blood glucose levels are normally kept within strict limits to prevent hypoglycaemia or dehydration from osmotic diuresis resulting from high levels of glucose in the blood with resultant glycosuria
temporary high levels of blood glucose are common in non-diabetics as part of the acute stress response
Mx of acute hyperglycaemia in the diabetic patient
check urine for ketones
consider arterial or venous blood gas to exclude evidence of acidosis
if glucose > 13.8 AND raised ketones AND pH < 7.30 AND Bicarb < 15 then Mx as for diabetic ketoacidosis (DKA)
if neither of the above are present Mx as for unstable diabetes:
look for cause such as infection, AMI, acute limb thrombosis, etc
Rx any dehydration
stabilise blood glucose levels with sub-cut insulin (insulin infusion is NOT usually indicated)
in addition, for the newly diagnosed diabetic
add the following FASTING blood tests:
HbA1c
lipids, c peptide, glucose, TSH, Anti-GAD Anti -IA2
Urine - Albumin/Creatinine Ratio
diabetic education
aetiology of persistent episodes of hyperglycaemia
type 1 diabetes mellitus
caused by insulin deficiency
account for 5-10% of cases of diabetes mellitus
most are autoimmune and onset is rapid with presentation usually before age 30 yrs
some have a slower rate of pancreatic beta cell destruction and present as latent autoimmune diabetes in adults (accounts for ~5% of “type 2 diabetics”)
require life long insulin replacement Rx otherwise will develop diabetic ketoacidosis (DKA) within hours or days
type 2 diabetes mellitus
predominantly caused by insulin resistance with relative insulin deficiency
accounts for 90-95% of cases of diabetes mellitus
usually occurs in adults with obesity or central obesity
gestational diabetes
impaired glucose tolerance during pregnancy
maturity-onset diabetes of the young (MODY)
NB. this does not include type 2 DM occurring in obese children