From the Guidelines
When a patient arrives at the ER with hyperglycemia, it is crucial to immediately assess their current blood glucose levels, symptoms, and medical history to identify potential complications like diabetic ketoacidosis or hyperglycemic hyperosmolar state, as highlighted in the most recent study 1. To evaluate the patient's condition, consider the following key points:
- Current blood glucose levels and any recent measurements
- Symptoms such as excessive thirst, frequent urination, blurred vision, or fatigue
- Medication compliance and any changes to their diabetes treatment plan
- Recent illness, stress, or changes in diet and exercise routine
- Presence of ketones in the urine, which can indicate diabetic ketoacidosis
- Any signs of infection, such as fever or pain, which can exacerbate hyperglycemia The patient's medical history, including any previous episodes of hyperglycemia, diabetic ketoacidosis, or hyperglycemic hyperosmolar state, should also be taken into account, as noted in 1. According to the latest guidelines 1, it is essential to consider the clinical presentation of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), including the development of symptoms over hours to days, alertness, and the presence of polyuria, polydipsia, weight loss, and dehydration. The patient's cognitive state, including any changes in mental status, should also be assessed, as HHS often presents with impaired mental status and elevated plasma osmolality, as mentioned in 1. By prioritizing the assessment of these factors, healthcare providers can quickly identify potential complications and develop an effective treatment plan to improve patient outcomes and reduce morbidity and mortality associated with hyperglycemia, as emphasized in 1 and 1.
From the FDA Drug Label
Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. The first symptoms of DKA usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath.
The presenting symptoms of a patient arriving at the Emergency Room (ER) with hyperglycemia may include:
- A drowsy feeling
- Flushed face
- Thirst
- Loss of appetite
- Fruity odor on the breath The medical history of a patient with hyperglycemia may include:
- Omitting insulin or taking less than prescribed
- Eating more than the meal plan suggests
- Developing a fever, infection, or other significant stressful situation
- History of diabetes, particularly type 1 or insulin-dependent diabetes 2
From the Research
Presenting Symptoms
- Hyperglycemia is a common finding in patients presenting to the emergency department (ED) 3
- Patients may present with symptoms of hyperglycemia, such as elevated random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) 3
- Hyperglycemic hyperosmolar state is diagnosed by an elevated glucose, elevated serum osmolality, minimal or absent ketones, and a neurologic abnormality, most commonly altered mental status 4
Medical History
- Many adults who present to the ED have risk factors for diabetes and meet American Diabetes Association (ADA) criteria for diabetes screening 3
- A new diagnosis of type 2 diabetes can be established in the ED by the ADA criteria in patients with a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) and symptoms of hyperglycemia 3
- Patients with a history of diabetes may present with hyperglycemic crisis, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state 5, 4
- Infection is a common precipitating condition for hyperglycemic crisis in patients with diabetes 6
Common Conditions
- Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies that commonly present to the ED 5
- Non-hyperglycemic medical emergencies, such as infection, can also present with hyperglycemia 5, 6
- Hyperglycemia can increase the mortality and morbidity associated with the primary condition, and related hospital admission rates and costs are also elevated 5