Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK
- Target glucose 6.0 -10.0 mmol/L (up to 12.0 mmol/L is acceptable)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.
Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.
- Hyperglycaemia – generally ≥30mmol/l
- High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
- & NOT:
- Acidotic – pH >7.3, HCO3 >15mmol/l
- Ketotic – blood <3mmol/l, Urine <2+