Diabetic ketoacidosis and hyperosmolar hyperglycemic state are two of the most serious acute complications of diabetes and occur when blood sugar levels are extremely high. In a recent review of hyperglycemic crises, the American Diabetes Association lists the following causes for these emergencies:

• Acute illness
  • Infection - especially pneumonia, urinary tract infection, and sepsis
  • Cerebral vascular accident (small stroke)
  • Heart attack
  • Acute pancreatitis
  • Acute pulmonary embolism
  • Intestinal obstruction
  • Dialysis (peritoneal)
  • Renal failure
  • Heat stroke
  • Hypothermia
  • Subdural hematoma
  • Severe burns
  • Endocrine disorders
• Drugs
  • Beta-blockers
  • Calcium-channel blockers
  • Chlorpromazine
  • Chlorthalidone
  • Cimetidine
  • Diazoxide
  • Diuretics
  • Encainide
  • Ethacrynic acid
  • Immunosuppressive agents
  • L-asparaginase
  • Loxapine
  • Phenytoin
  • Steroids
  • Total parenteral nutrition

Infections account for 30 to 50% of cases, so it's important to follow your sick-day routine when you are ill. Check your medications and ask your doctor or pharmacist if you have any concerns.

If you are sick and don't eat, that doesn't mean you should skip your insulin. The stress of the illness causes blood glucose to rise. The best way to avoid problems is to continue your medication and monitor blood glucose levels frequently - every 2 hours.

Remember, hyperglycemic emergencies are critical and demand immediate treatment.