In this section : Diabetes and Endocrinology
Paediatric Diabetic Ketoacidosis (DKA) Guideline
Paediatric Ketone Correction Guideline
Insulin Correction Factor Table (Paediatrics)
Management of Hypoglycaemia in Children with Type 1 Diabetes
Newly diagnosed diabetic – not in DKA (Walking wounded)
Prescribing Advice on Admission – Insulin
Diabetic Retinopathy
Adrenal Insufficiency
Hyperglycaemia & Steroids
Variable Rate Insulin Infusion
In-patient Hyperglycaemia Management
Hyperthyroidism
Newer Antidiabetic Drugs
Hypoglycaemia
Diabetic Ketoacidosis
Switching from VRII
Insulin Pumps
Diabetes Mellitus
The Diabetic Foot
Subcutaneous Insulin
Diabetes and Acute Coronary Syndrome
Hyperosmolar Hyperglycaemic State
Diabetes and Acute Coronary Syndrome
Last updated 26th June 2023
Thrombolysis
- If indicated by ECG changes give thrombolysis – diabetic retinopathy is not a contraindication.
- The risk of vitreous haemorrhage is minimal even in patients with proliferative retinopathy. If patient known to have proliferative retinopathy discuss the risk and record that you have done so in the notes.
- Do not waste time dilating the fundi of patients whose retinopathy status is not known – even if you know what to look for you should not delay giving the thrombolytic therapy (minutes mean muscle).
Glycaemic Control
- Blood sugar is likely to rise with discontinuation of usual treatment or stress of ACS
In All Known Patients With Diabetes
- Check HbA1c to assess premorbid glycaemic control
- Stop metformin temporarily to avoid lactic acidosis should cardiac failure or cardiogenic shock ensue.
- Stop sulphonylurea (theoretical risk of interference with ischaemic preconditioning).
- Start Variable Rate Insulin Infusion (VRII) & continue for at least 24 hrs.
In Patients Not Known to be Diabetic Previously
- Start VRII as above if BG >11mmol/l
What To Do Next
- Consider whether further tests required to rule out stress hyperglycaemia in newly diagnosed people with diabetes
- If premorbid glycaemic control was good (recent HbA1c < 64mmol/mol) return to usual therapy assuming there are no contraindications
- If premorbid glycaemic control was suboptimal
- (HbA1c > 64mmol/mol) consider whether there is room to augment OHA therapy or whether it might be preferable to continue with insulin in which case refer to diabetes team.
- If in doubt refer to diabetes team