clinical management of these syndromes involves careful evaluation and correction of the metabolic and volume status of the patient, identification and treatment of precipitating and comorbid conditions, a smooth transition to a long-term treatment regimen, and a plan to prevent recurrence.