INTRODUCTION The most common diabetes emergencies that occur in hospital emergency departments are diabetic ketoacidosis (DKA) and hypoglycemia while hyperglycemic hyperosmolar state (HHS) occurs less commonly in patients with type 2 diabetes (T2D). The review article focuses on key management algorithms for managing complications, of which this summary highlights application of appropriate aims and measures to approach DKA in the emergency department (ED).MAIN RESULTS<ul><li>Diabetic ketoacidosis (DKA)</li><li>The American Diabetes Association (ADA) Hyperglycemic Crises Consensus and the Joint British Diabetes Societies for Inpatient Care (JBDS IP) Guidelines remain the predominant protocols for management of emergencies in type 2 diabetes.</li><li>DKA is a complex state of metabolic disorders defined by the American Diabetes Association (ADA) 2009 as severe hyperglycemia; plasma glucose levels &gt;250 mg/dl, ketonemia and metabolic acidosis; pH&lt;7.3, serum bicarbonate &lt;18 mmol/l.</li><li>The aim of treatment in DKA is to improve circulatory volume with hydration/fluids, decrease blood glucose with insulin, and correct acidosis/electrolyte imbalances with potassium and bicarbonates.</li><li>Hydration in DKA: The most used hydration solution is saline (0.9%). Based on close monitoring of reduced serum glucose, 5% dextrose may be introduced into infusion regimen.</li><li>Insulin administration in DKA: Insulin infusion is required until the disappearance of ketone bodies and the subsequent correction of acidosis to avoid recurrent ketoacidosis. A soluble, fast acting insulin is used.</li><li>Potassium administration in DKA: Insulin administration may lead to hypokalemia. It is recommended to initiate potassium administration at the same time as insulin administration depending on urine output and to maintain potassium level of 4-5 mEq/L.</li><li>Bicarbonate correction in DKA: The correction of the bicarbonate level that appears in the DKA must be carried out under permanent pH control, to ensure optimal insulin treatment.</li></ul>Hypoglycemia<ul><li>Hypoglycemia is characterized by neuroglycopenic symptoms due to lack of glucose in the brain. The aim of treatment depends on the cause of hypoglycemia but in most cases glucagon administration can help resolve the acute symptoms.</li></ul>Hyperglycemic hyperosmolar state (HHS)<ul><li>HHS is a metabolic state characterized by marked hyperglycemia, hypovolemia with no significant ketonemia or acidosis. The therapeutic management of HHS is different from DKA as patients with HHS tend to be elderly with multiple complications and comorbidities.</li></ul>CONCLUSIONMost life-threatening emergencies that occur in the emergency department for patients with type 2 diabetes include ketoacidosis, hyperglycemic hyperosmolar state, and hypoglycemic comas. Apart from condition specific measures, it is also important to focus on proper diet, stress avoidance and intake of correct antidiabetic therapy with careful compliance.Note: Kindly access the full article with the below link:DOI: <a href="https://doi.org/10.3892/etm.2021.11101" rel="noopener noreferrer" target="_blank" style="color: rgb(32, 84, 147);">10.3892/etm.2021.11101</a>

New strategies of diagnostic and therapeutic approach to emergencies in the evolution of patients with diabetes mellitus (Review).

Timely resolution of symptoms is crucial for emergency management of diabetic ketoacidosis in type 2 diabetes.

