Emergency therapy of diabetic crises: insulin overdose, diabetic ketoacidosis, and hyperosmolar coma

Three types of diabetic crises occur: insulin overdose, diabetic ketoacidosis, and hyperosmolar coma. Neurologic signs may accompany each of these syndromes, and each must be differentiated quickly by the emergency clinician so that an appropriate treatment plan can be initiated. The basic goal is to restore metabolic derangements and to stabilize the patient so that it can then be managed more routinely as an uncomplicated diabetic.