dm_1stdxmx
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Table of Contents
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)
- 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
dm_1stdxmx.1759280543.txt.gz · Last modified: 2025/10/01 01:02 by gary1