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

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

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

See Also