IntroductionDiabetes is a chronic condition with lifelong implications that is mostly managed by the patients themselves. To ensure optimal self-management, patients living with diabetes require continuous education and support provided by trained HCPs. Diabetes self-management education is essential to ensure long-term health as it empowers and enables patients to take control of their own diabetes management (Powers MA, 2015; Dube L, 2015). A prospective, descriptive study was conducted in South Africa, to assess HCPs’ practical knowledge concerning insulin administration for diabetes before and after attending Diabetes 101 workshop. The workshop aimed at improving knowledge on practical aspects of diabetes and insulin administration.Main result<ul><li>The questionnaires from 146 HCPs were analyzed, of which majority were medical interns (31%), followed by medical registrars (22%)</li><li>The mean correct questionnaire percentage score obtained before training was 36%, with an average of 7/19 questions answered correctly</li><li>The mean correct percentage score obtained for the questionnaire after training improved significantly to 68%, with an average of 13/19 questions answered correctly per participant</li><li>The overall improvement in percentage score for the questionnaire after training was 32 percentage points (95% CI 35.6–28.3)</li><li>The comparison of the mean correct questionnaire score before and after the diabetes workshops was statistically significant (p &lt; 0.001)</li><li>All but two question items showed notable increases in correct responses following the training</li><li>The two question items regarding insulin initiation with HbA1c&gt;7% on oral medication and correct method of priming a pen, did not improve after training</li></ul>ConclusionThis is the first study specifically assessing the knowledge of HCPs regarding insulin administration in South Africa. Based on the results, it was observed that short and focused diabetes education leads to remarkable improvement in HCP knowledge on practical aspects of insulin initiation and administration, but this does not automatically indicate long-term retention and implementation of the acquired knowledge. This may require repeated contact sessions and continuous education.Note: Kindly access the full article with the below link:<a href="https://www.tandfonline.com/doi/full/10.1080/16089677.2022.2057692" rel="noopener noreferrer" target="_blank">https://www.tandfonline.com/doi/full/10.1080/16089677.2022.2057692</a>

Practical aspects of insulin administration: what the healthcare provider knows

Diabetes education is the key to efficient insulin administration

INTRODUCTIONThis educational video highlights one of the common emergencies in diabetes. The video brings attention to Hyperosmolar Hyperglycemic State (HHS), and its underlying multifactorial physiology which requires appropriate multifactorial intervention to prevent and manage patients with type 2 diabetes. It is of particular significance to differentiate between HHS and Diabetic Ketoacidosis (DKA). This session is aimed at primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes.The session consists of the following lectures:<ul><li class="ql-align-justify">Diabetic emergencies: Hyperosmolar Hyperglycaemic State (HHS)</li></ul>After attending the interactive session, the learner should be able to:<ul><li class="ql-align-justify">Understand pathophysiology, risk factors and diagnostic tools in HHS </li><li class="ql-align-justify">Assimilate the key differences between HHS and DKA to achieve apt management</li><li class="ql-align-justify">Focus on the role of fluids, insulin, electrolytes, and underlying causes for effective management of HHS in patients with type 2 diabetes</li></ul>Expert facultyProf. Abdoulaye LeyeEndocrinology, Diabetology and Nutrition Department, Pikine University HospitalFaculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop UniversityDakar, Senegal

Diabetic emergencies: Hyperosmolar Hyperglycaemic State (HHS)

Super Module 1: Laying the Foundations

Insulin intensification in type 2 diabetes

Highlights from the IDF Lisbon 2022

Early diagnosis and treatment start for type 2 diabetes

Join our celebration on World Diabetes Day

Prof. Abdoulaye Leye

INTRODUCTIONThis educational video brings attention to one of the most common complications that occur in patients with type 2 diabetes. The video focuses on Diabetic Nephropathy and it’s underlying multifactorial physiology which requires appropriate multifactorial intervention to prevent and manage patients with type 2 diabetes. This session is aimed at primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes.The session consists of the following lectures:<ul><li class="ql-align-justify">Diabetic nephropathy</li></ul>After attending the interactive session, the learner should be able to:<ul><li class="ql-align-justify">Understand the global prevalence and stages of chronic kidney disease</li><li class="ql-align-justify">Assimilate the role of key pathogenic processes such as glomerulosclerosis, tubulointerstitial damage, podocyte injury and inflammation in patients with chronic kidney disease</li><li class="ql-align-justify">Focus on chronic hyperglycemia as one of the key contributors to progression of chronic kidney disease </li><li class="ql-align-justify">List out strategies for effective prevention and management of chronic kidney disease in patients with type 2 diabetes</li></ul>Expert facultyDr. Hussein Bagha FRCP (Edin)Consultant Physcian and Nephrologist