06.05 Endo/Metabolic

06.05 Endocrine / Metabolic [PDF link]: Diabetic ketoacidosis (DKA) – Euglycaemic ketoacidosis. Hyperosmotic hyperglycaemic state (HHS). Hypoglycaemia. Diabetes insipidus – Water deprivation test.

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More on hypoglycaemia – practical management

• See the Joint British Diabetes Societies (JBDS) guidelines – PDF guideline is quite detailed and helpful, and there’s also a simple algorithm (no idea why it’s in pptx)

• If pt is on IV insulin, pause it. Restart when CBG ≥4mmol/L and monitor regularly (CBG every 1-2h)

• After any intervention, recheck glucose in 10-15 min

• If CBG ≤2.5-4 mmol/L after 2-3 cycles of treatment (depending on Trust policy) – GET HELP (escalate early / met call if needed)

• Parenteral options (prescribing)

  • Glucagon 1mg IM – licensed only for insulin-induced hypoglycaemia, can take up to 15min to work

  • IV glucose: 100ml of 20% glucose (at 400ml/hour over 15 minutes) or 200ml of 10% glucose (at 800ml/hour over 15 minutes)

• Once CBG ≥4 mmol/L, give longer acting carbohydrate (eg 1-2 slices of bread, biscuits)

  • If NBM, prescribe 10% IV glucose at 100 mL/h until senior review

  • If glucagon given, give double the amount of carbs (eg 4 slices of bread) to prevent hypos

• Do not omit regular insulin doses. Consider titration of insulin or sulfonylurea doses.