Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors for hyperglycaemia
  • presence of risk factors for hypoglycaemia
  • hx of diabetes mellitus
  • signs of hypoglycaemia

Other diagnostic factors

  • hx of recent corticosteroid use
  • signs of diabetic retinopathy
  • signs of diabetic neuropathy
  • polyuria, polydipsia, or unintentional weight loss

Risk factors

  • severe illness (hyperglycaemia or hypoglycaemia)
  • corticosteroid use (hyperglycaemia)
  • poorly controlled diabetes mellitus (hyperglycaemia)
  • insulin administration (hypoglycaemia)
  • changes to corticosteroid or insulin regimen (hypoglycaemia or hyperglycaemia)
  • poor nutritional intake (hypoglycaemia)
  • older age or cognitive impairment (hypoglycaemia)

Diagnostic investigations

1st investigations to order

  • random plasma glucose
  • HbA1c
  • serum urea nitrogen, creatinine, and glomerular filtration rate (GFR) calculation
  • spot urine albumin/creatinine ratio
  • serum ketones
Full details

Investigations to consider

  • post-discharge fasting plasma glucose or HbA1c
  • post-discharge oral glucose tolerance test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

M. Cecilia Lansang

Associate Professor of Medicine

Director

Inpatient Diabetes Service

Department of Endocrinology

Diabetes and Metabolism Cleveland Clinic

Cleveland

OH

Disclosures

MCL declares that she has no competing interests.

Endocrinology Section

Orlando Veterans Administration Medical Center

Clinical Associate Professor

Department of Medicine

University of Central Florida College of Medicine

Orlando

FL

Disclosures

SQ declares that she has no competing interests.

Dr M. Cecilia Lansang and Dr Suzanne Quinn would like to gratefully acknowledge Dr Ajay Rao and Dr Vivian Fonseca, previous contributors to this monograph. AR and VF declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Division of Endocrinology

Metabolism and Lipids

Emory University School of Medicine

Atlanta

GA

Disclosures

GEU is an author of a number of references cited in this monograph.

Consultant Diabetologist

Beta Cell Unit

Chelsea and Westminster NHS Trust

London

UK

Disclosures

DM declares that he has no competing interests.

Senior Lecturer in Medicine

National University of Ireland

Consultant in Diabetes and Endocrinology

Galway University Hospitals

Galway

Ireland

Disclosures

SD declares that he has no competing interests.

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