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Hyperglycemia

  • Ddx

    • diabetes
    • diabetic exacerbation due to infection (pneumonia, UTI, gastroenteritis)
    • diabetic medication non-adherence
  • Serious ddx

    • DKA
  • Labs

    • CBC, chem, glc, a1c
    • r/o DKA (anion gap)
    • UA
    • blood culture if suspect sepsis
  • ER tx

    • IV fluids
    • insulin
    • antibiotics if infection
  • Dx criteria for diabetes

    • random glc > 200 and symptomatic
    • fasting glc > 126
    • 2h oGTT > 200
    • a1c > 6.5
  • Tx for diabetes

    • diet and exercise (firstline)
    • metformin (if diet/exercise doesn't work): start with 500mg bid. Can ramp up to 1000mg bid. Contraindicated in liver or renal (Cr > 1.4) dz
    • sulfonylurea (if can't take metformin, or just go straight to insulin)
    • insulin (if fasting glc > 200 or metformin fails)
  • Rare ddx

    • glucagonoma
  • HPI

    • onset: acute vs chronic, new vs old
    • triggering events
    • alleviation
    • aggravation
  • ROS

    • fever
    • syncope, dizziness
    • vision changes
    • numbness/tingling in extremities
    • recent infections, cellulitis
    • chest pain
    • dyspnea
    • abdominal pain, nausea, vomiting, diarrhea
    • dysuria, polyuria
  • PMH

    • diabetes
  • Meds

    • insulin usage, missed doses, medication adherence
  • SH

    • smoking
  • Px

    • mental status
    • mucous membranes
    • vision (gross), funduscope
    • cardio
    • pulm: crackles
    • abdomen: tenderness to palpation
    • foot exam (ulcers, sensation)

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    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.