Controversies and pitfalls in the management of hyperglycaemic crises in critically ill diabetic patients

SummaryHyperglycaemic states often occur in critically ill patients with diabetes mellitus and may lead to significant morbidity and mortality if not recognised promptly and treated appropriately. The introduction of intravenous insulin regimes and protocolised management has led to a reduction in the overall mortality of such conditions to less than 10%. However there remains debate regarding optimal fluid and electrolyte replacement regimes, and critically ill patients may require more personalised therapy to achieve the best clinical outcomes.