Rationale

Diabetes accounts for a great many presentations to outpatient clinics and emergency departments every year. In addition, people present to community centres and general practitioners with potential emergency situations, for example, silent myocardial infarction, see Chapter 8 . People are also being managed in general practice settings and practice nurses are playing increasingly important roles in diabetes ambulatory care. These nurses provide important care planning, education, monitoring, and assessment care that complements that of the GP and specialist diabetes services. They often act as the link between the specialist and primary care services.

This chapter outlines important issues. The other chapters in the book should be cross-referenced for specific information about the conditions patients present to these areas. It is important that diabetes is identified as soon as the individual presents for treatment and their metabolic status is assessed to limit the morbidity and mortality associated with diabetic emergencies.

It is important to be aware that conditions such as myocardial infarction and urinary tract infections can be present with few of the classical signs and symptoms.

The emergency department

Medical emergencies are a major source of morbidity and mortality for people with diabetes. The particular presenting problem may be unrelated to diabetes; however, the existence of diabetes usually affects metabolic control and complicates the management of the presenting problem such as trauma and other medical or surgical emergencies. Extra vigilance is needed to reverse or limit the abnormalities arising as a consequence of altered glucose metabolism due to stress, illness, or trauma.

Diabetes-related abnormalities frequently presenting to the emergency department are: