Hyperglycemic emergencies

DKA is characterized by :

• High blood sugar, often greater than 20 mmol/L
• The presence of ketones in the blood or urine

DKA is usually caused by low insulin levels, which means blood glucose can’t get into the cells as it should. Therefore, the body use its fat reserves for the energy it normally gets from glucose.

Ketones are produced from the breakdown of fats. Their accumulation in the blood is toxic for the body.

DKA can arise due to :

• A forgotten or skipped insulin dose
• An improper adjustment to the insulin dose
• An insulin pump that stops working
• An infection (e.g., pneumonia, urinary tract infection (UTI))
• A serious medical problem (e.g., heart attack, stroke, pancreatitis)
• A serious physical injury

The following symptoms are associated with DKA:

• Deep and rapid breathing
• Fruity breath (ketonic odor)
• Nausea, vomiting
• Abdominal pain
• Decreased consciousness, confusion, agitation, unusual behavior

IF YOU ARE EXPERIENCING THESE SYMPTOMS, CONTACT YOUR DOCTOR IMMEDIATELY OR GO TO THE EMERGENCY ROOM.

This state is characterized by :

• Hyperglycemia often greater than 30 mmol/L
• Severe dehydration

During a hyperglycemic episode, the accumulation of glucose in the blood increases the frequency and volume of urination. This can cause excessive water loss and significant dehydration. This can be followed by a drop in blood pressure leading to decreased consciousness and eventually to coma if the HHS is left untreated.

Contrary to DKA, there is normally no significant presence of ketones in the blood or urine because insulin is not totally absent.

The symptoms are typical of hyperglycemia, including :

• Frequent and abundant urination
• Intense thirst
• Exhaustion
• Signs of dehydration (e.g., dry mouth, sunken eyes, dry skin, etc.)

Who is at risk?

The risk is minimal with an appropriate diabetes management. It is higher for some people :

• People with kidney problems
• Elderly people

Call a doctor without delay or get the person to the emergency room if:

• They cannot retain liquids because of vomiting or diarrhea
• Their level of consciousness changes; e.g., confusion, agitation, absence of reaction to stimuli, hallucinations or unusual behaviour
• There are signs of dehydration: dry mouth, sunken eyes, dry skin, etc.
• The body temperature is above 38.5°C for more than 48 hours

For type 1 diabetes:

• Blood sugar level is above 14 mmol/L and ketones are present :
  • in the urine: “medium” to “high” level
  • in the blood: level higher than 1.5 mmol/L
• Blood sugar level is above 20 mmol/L with nausea, vomiting and/or abdominal pain

For type 2 diabetes:

• Blood sugar level is above 25 mmol/L with excessive drowsiness

In addition to the basic measures to prevent hyperglycemia, the following recommendations can help you prevent a hyperglycemic emergency.

If you have type 1 diabetes:

• Check for ketones in your urine or blood if your blood sugar levels are higher than 14mmol/L, and during sick days.
• Measure your blood sugar levels more frequently and follow the protocol established by your health care team for sick days.
• Keep adequately hydrated if your blood sugar level is above 14 mmol/L.

If you have type 2 diabetes:

• Measure your blood sugar levels more frequently and follow the recommendations of your health care team for sick days.
• Keep adequately hydrated if your blood sugar level is above 14 mmol/L.