Diabetes mellitus (main): Difference between revisions
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==Management== | ==Management== | ||
*There is no need to treat the glucose "number" in the emergency setting (i.e. with insulin) | |||
**[[EBQ:Relevance of Discharge Glucose Levels|Higher discharge glucose levels are not associated with a greater risk of repeated ED visits, hospitalization, or other adverse outcomes.]] | |||
{{DM outpatient managment}} | |||
*May consider IV hydration or IV insulin administered in the ED | *May consider IV hydration or IV insulin administered in the ED | ||
*All patients with diabetes newly diagnosed in the ED will require reliable follow-up for education and blood sugar monitoring | *All patients with diabetes newly diagnosed in the ED will require reliable follow-up for education and blood sugar monitoring | ||
Revision as of 03:59, 10 November 2018
Background
- Growing in worldwide prevalence
- Results from either inability of the body to release insulin from the pancreas or a resistance against the actions of insulin
Clinical Features
- Patients with diabetes may be asymptomatic
- Acute symptoms range from those of nonketotic hyperglycemia (e.g. polyuria, polydipsia) to DKA (ill appearance, acetone breath, Kussmaul's breathing, somnolence)
Differential Diagnosis
Hyperglycemia
- Physiologic stress response (rarely causes glucose >200 mg/dL)
- Diabetes mellitus (main)
- Hemochromatosis
- Iron toxicity
- Sepsis
Evaluation
- Diabetes mellitus itself is not normally a diagnosis sought in the emergency department (i.e. via A1C)
- Hyperglycemia can be found on laboratory testing
- Asymptomatic patients do not necessarily require additional testing
- Symptomatic or potentially symptomatic patients require additional testing
- Check CBC, BMP, and ketones (if sick, additionally see DKA workup)
- UA is only necessary if you are ruling out urinary infection or do not have serum ketones available and are using it as a screening mechanism
Management
- There is no need to treat the glucose "number" in the emergency setting (i.e. with insulin)
Type II Diabetes Outpatient Management
- 1st line: Metformin 500mg BID → 1000mg BID, do not give in people with abnormal LFT's, CHF Stage 3/4 and ARI, CKD
- 2nd Agent: Glipizide start 2.5mg BID → 5mg BID, need to monitor for hypoglycemia
- 3rd Agent: Pioglitazone
- After 3 agents: need to start insulin if not controlled
- NPH BID or Lantus Qday (0.1 to 0.2mg/kg) and titrate to Fasting Blood Sugar
- May consider IV hydration or IV insulin administered in the ED
- All patients with diabetes newly diagnosed in the ED will require reliable follow-up for education and blood sugar monitoring
- May consider discharging patient with prescription for metformin, starting dose is 850 mg daily