Diabetes & Endocrine
Emergencies

• Recognise diabetic ketoacidosis (DKA) and distinguish it from hyperosmolar hyperglycemic state (HHS)
• State the management principles of DKA — fluids first, insulin, potassium, and the classic pitfalls
• Execute a hypoglycemia rapid-action protocol for the conscious and the unconscious patient (15–15 rule, glucagon)
• Identify insulin types by onset, peak, and duration and match them to clinical situations
• Recognise thyroid storm and adrenal (Addisonian) crisis as time-critical endocrine emergencies
• Differentiate type 1 (always insulin-dependent) from lifestyle-driven type 2 diabetes
• Apply a food-first, drug-last framework to type 2 care, citing the mainstream remission evidence

This module carries two duties at once, and refuses to choose between them. The first is uncompromising emergency rigour: when a patient is in diabetic ketoacidosis, when their glucose is crashing, when a thyroid storm or an adrenal crisis is unfolding, there is no room for philosophy — only for fast, correct, protocol-driven action. Half of this book exists to make that action automatic.

The second duty is to ask the question the emergency conveniently buries: did this have to happen? For type 1 diabetes the answer is no — it is an autoimmune condition, insulin is non-negotiable and lifelong, and nothing in this module suggests otherwise. But for the far larger population living with type 2 diabetes, the honest answer is often yes, it was largely preventable, and in many people, even after diagnosis, it is reversible.

The single most consequential clarification in this entire module: type 1 and type 2 diabetes are different diseases that happen to share a number. Conflating them harms both groups. Type 1 patients hear careless “you can reverse it with diet” talk and feel blamed for an autoimmune illness they did not cause. Type 2 patients hear “it is chronic and progressive” and lose the hope — and the agency — that the evidence now says many of them deserve.