Nonketotic hyperglycemia

Clinical Features

• Polyuria
• Polydipsia

Differential Diagnosis

Hyperglycemia

• Diabetic foot infection
• Diabetic ketoacidosis (DKA)
• Diabetic ketoacidosis (peds)
  • Cerebral edema in DKA
• Hemochromatosis
• Hyperosmolar hyperglycemic state (HONC)
• Iron toxicity
• New onset diabetes mellitus
  • Diabetic peripheral neuropathy
• Nonketotic hyperglycemia
• 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 (0.5mg/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

References

Authors

Ross Donaldson