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 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)
  • Nonketotic hyperglycemia
  • Hyperosmolar hyperglycemic state (HHS/HONC)
  • Diabetic ketoacidosis (adult)
  • Diabetic ketoacidosis (peds)
    • Cerebral edema in DKA
  • Diabetic foot infection
  • Diabetic peripheral neuropathy
• 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

See Also

• Hypoglycemia
• Evidence Review Sodium Bicarbonate in DKA
• EBQ:Relevance of Discharge Glucose Levels