GUIDELINES OF MANAGEMENT OF DIABETES MELLITUS UNDER STRESSFUL CONDITIONS

Therapy for both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) includes: fluid replacement to correct both hypovolemia and hyperosmolality, insulin administration to correct hyperglycemia and, in DKA, metabolic acidosis, potassium repletion, and, in selected patients with DKA, sodium bicarbonate. Frequent monitoring is essential and underlying precipitating events should be identified and corrected.As regard to hypoglycemia , We recommend the following approach for all insulin-treated patients, particularly those about to begin an intensive insulin regimen :• Take a detailed history concerning previous major episodes of hypoglycemia, what symptoms the person usually gets with hypoglycemia, how frequent minor episodes are, and how they are usually treated.• Explain that the risk of hypoglycemia will increase substantially with intensive therapy, and explore with the patient their fears of hypoglycemia.• Consider an inpatient estimation of the adequacy of counterregulation before starting intensive insulin therapy, particularly if there is a previous history of hypoglycemic episodes. Provide education for the patient on the recognition and treatment of hypoglycemia, including blood glucose awareness training.