Hyperglycemic emergencies consist of diabetic ketoacidosis and hyperosmolar hyperglycemic state. These situations require immediate medical attention since they can lead to serious conditions if left untreated.
Cells in the human body normally use glucose as their major source of energy. However, when there is not enough insulin, glucose cannot enter the cells and the cells must find another way to produce the energy needed to function. As a result, the body must break down body fat, creating ketones, a potentially harmful substance.
Diabetic ketoacidosis is characterized by the presence of ketones in the blood or urine, along with hyperglycemia often greater than 14 mmol/L. This complication occurs mainly in patients with type 1 diabetes.
Symptoms associated with diabetic ketoacidosis are:
Hyperosmolar hyperglycemic state occurs when hyperglycemia is high, often greater than 30 mmol/L, leading to severe dehydration due to the frequency and volume of urination. Dehydration can then lead to a drop in blood pressure, which can alter the individual's state of consciousness. It mainly affects patients with type 2 diabetes. This state is not characterized by an accumulation of ketones because insulin is not totally absent.
Symptoms of hyperglycemia as well as signs of dehydration are present and include:
On sick days, blood glucose is often higher due to the secretion of stress hormones (e.g., cortisol, adrenaline, glucagon), and the fact that patients exercise less, making insulin less effective. However, eating fewer carbohydrates can also lead to lower blood glucose. As a result, it is important for patients to check their blood glucose more frequently (at least 4 times a day) to make sure that it is neither too high nor too low. When sick, checking it more frequently (e.g., every 2 hours) than you normally do may be appropriate. Furthermore, patients with type 1 diabetes should check for ketones in their blood or urine every 2 to 4 hours when their blood glucose is high.
If you have difficulty drinking and eating, or if you are experiencing vomiting or diarrhea, your medication or insulin may need to be adjusted to prevent kidney damage and to minimize the risk of adverse effects. Using the table below, ask your health professional to indicate the steps to take with some of your medications, if necessary:
|ACEI, direct renin inhibitors|
|Boiled water||2 ½ cups (600 mL)|
|Unsweetened orange juice||1 ½ cup (360 mL)|
|Table salt||½ tsp (2.5 mL)|
When you are sick, you should see your doctor as quickly as possible or go to the hospital if any of the following situations apply to you:
For more information or for support:
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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.