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

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 see additionally 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

See Also