Monday, July 5, 2021

New-Onset Hyperglycemia

EmDocs - July 05, 2021 - By Xavier Schwartz; Alison Sullivan
Reviewed by: Andrew Grock; Alex Koyfman; Brit Long
Take-Home Points
  • Type 1 (autoimmune) diabetes can present in adults.
  • Consider type 1 diabetes in adult patients with hyperglycemia and severe weight loss, polyuria, or polydipsia. This mandates an ED endocrinology consult or hospital admission.
  • For hyperglycemic, stable patients without concern for type 1 diabetes:
    • If asymptomatic with random BG >126 mg/dL (7.0 mmol/L), outpatient follow-up for diabetes screening is appropriate.
    • If symptomatic with a BG between 200 mg/dL (11.1 mmol/L) and 300 mg/dL (16.7 mmol/L), Metformin 500 mg once a day can be safely started in the ED and is usually well tolerated.
    • For severe hyperglycemia (BG >300 mg/dL or 16.7 mmol/L), the patient will likely require long-term insulin therapy. Disposition of these patients will vary by practice environment. Consider initiation of long-acting glargine at 0.1-0.2 units/kg/day on discharge for reliable patients in well-resourced settings with established hospital support.