Endocrine & Metabolic

Diabetes is diagnosed by any of: A1c >=6.5%, fasting plasma glucose >=126, OGTT 2-hr >=200, or random glucose >=200 with classic symptoms. With symptoms plus a random glucose >=200, the diagnosis is established.

Metformin is first-line for type 2 DM (alongside lifestyle modification). Add a GLP-1 agonist or SGLT2 inhibitor for patients with ASCVD, heart failure, or chronic kidney disease for cardiorenal benefit.

Screen for retinopathy (dilated eye exam), nephropathy (urine albumin/creatinine; treat with ACEi or ARB), neuropathy (annual foot exam), and ASCVD risk (statin). ACEi/ARB slows diabetic nephropathy.

This is DKA. The first step is aggressive IV isotonic fluids, then start an insulin drip. Replace potassium (give K before insulin if K is low or low-normal). Identify and treat the trigger.

Insulin drives potassium intracellularly, which can precipitate dangerous hypokalemia and arrhythmias. If serum K is below ~3.3, hold insulin and replace K first. Monitor K closely throughout treatment.

Cerebral edema is the most feared complication in children, often linked to overly rapid fluid resuscitation or rapid osmolar shifts. Watch for headache and altered mental status; treat with mannitol or hypertonic saline.