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Sir,We were interested to read the recent articles on the confidence of junior doctors in managing diabetes in hospitals.1,2 We have also been concerned about the knowledge of junior doctors in managing hyperglycaemic emergencies in the emergency department (ED). We would like to share the results of an audit we have conducted on the early recognition and management of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). Early recognition and correct management of such emergencies is key to successful outcomes.3 In particular, a clear distinction between DKA and HHS must be made early, as treatment for the two conditions is very different. DKA requires rapid high-dose insulin therapy to be instituted immediately, while HHS requires no, or extremely low-dose …

Diagnosis and early management of hyperglycaemic emergencies in the emergency department