Nonketotic hyperglycemia: Difference between revisions
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==Management== | ==Management== | ||
*There is no need to treat the glucose "number" in the emergency setting | *There is no need to treat the glucose "number" in the emergency setting (i.e. with insulin) | ||
**[[EBQ:Relevance of Discharge Glucose Levels]] | **[[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}} | ||
Revision as of 12:21, 1 February 2017
Background
Clinical Features
- 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]