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New onset diabetes mellitus
From WikEM
Contents
Background
Clinical Features
Differential Diagnosis
Hyperglycemia
- Diabetic foot infection
- Diabetic ketoacidosis (DKA)
- Diabetic ketoacidosis (peds)
- Hemochromatosis
- Hyperosmolar hyperglycemic state (HONC)
- Iron toxicity
- New onset diabetes mellitus
- Nonketotic hyperglycemia
- Sepsis
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
- ↑ American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care 2013; 36 Suppl 1:S11.
- ↑ EBQ:Relevance of Discharge Glucose Levels
