Hyperglycemic Emergencies: What Primary Care Providers Need to Know

Until the discovery of insulin inthe early 1920s, the mortalityrate from diabetic ketoacidosis (DKA) was virtually 100%. The current overall mortality from DKA in devel-oped countries is now between 2 and 10%, a rate that has not changed in 3 decades.1 It is estimated that 2–8 % of all hos-pital admissions are for the treatment of DKA. By contrast, hyperosmolar hyper-glycemic state (HHS) accounts for 1 in 1,000 hospital admissions.2 Published mortality rates for HHS vary, but the trend is that the older the patient and the higher the osmolarity, the greater the risk for death. Unfortunately, many cases of DKA occur as recurrent episodes, which we often consider a failure of long-term treatment. Too often, these individuals are treated and sent home without dis-secting the main problem, which is usu-ally intentional insulin omission. Often, insulin omission is related to a psycho-logical disorder; in adolescent girls and young women, it is often related to an eating disorder