Diabetic Emergencies: Pathophysiology

It helps a man immensely to be a bit of a hero-worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies. Sir William Osler


At the present time, we take the ability to treat diabetic emergencies for granted. We follow relatively straightforward protocols and the diagnosis, of diabetic ketoacidosis (DKA) at least, rarely triggers much angst on the ward round. It is sobering to think that less than a century ago, the young child or teenager affected by an episode of DKA faced certain death. That was before the achievements of the men photographed above. Dr Sir Frederick Grant Banting (far left) and his colleagues (left to right), Dr Charles Herbert Best, Dr James Bertram Collip and Professor John James Rickard Macleod were responsible for the discovery and isolation of insulin. In addition to his Nobel prize winning work on metabolism, Dr Banting was earlier in his career awarded the Military Cross for his actions saving the lives of soldiers at the battle of Chambri in WWI while he himself was seriously wounded. Dr Banting, Dr Collip and Dr Best gave the patent for insulin to the University of Toronto in order to fund future medical research. The phrase ‘we’re not worthy’ was probably never more apt!¬†Sadly, the four men became estranged during the course of their work and were never reconciled. However, the legacy of their time working together ranks among the greatest achievements in human history.¬†

‘Children dying from diabetic ketoacidosis were kept in large wards, often with 50 or more patients in a ward, mostly comatose. Grieving family members were often in attendance, awaiting the (until then, inevitable) death.

In one of medicine’s more dramatic moments Banting, Best, and Collip went from bed to bed, injecting an entire ward with the new purified extract. Before they had reached the last dying child, the first few were awakening from their coma, to the joyous exclamations of their families.’

The videos below teach you the pathophysiology of diabetic ketoacidosis (DKA). The videos are followed by an article explaining the difference between the two major diabetic emergencies, DKA and hyperosmolar hyperglycemic state (HHS).

Video 5: Effects of Hyperglycemia 2

Video 6: DKA: Lethal Impact of the ‘Starvation Response’

What is the difference between diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS)?

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