Care in diabetic emergencies

A review is presented on the care of three diabetic emergencies: diabetic ketoacidosis (DKA), hypoglycemias and sick days. A treatment scheme, based on low-dose insulin regime and i.v. insulin administration is presented. Plenty of emphasis is laid on fluid and electrolyte therapy. It is stressed that the primary goal in the treatment of DKA is not to reduce blood glucose, but to correct the fluid and electrolyte deficit and by administering insulin to correct the metabolic acidosis and change catabolism into anabolism. The use of bicarbonate in severe DKA is discouraged, and the risk of cerebral edema as a complication of the treatment is stressed. A diabetic child being treated for DKA needs particularly love and care. The three categories of hyperglycemias, mild, moderate, and severe, are briefly reviewed. In severe hypoglycemia (hypoglycemic shock) the treatment is either i.m. glucagon or i.v. glucose. In acute illnesses the use of extra doses of regular insulin is emphasized, in order to prevent DKA.