Nonketotic hyperglycemia: Difference between revisions
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==Background== | ==Background== | ||
*Typically defined as glucose >180 | |||
==Clinical Features== | ==Clinical Features== | ||
*Asymptomatic | |||
*[[Polyuria]] | |||
*Polydipsia | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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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}} | {{DM outpatient managment}} | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Endocrinology]] | |||
Latest revision as of 16:49, 28 September 2019
Background
- Typically defined as glucose >180
Clinical Features
- Asymptomatic
- Polyuria
- Polydipsia
Differential Diagnosis
Hyperglycemia
- Physiologic stress response (rarely causes glucose >200 mg/dL)
- Diabetes mellitus (main)
- Hemochromatosis
- Iron toxicity
- Sepsis
Evaluation
- Elevated glucose
- May check:
- CBC
- Chemistry (gap)
- Ketones
Management
- There is no need to treat the glucose "number" in the emergency setting (i.e. with insulin)
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
Disposition
- Asymptomatic patients can be discharged with follow up with primary care physician[1]