View source for Diabetes mellitus (main)

==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, polyphagia) to [[DKA]] (ill appearance, acetone breath, Kussmaul's breathing, somnolence)

==Differential Diagnosis==
{{Hyperglycemia DDX}}

==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
***Obtaining HbA1c prior to initiation of therapy helpful to establish a baseline

===American Diabetes Association Diagnostic Criteria===
Need 1 of the following:<ref>American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care 2013; 36 Suppl 1:S11.</ref>
*HbA1C ≥6.5%
*FPG ≥126mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours
*Two-hour plasma glucose ≥200mg/dL (11.1 mmol/L) during an oral glucose tolerance test
*In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200mg/dL (11.1 mmol/L)
**Most common way diagnosed in ED

==Management==
*There is no need to treat the glucose "number" (i.e. [[nonketotic hyperglycemia]] 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.]]
*For [[HHS|hyperosmolar hyperglycemic state]], [[DKA]], or another specific process see that particular page

{{DM outpatient managment}}

==Disposition==
*Asymptomatic patients or those with [[nonketotic hyperglycemia]] can be discharged with follow up with primary care physician<ref>[[EBQ:Relevance of Discharge Glucose Levels]]</ref>

==See Also==
*[[Hypoglycemia]]
*[[EBQ:Sodium_Bicarbonate_use_in_DKA|Evidence Review Sodium Bicarbonate in DKA]]
*[[EBQ:Relevance of Discharge Glucose Levels]]

==References==
<references/>

[[Category:Endocrinology]]