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) 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
- 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