Diabetic control following hypoglycaemia is likely to be poor for a few days because of the large amounts of glucose required to achieve recovery. Advise the patient to discuss this with their regular medical specialist or diabetic liaison nurse. The GP, or diabetic clinic responsible for the long-term management of the patient, should try to establish why hypoglycaemia occurred in order to develop strategies to prevent it happening again. Hypoglycaemia can often be anticipated or promptly reversed by good patient education. If need be the families or companions of diabetic patients at risk of hypoglycaemia should be taught how to inject glucagon.
Diabetic ketoacidosis can occur in any patient with insulin-dependent diabetes.
It is most commonly precipitated by minor illnesses such as urinary tract infections, gastroenteritis or upper respiratory tract infections - patients should not stop their insulin during such illnesses. The rate of development of ketoacidosis varies. If it is the presenting feature in a new diabetic it may have taken days or weeks to become established. In an otherwise well-controlled diabetic, some symptoms may begin within a few hours of glucose levels rising although it is likely to take days before there is impaired mental function and unconsciousness. Initially the symptoms may be masked by those of the precipitating illness.