Diabetes mellitus (main): Difference between revisions
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*Growing in worldwide prevalence | *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 | *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 may range from those of [[nonketotic hyperglycemia]] (e.g. polyuria, polydipsia) to [[DKA]] (ill appearance, acetone breath, Kussmaul's breathing, somnolence) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 02:44, 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 may 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
Workup based on provider level of suspicion for emergent process such as DKA, HHS, sepsis
- In asymptomatic patient may consider UA to check for ketones
- Sick patients will require CBC, BMP, blood gas, EKG, additional tests at provider discretion
Management
- 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