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

Forțofoiu,Maria; Vladu,Ionela Mihaela; Forțofoiu,Mircea-Cătălin; Pădureanu,Rodica; Clenciu,Diana; Rădulescu,Dumitru; Pădureanu,Vlad

doi:10.3892/etm.2021.11101

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

Authors:
- Maria Forțofoiu
- Ionela Mihaela Vladu
- Mircea-Cătălin Forțofoiu
- Rodica Pădureanu
- Diana Clenciu
- Dumitru Rădulescu
- Vlad Pădureanu
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Affiliations: Department of Emergency, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Diabetes and Nutritional Diseases, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Internal Medicine, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania, Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Published online on: December 28, 2021 https://doi.org/10.3892/etm.2021.11101
Article Number: 178
Copyright: © Forțofoiu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Diabetes mellitus, known as the most widespread disease in the world, along with four other chronic diseases, involves major expenditures and significant human resources for care, thus representing a burden on any type of health care system especially due to its rapid evolution of acute and chronic complications. For the emergency department (ED), the requirements of patients with acute complications of diabetes, determine expenses which are three times higher than those for non‑diabetic patients and their hospitalizations are four times more frequent. The acute complications for which patients with diabetes most frequently require the ED are hypoglycemic, hyperosmolar, or ketoacidosis coma as well as alterations of the general condition that is typical of hypoglycemia, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state and new‑onset hyperglycemia. Hypoglycemia and the Somogyi phenomenon are the most common complications of type 1 diabetes but they can also occur in patients with type 2 diabetes who are treated with insulin through its overdose. DKA can occur in type 1 and 2 diabetes either by administering inadequate doses of insulin or due to the existence of precipitating factors such as stress, acute myocardial infarction, infections, sepsis, and/or gastrointestinal bleeding. Hyperosmolar hyperglycemic status is the most common complication in patients with type 2 diabetes and DKA. Treating the acute complications of diabetes in the ED involves, besides taking immediate measures to assess and maintain vital functions, monitoring patients, assessing blood sugar, electrolytes, urea, creatinine, and bicarbonate, and applying appropriate immediate therapeutic measures for each type of acute diabetes complication.

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