Hyperglycemia

Rationale

Elevation of blood glucose above usual physiologic parameters is a very common and important clinical condition, with both acute and chronic complications.

Causal Conditions

(list not exhaustive)

1. Diabetes mellitus (type 1, type 2, gestational)
2. Other endocrine conditions
3. Adverse effects of medications

Key Objectives

Given a patient with acutely or chronically elevated blood glucose, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. Particular attention should be paid to management of emergent situations, prevention of progression of pre-diabetes, and prevention of complications.

Enabling Objectives

Given a patient with elevated blood glucose, the candidate will

1. identify emergent situations (e.g., diabetic ketoacidosis, hyperosmolar state)
2. list and interpret critical clinical findings, including those based on
   1. an appropriate history and physical examination aimed at determining the cause and complications, and
   2. differentiation of true hyperglycemia from pseudohyperglycemia;
3. list and interpret critical investigations, including
   1. laboratory investigations for both acute and chronic hyperglycemia (e.g., arterial blood gas, electrolytes, hemoglobin A_1C), and
   2. investigations for complications of chronic hyperglycemia (e.g., urine albumin to creatinine ratio);
4. construct an effective management plan for hyperglycemia in general and diabetes in particular, including
   1. providing emergent and resuscitative treatment,
   2. counselling and educating the patient on preventive and nonpharmacologic measures,
   3. determining appropriate pharmacotherapy, including use of insulin and noninsulin medications,
   4. determining whether the patient requires specialized care, and
   5. referring the patient to appropriate support services, including lifestyle and psychosocial supports.