Diabetic Emergencies: Ketoacidosis, Hyperglycemic Hyperosmolar State, and Hypoglycemia

Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are two hyperglycemic diabetes emergencies. Severe hypoglycemia represents the opposite glycemic state but is also considered a diabetes emergency. DKA and HHS both result from a relative or absolute insulin-deficient state and result in a state of hyperglycemia, electrolyte disturbance, and volume depletion with some key differences. Their treatments are similar and include volume resuscitation, insulin therapy, and correction of electrolyte disturbances. Severe hypoglycemia in patients with diabetes is typically a result of antihyperglycemic agents, often in the context of an altered physiologic state that precipitates the event. Treatment with glucose will reverse the hypoglycemia; however, further glucose monitoring and, in some cases, re-treatment may be necessary. In all three of these diabetes emergencies, prevention through patient education and addressing underlying precipitants is necessary.