Recommendations for the management of emergencies in patients with diabetes, acute metabolic complications of diabetes, and steroid-related hyperglycemia

Álvarez-Rodríguez E, Agud Fernández M, Caurel Sastre Z, Gallego Mínguez I, Carballo Cardona C, Juan Arribas A, Piñero Panadero R, Rubio Casas O, Sáenz Abad D, Cuervo Pinto R

Persons with diabetes make up a large percentage of patients attended in the emergency department. Most will be discharged, but patients who remain under observation in wards managed by the emergency department or who wait are waiting to be admitted to a conventional ward must receive appropriate, protocol-guided treatment for their diabetes. Situations of hyper- or hypoglycemia must be avoided because both worsen prognosis. Emergency physicians must correctly and efficiently prevent, diagnose, and manage acute metabolic complications of diabetes such as simple hyperglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. They must also be ready to prescribe and properly administer intravenous insulin to critically ill patients. Hyperglycemia induced by treatment with steroids deserves special mention. If this complication develops, the hyperglycemia is intense, influenced by increased

insulin resistance and gluconeogenesis in the liver. Thus, it usually appears after meals and is dependent on steroid dose, duration of treatment, and individual predisposition. The recommendations in this paper elaborated by consensus of the Spanish Society of Emergency Medicine (SEMES) experts, are the first to be written specifically for use in

emergency departments in Spain. They give a detailed, in-depth overview of emergencies related to diabetes and diabetic complications.

Agud Fernández M, Carballo Cardona C, Caurel Sastre Z, Cuervo Pinto R, Gallego Mínguez I, Juan Arribas A, Piñero Panadero R, Rubio Casas O, Saénz Abad D, Álvarez-Rodríguez E