Last reviewed: 29 Oct 2020
Last updated: 18 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • acute cognitive impairment
  • risk factors

Other diagnostic factors

  • polyuria
  • polydipsia
  • weight loss
  • nausea and vomiting
  • weakness
  • dry mucous membranes
  • poor skin turgor
  • tachycardia
  • hypotension
  • hypothermia
  • oliguria
  • abdominal pain
  • focal neurological signs
  • seizures

Risk factors

  • infection
  • inadequate insulin or oral antidiabetic therapy
  • acute illness in a known patient with diabetes
  • nursing home residents
  • postoperative state
  • precipitating medications
  • total parenteral nutrition (TPN)
  • Cushing's syndrome
  • hyperthyroidism
  • acromegaly

Diagnostic investigations

1st investigations to order

  • blood glucose
  • blood ketones
  • venous blood gas
  • serum osmolality
  • urea, electrolytes, and creatinine
  • full blood count
  • ECG
Full details

Investigations to consider

  • urinalysis
  • cardiac enzymes
  • chest x-ray
  • liver function tests
  • C-reactive protein
  • 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 expert contributors, whose work has been retained in parts of the content:

Natasha Khazai, MD

Endocrinologist

Joslin Diabetes Clinic

Boston

MA

Guillermo Umpierrez, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

Disclosures

NK declares that she has no competing interests. GU is supported by research grants from the American Diabetes Association and the National Institutes of Health, and has received research funds from Sanofi-Aventis, Novo Nordisk, Takeda, and GlaxoSmithKline.

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.

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.

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