Updated July 24, 2006

Hyperglycemic Crises
What They Are and How to Avoid Them

by Robert S. Dinsmoor

Lactic acidosis. Although it is not a hyperglycemic crisis, lactic acidosis is another diabetes-related crisis worth knowing about, particularly if you take any drug containing metformin (Glucophage, Glucophage XR, or Glucovance). Lactic acidosis is a potentially deadly condition caused by a buildup of lactic acid in the tissues. Such a buildup can be due to dehydration, lack of oxygen, prolonged exercise, hyperventilation, diarrhea, vomiting, kidney disease, or liver disease. If you take metformin and notice symptoms of lactic acidosis, such as lightheadedness, tiredness, weakness, muscle pain, slowed or irregular heartbeat, feeling cold, or unusual stomach pain, call your physician.

Treatment
Although your doctor may be able to talk you through the treatment of a mild case, both DKA and HHS usually call for a trip to the emergency room. If caught in time, these conditions can sometimes be reversed in 6-12 hours. If they are advanced, it may require a 2- to 3-day hospital stay. To treat either condition, doctors must carefully monitor and treat several chemical imbalances at once. Here's a summary of how hyperglycemic crises are treated:

• Intravenous saline solution (water and sodium) is given to reverse dehydration. This improves circulation and helps the kidneys function properly again.
• Insulin is given to lower the blood glucose level, stop the breakdown of fats, and thus stop the production of ketones.
• Potassium is also replaced. Potassium is lost in the urine, a problem that is compounded when insulin is administered, because it can cause a person's cells to suddenly soak up large amounts of potassium from the bloodstream. Because a very low blood potassium level (called hypokalemia) can interfere with the ability of the heart to function properly, potassium replacement is extremely important.
• In the case of DKA, depending on how acidic the blood is, doctors may also inject sodium bicarbonate to restore it to a normal level of acidity.

Throughout this treatment, doctors and nurses may check the person's pulse, blood pressure, mental status, temperature, blood glucose level, acid levels, and serum potassium and phosphate levels to make sure the treatment is working properly. Sometimes electrocardiograms are performed to make sure that the heart is beating properly.

An experience worth missing
Diabetic ketoacidosis and hyperosmolar hyperglycemic state are both serious and life-threatening conditions. Even though they can be treated successfully in many cases, especially if caught early, they're both worth skipping in the first place. The best way to prevent them is to keep close tabs on your blood glucose levels, to observe the "sick-day management" rules when you become ill, and to seek medical help if you cannot control your blood glucose level with self-care efforts.

Also in this article:
Sick-Day Management

Robert Dinsmoor is a freelance writer and editor based in Massachusetts. He is a Contributing Editor of Diabetes Self-Management.

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