Patients w/type 2 DM who are either not taking (enough) insulin and/or have increased resistance due to a concomitant stressor: infection, MI, PE, pancreatitis, meds (steroids), other precipitant
Risk Factors
Poorly controlled type 2 dm
Older age, significant co-morbid illnesses
Symptoms
Confusion to obtundation
May have felt weak, N, V, fatigued prior
Polyuria, polydypsia
Fever, pain, other localizing sign related to underlying problem (e.g. infection, MI, etc).
Physical Exam Findings
Can be very ill appearing
Fever if related to infection
Often tachycardia, low bp, tachypnea - w/degree of abnormality based on severity and level of compensation
May have focal exam findings based on primary problem (e.g. findings of pneumonia, intra-abdominal infection, etc).
Tests
Typically: Glucose > 600, Serum OSM > 320, pH > 7.3, bicarb > 18; sometimes + AG