IM11.{14-15,22-24} | Diabetic Emergencies — Summary & Reflection

KEY TAKEAWAYS

Diabetic emergencies require structured, protocol-driven management. Hypoglycaemia: causes — insulin excess, SU (especially glibenclamide), missed meal, exercise, alcohol, renal failure; counter-regulation by glucagon → adrenaline → cortisol/GH; conscious = 15–15 rule (15 g carbs, recheck at 15 min); unconscious = IV 50% dextrose 25 mL or IM glucagon 1 mg (glucagon fails in alcohol-related hypoglycaemia — use IV dextrose); SU-induced = admit for 24h with glucose infusion. DKA: triad = hyperglycaemia + ketonaemia + metabolic acidosis (HAGMA); precipitants = infection, missed insulin, new T1DM; management = 0.9% NaCl fluids → K+ check (hold insulin if K+ <3.5) → insulin 0.1 U/kg/hr → treat precipitant → add dextrose at glucose 200–250 → resolve when BHB <0.6, HCO₃ ≥15, glucose <200. HHS: extreme hyperglycaemia (>600) + osmolality >320 + no significant ketosis; elderly T2DM; 10–12 L fluid deficit; 0.9% NaCl initially, then 0.45% NaCl if hypernatraemic; insulin 0.05 U/kg/hr (lower dose); LMWH anticoagulation mandatory; osmolality reduction target ≤3–4 mOsm/kg/hour.

REFLECT

The three patients in the opening hook each needed a different response within the first 5 minutes: Patient 1 (T1DM, glucose 38) — IV 50% dextrose 25 mL immediately; Patient 2 (elderly T2DM, glucose 720, no ketones, osmolality 352) — IV normal saline 1 L over 30 minutes, then K+ check, then low-dose insulin, LMWH; Patient 3 (new T1DM, DKA, pH 7.18) — check K+ urgently, fluids, if K+ ≥3.5 start insulin 0.1 U/kg/hr, identify precipitant. Each management decision followed directly from the pathophysiology you now understand. Reflect on this: the intern on call at 2 am has approximately 5 minutes before each of these patients deteriorates further — the knowledge in this module is not examination preparation, it is the clinical intelligence that keeps these patients alive. Every physician, regardless of specialty, will encounter a hypoglycaemic, ketoacidotic, or hyperosmolar patient during their career. When that moment comes, the algorithm built in this session is the tool you reach for first.