Metabolic Storms: Pathophysiological Insights into Diabetic Emergencies

Abstract

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state are life-threatening metabolic emergencies arising from insulin deficiencyand excess counter-regulatory hormones. They share similar mechanisms but differ in onset and severity—DKA develops rapidly with ketosisand acidosis, while HHS evolves slowly with marked hyperglycemia and dehydration. Euglycemic DKA, often linked to sodium–glucosecotransporter-2 inhibitors or pregnancy, presents with normal glucose yet significant acidosis, posing diagnostic challenges. Inflammatorycytokines, oxidative stress, and decreased adiponectin and osteocalcin levels aggravate insulin resistance and multi-organ dysfunction. Effectivemanagement involves prompt fluid resuscitation, low-dose insulin infusion, electrolyte correction, and identification of underlying triggerssuch as infection or medication use. Recognizing these crises as systemic metabolic failures rather than isolated glucose disorders is crucial fortimely intervention and improved outcomes.