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Hyperglycemia (assess severity (severe 400 需要停止前OHA用藥，換成IV…

- - - - STAT measure randome glucose
      - regular insulin 5-10 U
      - If hyperglycemia is documented at 3 a.m., then prebreakfast hyperglycemia may reflect inadequate insulin coverage overnight.
  - - - fasting glucose: 多於一次>126mg/dl
      - finger stick before meal and bedtime
        
        400 /<50都應多加注意
      - OGTT: 2hr:>200
      - HbA1C>6.5
      - symptoms+ 兩次random glucose>200
  - - - 500 to 1000 mL of normal saline intravenously over the first hour
      - insulin infusion
      - monitor BS hourly
        
        若有降到250,繼續原insulin量並換成D5W
        持續到140-180可改成SC
      - monitor BS,serum electrolyte,ABG
      - search for 加重因子
        
        a. Infection
        
        b. Inadequate insulin dosage
        
        c. Dietary indiscretion
        
        d. Pancreatitis
- - - - symptoms
        
        • ketone breath
        
        • Kussmaul breathing
        (deep, pauseless respirations<= pH <7.2)
        
        • Volume depletion (tachycardia, decreased JVP, with or without hypotension)
        
        • Anorexia, nausea, vomiting, abdominal pain (may mimic a “surgicalabdomen”)
        
        • Ileus, gastric dilation
        
        • Hyporeflexia, hypotonia, delirium, coma
    - - • Polyuria, polydipsia
        
        • Volume depletion
        
        • Confusion, coma