Management of hyperglycaemic emergencies in the tropics

Abstract

Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state are the two most serious acute metabolic complications of diabetes even if managed properly. These disorders can occur in both types 1and 2 diabetes, and remain an important cause of morbidity and mortality in diabetic populations especially, in the developing countries. Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. Bicarbonate therapy is rarely needed. Infection, omission of insulin, and other precipitating factors should be treated. This review is intended to discuss some of the advances in the management of hyperglycaemic emergencies and also to highlight some of the peculiarities of the management of hyperglycaemic emergency in our setting if we are going to be able to improve outcome significantly.Key words: Hyperglycaemic emergencies, diabetic ketoacidosis, hyperglycaemic hyperosmolar, fluid therapy, insulin therapy Résumé Ketoacidose diabétique (DKA) et l'état d'hyperglycémique hyperosmolaire sont les deux complications métaboliques aigues les plus sérieuses des diabètes même si on les avait correctement soignées. Ces troubles peuvent arriver dans le type 1 et type 2 les deux diabètes et demeure une cause importante de la morbidité et mortalité dans les populations diabétiques en particulier, dans les pays en voie de développement. Insuline intraveneuse et la remise en place du liquide sont les bases de la thérapie, avec une surveillance soigneuse du niveau du potassium. La thérapie bicarbonate est rarement exigée. L'infection l'omission de l'insuline, et des autres facteurs precipitants devraient être traités. L'objet de cette étude est d'étudier quelques uns de ces progrès dans la prise en charge des urgences hyperglycémique et aussi de souligner quelques singularités de la prise en charge d'hyperglycémique d'urgence dans notre milieu si nous aurions à mésure d'améliorer le résultat d'une manière remarquable.

Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia

“…Otherwise, this non-compliance rate is not acceptable and hence patient education, improvement in accessibility of nearby health facilities that provide medical care for diabetics and economic empowerment of DM patients may be warranted. It has been reported [ 27 , 31 ] that stopping insulin for economic reasons, unavailability and unaffordability of insulin, missed clinics, perceived ill-health and alternative therapies like herbs, prayers and rituals are common problems that contributed to non-compliance to antidiabetic medications in the Tropical and Sub-Saharan African diabetic patients.…”

Treatment outcome and prognostic indices in patients with hyperglycemic emergencies

“…Another study by Kitabchi and Nyenwe7 in the US showed a declining mortality rate in patients with DKA compared with HHNK, which remained alarmingly high. In Nigeria, hyperglycemic emergencies are an important cause of morbidity and mortality due to poor drug compliance, and this may be attributed to poverty, ignorance, poor health education, infection, delayed diagnosis and treatment, lack of access to medical care, erratic supply of essential drugs, cultural and religious beliefs, poor laboratory support, and less emphasis on electrolyte monitoring, especially potassium 8–11…”

Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

“…The comparatively higher percentage of known DM patients on treatment in our study might explain this disparity. The nancial hitches and unjust traditional tenets have been linked with missed insulin doses and antidiabetic medication discontinuation among Tropical and Sub-Saharan African DM patients (32,33). Hence, it would be matter-of-factly to devise strategies to ensure accessible standard DM care in the region and abate the dreadful consequences of noncompliance.…”