Table of Contents

Introduction
Initial Ix in ED of adults
- ketotic patient
- non-ketotic patient

Mx of 1st presentation diabetes mellitus

see also:

Introduction

this is a brief outline of initial ED Mx of an adult patient found to have a high blood glucose

Initial Ix in ED of adults

usual ABC's of ED - move to resus if critically unwell
take bloods for glucose, FBE, U&E, osmolarity, and if raised ketones > 1mmol/L on bed side testing, do blood gases
look for precipitants
- bloods, etc for septic workup as indicated
- in older adults check for acute coronary syndrome
clinical history and exam as usual
- is their FH?
- Hx of hyperglycaemic symptoms of polyuria, polydipsia, etc
- BMI

ketotic patient

Mx as per diabetic ketoacidosis (DKA)

non-ketotic patient

hyperosmolar state

IV fluid rehydration and insulin Rx as per your hospital's procedures

normal osmolarity

discuss with endocrine team for a plan which may include:
- serum HbA1c (NB. may be artificially low in those with G6PD deficiency)
- TFTs
- fasting lipids
- fasting C-peptide
- fasting glucose
- additional auto-antibody tests
  - zinc transport 8 antibodies
  - anti gliadin antibodies
  - tissue transglutaminase antibodies
  - anti glutamic acid decarboxylase antibodies
  - insuloma antigen (IA2) antibodies
- start basal bolus insulin
  - eg. glargine insulin 14 units nocte if normal BMI
- initial tds short acting insulin
  - eg. aspart insulin 4 units tds if normal BMI
- observe until glucose under control then pending results consider changing to oral agents