Acute complications of diabetes mellitus: current insights into pathophysiology and clinical management

Abstract

Diabetes mellitus is a chronic metabolic disorder with rising global prevalence and significant morbidity and mortality due to its complications. Among these, acute complications such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS), hypoglycaemia, and lactic acidosis represent urgent and life-threatening conditions requiring immediate medical intervention. DKA and HHS share common pathophysiological pathways involving insulin deficiency and counter-regulatory hormone excess, leading to profound metabolic disturbances. Although DKA is more common in type 1 diabetes (T1D) and HHS in type 2 diabetes (T2D), both demand prompt diagnosis and structured therapeutic strategies to restore fluid and electrolyte balance and normalise blood glucose levels. Hypoglycaemia is often due to drug-induced insulin overdosing, and is associated with neuroglycopenic symptoms, while lactic acidosis involves derangements in lactate metabolism and may be triggered by conditions such as sepsis or metformin use. This review explores the pathophysiology, clinical presentation, diagnostic features, and management protocols for these acute complications. It further highlights the importance of preventive strategies, patient education, and the potential role of digital health and personalised medicine in reducing the risk of complications and improving diabetes outcomes.