Primary Hypothyroidism: Diagnosis and Management

Diabetic Ketoacidosis (DKA): Diagnosis and Management

Diagnose DKA with diabetes or hyperglycemia, ketosis and metabolic acidosis; remember that SGLT2-associated DKA can occur without marked hyperglycemia. Start intravenous isotonic saline or balanced crystalloid, adapting the rate to hydration, cardiac and renal status. Check potassium before insulin: if potassium is below 3.5 mmol/L, replace it and delay insulin until potassium is above 3.5 mmol/L. Follow a monitored insulin and electrolyte protocol, adding dextrose as glucose falls so insulin can continue to clear ketones. Assess resolution using ketones and acid-base recovery rather than glucose or the anion gap alone. Treat the precipitant and overlap subcutaneous insulin before stopping the infusion.

Insulin Deficiency: Causes, Diagnosis and Management

Insulin deficiency is a metabolic condition characterized by inadequate production or complete absence of insulin from the pancreatic beta cells, resulting in impaired glucose utilization and elevated blood glucose levels. This typically leads to a diagnosis of Type 1 Diabetes Mellitus or represents a late stage of other pancreatic diseases. The mainstay of treatment is lifelong exogenous insulin replacement, administered through multiple daily injections or an insulin pump, to mimic physiological insulin secretion. Management also involves diligent blood glucose monitoring, carbohydrate counting, dietary adjustments, and regular physical activity to optimize glycemic control and prevent complications. Key symptoms include polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (increased hunger), and unexplained weight loss. Patients often experience fatigue, blurred vision, recurrent infections, and in acute severe cases, symptoms of diabetic ketoacidosis such as nausea, vomiting, abdominal pain, and rapid, deep breathing (Kussmaul respirations).

Gestational Diabetes Mellitus (GDM): Screening and Management

Screen all pregnant women at 24-28 weeks with a 75 g oral glucose tolerance test, or earlier when risk factors such as obesity or previous GDM exist. First-line management is medical nutrition therapy with structured physical activity and daily glucose self-monitoring. If fasting or postprandial targets are repeatedly exceeded despite lifestyle measures, start insulin, with metformin as an accepted alternative in many guidelines. Monitor fetal growth because GDM drives macrosomia, and plan delivery around 38-39 weeks when medication is required. After delivery, insulin needs fall sharply; arrange a 75 g OGTT at 6-12 weeks postpartum because about half of women with GDM later develop type 2 diabetes.