小结
定义
病史和体格检查
关键诊断因素
- 高血糖的高危因素
- 低血糖的高危因素
- 糖尿病史
- 严重的并发疾病或感染（高血糖）
- 使用胰岛素（低血糖）
- 意识水平降低/昏迷（低血糖和高血糖）
- 出汗（低血糖）
- 心动过速（低血糖）
- 异常行为（低血糖）
其他诊断因素
- 皮质类固醇近期用药史
- 糖尿病视网膜病变的体征
- 糖尿病肾脏病变的体征
- 多尿，多饮或非刻意的体重减轻
危险因素
- 危重病（高血糖或低血糖）
- 糖皮质激素应用（高血糖）
- 糖尿病患者血糖控制不佳（高血糖）
- 胰岛素治疗或胰岛素促泌剂（低血糖）
- 改为糖皮质激素或胰岛素治疗（低血糖或高血糖）
- 摄入不足（低血糖）
- 高龄或认知功能障碍（低血糖）
诊断性检查
首要检查
- 随机血糖
- HbA1c
- 血清尿素、肌酐和 eGFR
- 尿白蛋白/肌酐比值
- 血清酮体
需考虑的检查
- 出院后空腹血糖或糖化血红蛋白
- 出院后检测口服 75 g 葡萄糖后 2 小时的血糖
治疗流程
重症或急诊手术或ICU患者：高血糖
病情稳定的非重症患者：未控制的高血糖
病情稳定的非重症患者：血糖控制良好
低血糖
术前：择期小手术
撰稿人
作者
M. Cecilia Lansang, MD, MPH
Professor of Medicine
Director of Endocrinology, Main Campus
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
利益声明
MCL has received research support from Dexcom, Xeris, and Abbott. She is also a consultant at Glooko.
Keren Zhou, MD
Clinical Assistant Professor of Medicine
Research Director, Endocrinology and Metabolism Institute
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
利益声明
KZ declares that she has no competing interests.
鸣谢
Dr M. Cecilia Lansang and Dr Keren Zhou would like to gratefully acknowledge Dr Suzanne Quinn, Dr Ajay Rao, and Dr Vivian Fonseca, previous contributors to this topic.
利益声明
SQ, AR, and VF declare that they have no competing interests.
同行评议者
Guillermo E. Umpierrez, MD
Professor of Medicine
Division of Endocrinology
Metabolism and Lipids
Emory University School of Medicine
Atlanta
GA
利益声明
GEU is an author of a number of references cited in this monograph.
Daniel Morganstein, MBBS, MA (Cantab), MRCP, PhD
Consultant Diabetologist
Beta Cell Unit
Chelsea and Westminster NHS Trust
London
UK
利益声明
DM declares that he has no competing interests.
Sean Dinneen, MBBCh, FRCPI, FACP
Senior Lecturer in Medicine
National University of Ireland
Consultant in Diabetes and Endocrinology
Galway University Hospitals
Galway
Ireland
利益声明
SD declares that he has no competing interests.
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