Last reviewed: July 2020
Last updated: May  2020

Summary

Definition

History and exam

Key diagnostic factors

  • known diabetes or features of diabetes
  • nausea and vomiting
  • abdominal pain
  • dehydration
  • hyperventilation
  • reduced consciousness
  • risk factors
  • hypothermia

Risk factors

  • inadequate or inappropriate insulin therapy
  • infection
  • myocardial infarction
  • pancreatitis
  • stroke
  • acromegaly
  • hyperthyroidism
  • drugs (e.g., corticosteroids, thiazides, pentamidine, sympathomimetics, second-generation antipsychotics, cocaine, immune checkpoint inhibitors, or SGLT2 inhibitors)
  • Cushing's syndrome
  • Hispanic or black ancestry
  • bariatric surgery

Diagnostic investigations

1st investigations to order

  • venous blood gas
  • blood ketones
  • blood glucose
  • urea and electrolytes
  • full blood count
Full details

Investigations to consider

  • urinalysis
  • ECG
  • pregnancy test
  • amylase and lipase
  • cardiac enzymes
  • creatinine kinase
  • chest x-ray
  • liver function tests
  • blood, urine, and sputum cultures
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Biography

GR is Lead and Innovator of the National Inpatient Diabetes Audit; and Joint Clinical Lead of the Diabetes, Getting It Right First Time programme.

Disclosures

GR has been paid for advisory board meetings with the following companies: Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, and Bayer. GR has received lecture fees from Sanofi Aventis, Abbott Diabetes UK, Lilly Diabetes, Novo Nordisk, and Napp Pharmaceuticals Ltd.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Aidar R. Gosmanov, MD, PhD, FACE

Associate Professor of Medicine

Division of Endocrinology

Albany Medical College

Chief, Endocrinology Section

Albany VAMC

Albany

NY

Laleh Razavi Nematollahi, MD

Assistant Professor of Medicine

Case Western Reserve University

Cleveland

OH

Disclosures

ARG and LRN declare that they have no competing interests.

Peer reviewersVIEW ALL

Honorary Professor of Medicine

University of Manchester

Consultant Physician/Diabetologist/Endocrinologist

Tameside and Glossop Integrated Care NHS Foundation Trust 

Manchester

UK

Disclosures

EJ declares that he has no competing interests.

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Head of Research and Development, BMJ

Disclosures

LD declares that she has no competing interests.

Head of Editorial, BMJ Best Practice

Disclosures

AE declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Use of this content is subject to our disclaimer