From the Guidelines
Acute complications of diabetes include diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which are the two most serious acute metabolic complications of diabetes, with mortality rates of 5% and 15%, respectively, as reported by 1. These complications can occur in both type 1 and type 2 diabetes, and their prognosis is substantially worsened at the extremes of age and in the presence of coma and hypotension. Some key points to consider about these complications include:
- DKA occurs primarily in type 1 diabetes when insulin deficiency leads to the breakdown of fats, producing ketones that acidify the blood, with symptoms such as excessive thirst, frequent urination, nausea, abdominal pain, and fruity-smelling breath.
- HHS typically affects type 2 diabetics and involves extreme hyperglycemia without significant ketone production, causing severe dehydration and altered mental status.
- Treatment for DKA and HHS requires hospitalization with IV fluids, insulin, and electrolyte management, as outlined in the position statement by 1.
- Common complications of DKA and HHS include hypoglycemia, hypokalemia, and hyperglycemia, as well as hyperchloremia and transient non–anion gap metabolic acidosis, as noted in 1.
- It is essential for patients to understand how to recognize and treat these complications, as they can be life-threatening if not addressed promptly, and to take preventive measures such as carrying glucose sources and wearing medical identification.
From the FDA Drug Label
Hypoglycemia is the most common adverse reaction of all insulin therapies, including Humulin R U-100. Severe hypoglycemia may lead to unconsciousness and/or convulsions and may result in temporary or permanent impairment of brain function or death Hyperglycemia, diabetic ketoacidosis, or hyperosmolar coma may develop if the patient takes less Humulin R U-100 than needed to control blood glucose levels Insulin stimulates potassium movement into the cells, possibly leading to hypokalemia, that left untreated may cause respiratory paralysis, ventricular arrhythmia, and death. Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including Humulin R U-100
The acute complications of diabetes include:
- Hypoglycemia: mild to severe, which can lead to unconsciousness, convulsions, and even death 2
- Hyperglycemia: which can lead to diabetic ketoacidosis or hyperosmolar coma 2
- Hypokalemia: which can cause respiratory paralysis, ventricular arrhythmia, and death 2
- Severe allergic reactions: including anaphylaxis, which can be life-threatening 2
From the Research
Acute Complications of Diabetes
The acute complications of diabetes include:
- Diabetic ketoacidosis (DKA) 3, 4, 5, 6
- Hyperosmolar hyperglycemic syndrome (HHS) 3, 4, 5, 6
- Hypoglycemia 7, 6
- Hyperglycemic hyperosmolar nonketotic coma 7
Characteristics of Acute Complications
- DKA and HHS are life-threatening complications that occur in patients with diabetes 3, 4, 5, 6
- DKA is usually seen in patients with type 1 diabetes, while HHS is usually seen in patients with type 2 diabetes 4
- Hypoglycemia is a frequent and serious adverse effect of antidiabetic therapy 6
Management of Acute Complications
- The management of DKA and HHS involves aggressive administration of intravenous fluids with appropriate replacement of electrolytes, and administration of insulin 3, 4, 5
- The management of hypoglycemia involves prompt recognition, diagnosis, and treatment 6
- Careful monitoring by experienced physicians is needed during treatment for DKA and HHS 3