Preface

Diabetes is a chronic disease which requires early diagnosis and continuous treatment, or complications are likely to occur and to threaten health and life. There are three main acute complications: hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar state.

Hypoglycemia

• Definition: lower than normal blood glucose level (<70 mg/dL).
• Symptoms: There are sympathetic symptoms for the early stage when patients feel hunger, accelerated heartbeat, shivering, and sweating; and there are central nerve symptoms for the later stage when patients are troubled by dizziness, fainting, blurred vision, babbling, irritating disturbance, and even coma.
• Causes: Insulin or oral hypoglycemic agent overdose, inadequate food intake or delayed meals, excessive exercise without food intake, and too much alcohol drinking.
• Treatment:
• If the patient is conscious, give 15-20 grams of fast-acting carbohydrates (e.g., 4-6 sugar cubes or 120-150 mL of juice or other sugary drinks.). If hypoglycemia does not improve, give another 15-20 grams of fast-acting carbohydrates, and seek emergent medical care.
• If the patient is unconscious, do not give food or drink orally. Seek emergency medical care immediately. Administer glucagon subcutaneous, intramuscular or intravenous if available.
• Prevention:
• Have regular meals. Do not delay your meal time or eat less than you need.
• Take extra snacks after vigorous exercises.
• Maintain the amount of insulin or oral hypoglycemic agents you take.
• Frequently monitor your blood glucose level.

Hyperglycemic crises: Diabetic ketoacidosis & hyperglycemic hyperosmolar state

• Definition:
• Diabetic ketoacidosis: Blood glucose levels are significantly elevated (typically >200 mg/dL), accompanied by ketone accumulation and metabolic acidosis.
• Hyperglycemic hyperosmolar state: Blood glucose levels are extremely elevated (typically > 600 mg/dL), accompanied by increased plasma osmolality and dehydration, without significant ketone body accumulation and metabolic acidosis.
• Common symptoms include:
• Thirst, polyuria, fatigue
• Dry skin and dehydration
• Sunken eyes
• Tachycardia and hypotension
• Altered consciousness or coma
• In addition:
• HHS: May present with altered consciousness or coma
• DKA: May present with nausea, vomiting, abdominal pain, and shortness of breath with a fruity odor

Patients with these symptoms should seek medical attention immediately.

• ​Common causes include:
• Stressful conditions such as infection, injury, surgery, stroke, or myocardial infarction
• Poor treatment adherence or inadequate glucose control
• Undiagnosed diabetes​
• Treatment: Go to a hospital immediately.
• Prevention:
• Regular treatment of diabetes.
• Regular clinic follow-up.
• Frequently monitor your blood glucose level.
• Increase self awareness and go to a hospital timely.