Nonketotic hyperglycemia

Clinical Features

• Polyuria
• Polydipsia
• Altered mental status
• Significant dehydration (fluid losses higher than in DKA)
• Infectious symptoms (nonketotic hyperglycaemia often caused by intercurrent illness)

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

• 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)
  • Higher discharge glucose levels are not associated with a greater risk of repeated ED visits, hospitalization, or other adverse outcomes.

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

See Also

• EBQ:Relevance of Discharge Glucose Levels