New onset diabetes mellitus

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Background

Clinical Features

Differential Diagnosis

Hyperglycemia

Evaluation

American Diabetes Association Diagnostic Criteria. Need 1 of the following criteria.[1]

  • HbA1C ≥6.5 percent
  • 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

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 (0.5mg/kg) and titrate to Fasting Blood Sugar

Primary Care

  • If HbA1c > 6.5, titrate fasting blood sugar to 80 to 120
  • ADA diet control until HbA1c is >7
  • all diabetes mellitus need HbA1c q 3mo, Ma-cr to check for microalbuminuria q year

Disposition

  • Asymptomatic patients can be discharged with follow up with primary care physician[2]

See Also

References

  1. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care 2013; 36 Suppl 1:S11.
  2. EBQ:Relevance of Discharge Glucose Levels