Acute complications of diabetes mellitus from out-patient department perspective

Authors: Zbynek Schroner
Authors‘ workplace: SchronerMED, s. r. o., interná a diabetologická ambulancia, Košice
Published in: Forum Diab 2015; 4(2): 119-123
Category: Main Theme: Review


Due to frequent occurrence of acute complications of diabetes mellitus (DM) also in out-patient departments, its proper management is very important. Prevention of these states is very important. Acute complications of diabetes mellitus can be divided into: metabolic decompensations and complications of antidiabetic treatment. To meta­bolic decompensations belong acute hyperglycemic states (diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state). Diabetic ketoacidosis is acute metabolic emergency mainly of typ 1 diabetes mellitus. It is characterized by: hyperglycemia, acidosis and ketosis . Hyperglycemic hyperosmolar nonketotic state is acute complication mainly of type 2 diabetes mellitus. The ketoacidosis is not present , what is explained by higher intra­portal insulin level, preventing mobilisation of free fatty acids. Lactic acidosis is the most serious complication of metformin therapy mainly in patients having risk factors. For this reason it is necessary to observe contraindications of metformin therapy. Hypoglycemias are the most frequent acute complications mainly in diabetics treated by insulin or sulphonylurea derivatives.

Key words:
diabetic ketoacidosis – hyperglycemic hyperosmolar nonketotic state – hypoglycemia – lactic idosis


1. Šmahelová A. Akútní hyperglykemické komplikace u diabetu 1. a 2. typu. In: Perušičová J (ed). Trendy soudobé diabetologie 5. Galén: Praha 2001. ISBN 8072620991.

2. Šmahelová A. Akutní komplikace diabetu. Postgrad Med 2002; 6(4): 617- 622.

3. Schroner Z, Pella J. Diabetes mellitus v skratke. Oriens: Košice 2002. ISBN 80–88828–24–4.

4. Carrol F, Schade DS. Ten pivotal questions about diabetic ketoacidosis. Postgrad Med 2001; 110(5): 89- 93, 95.

5. Nathan MH. Diabetic ketoacidosis and hyperosmolar coma. In: Leahy JL, Clark NG, Cefalu WT. Medical management of diabetes mellitus. Marcel Dekker: New York 2000. ISBN 978–1420001631.

6. American Diabetes Association. Hyperglycemic crisis in patients with diabetes mellitus. Diabetes Care 2001; 24(11): 1988–1996.

7. Šmahelová A, Perušičová J. Akutní komplikace diabetes mellitus. Interná Med 2001; 1(1): 38–42.

8. American Diabetes Association. Clinical Practice Recommendations 2012. Hospital admission guidelines for diabetes. Diabetes Care 2012; 35(Suppl 1): S103 -S104.

9. Rybka J. Akutní komplikace diabetu. In: Svačina Š (ed). Trendy soudobé diabetologie 10. Galén: Praha 2005. ISBN 8072623591.

10. Perušičová J (ed). Diabetes mellitus 2. typu. Galén: Praha 1996. 80–85824–33–7.

11. Bartoš V, Pelikánová T. Praktická diabetologie. 4th ed. Maxdorf: Praha 2010. ISBN 978–80–7345–216–2.

12. Lalau JD., Race JM. Lactic acidosis in metformin therapy: searching for a link with metformin in reports of metformin- associated lactic acidosis. Diabetes Obes Metab 2001; 3(3): 195–201.

13. Calabrese AT, Coley KC et al. Evaluation of prescribing practices: risk of lactic acidosis with metformin therapy. Arch Intern Med 2002; 162(4): 434- 437.

14. Mokáň M. Hypoglykémia. P+M Turany 2005. 80–968742–6-8.

15. Šmahelová A. Hypoglykémie jako komplikace diabetes mellitus. In: Perušičová J (ed). Trendy soudobé diabetologie. Galén: Praha 1998.

16. Škrha J. Hypoglykémie, akútní komplikace nebo syndróm? Vnitř Lék 2002; 48(6): 479–482.

17. Schroner Z. Deriváty sulfonylurey – ich súčasné miesto v liečbe pacientov s DM 2. typu. Diabetes a obezita 2005; 5(10): 32–39.

18. Schernthaner G, Grimaldi A, Di Mario U et al. GUIDE study: double blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients. Eur J Clin Invest 2004; 34(8): 535–542.

Diabetology Endocrinology Internal medicine
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