Uncontrolled Diabetes Mellitus in Adults: Experience in Treating Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma with Low-Dose Insulin and a Uniform Treatment Regimen

Abstract

A number of changes in therapy of uncontrolled diabetes have occurred in recent years. These include low-dose insulin regimens, often routine phosphate repletion, more cautious bicarbonate replacement, infusion of larger fluid volumes, the use of hypotonic solutions in hyperosmolar states, and recently magnesium repletion. These modalities (with the exception of routine magnesium repletion) have been employed at North Central Bronx Hospital since its opening in 1976. Through this retrospective analysis of 275 cases of uncontrolled diabetes we have tried to answer the following questions: What is the outcome of all episodes of uncontrolled diabetes in a municipal hospital population with a uniform treatment protocol? What are the results of treatment with new modalities in various age groups? Are the causes of death different from those tabulated in previous reports? Our results indicate a good outcome in those under the age of 50 yr regardless of the diagnosis of hyperosmolar nonketotic coma (HNC) or diabetic ketoacidosis (DKA). Mortality from DKA was 2% in those under age 50 yr and 26% in the older age group. Surprising was the low mortality in the hyperosmolar group with 0% mortality under age 50 yr and 14% in patients over this age. The major categories of causes of death in the series included sepsis, adult respiratory distress syndrome (ARDS), metabolic, cardiovascular, and shock. With the exception of ARDS, these categories were not different from other reported series. There were few thromboembolic events in this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Hyperglycemic Crises in Patients With Diabetes

“…Mortality rates, which are Ͻ5% in DKA and ϳ15% in HHS (4)(5)(6)(8)(9)(10)(11)(12)13), increase substantially with aging and the presence of concomitant life-threatening illnesses. Similar outcomes of treatment of DKA have been noted in both community and teaching hospitals (14)(15)(16), and outcomes have not been altered by whether the managing physician is a family physician, general internist, house officer with attending supervision, or endocrinologist, so long as standard written therapeutic guidelines are followed (17,18).…”

The evolution of DKA management

“…7 Low dose insulin and aggressive fluid replacement Whilst there had been sporadic reports of low dose insulin being used to successfully treat DKA, it was not until Sönksen et al in 1972, 8 9 The weight based FRIII has also now been used successfully for several decades. 7,11 The concept of an FRIII is well established in paediatric diabetes, 12 and the question often arises 'when does a child become an adult?'. What was still missing from the report by Kidson et al was the fluid replacement regimen.…”

Factors Associated With Hyperglycemic Crisis in Patients With Diabetes Mellitus Type 2 in the Internal Medicine Emergency Service of Vitarte Hospital in 2016

“…Los que recibieron tratamiento fueron el 68,9% (82), de ellos el 53,6% (44) desarrollaron estado hiperglicémico hiperosmolar. Conclusión: Existe asociación entre las infecciones y la HHS con un OR de 9,12(IC:3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]4). No se encontró diferencia estadisticamente significativa entre el tiempo de enfermedad y la crisis hiperglicémica con un OR 0,82(IC:0,3-1,7), así como tampoco el tratamiento con un OR de 7,7(IC:0,5-2,3).…”