What is the treatment for acute hyperglycemia with glucose levels in the 600s (milligrams per deciliter)?

From the Guidelines

Immediate treatment for acute hyperglycemia with glucose levels in the 600s mg/dL requires insulin therapy, intravenous fluids, and electrolyte management, with a target glucose range of 140–180 mg/dL, as recommended by the most recent guidelines 1. The treatment approach should involve regular insulin administered intravenously, typically starting with a bolus of 0.1 units/kg followed by a continuous infusion at 0.1 units/kg/hour, titrated to reduce glucose by 50-75 mg/dL per hour, as outlined in previous protocols 1. Simultaneously, isotonic fluids (normal saline) should be given at 15-20 mL/kg in the first hour, then adjusted based on hydration status. Key considerations include:

• Potassium replacement, crucial once levels fall below 5.2 mEq/L or if the patient is hypokalemic, typically giving 20-30 mEq potassium per liter of IV fluid.
• Blood glucose monitoring hourly until stable, then every 2-4 hours.
• Identifying and addressing the underlying cause of hyperglycemia, whether it's undiagnosed diabetes, medication non-compliance, infection, or other stressors.
• Considering the addition of dextrose to IV fluids to prevent hypoglycemia once glucose levels decrease below 250-300 mg/dL, while continuing insulin therapy. This approach is supported by the most recent guidelines, which emphasize the importance of achieving a target glucose range without causing significant hypoglycemia 1.

From the FDA Drug Label

The intravenous administration of Humulin R U-100 was tested in 21 patients with type 1 diabetes The patients' usual doses of insulin were temporarily held, and blood glucose concentrations were maintained at a range of 200 – 260 mg/dL for one to three hours during a run-in phase of intravenous Humulin R U-100 followed by a 6-hour assessment phase. During the assessment phase patients received intravenous Humulin R at an initial dose of 0. 5 U/h, adjusted to maintain blood glucose concentrations near normoglycemia (100 to 160 mg/dL).

The treatment for acute hyperglycemia with glucose levels in the 600s (milligrams per deciliter) is not directly addressed in the provided drug label. However, based on the information provided for patients with blood glucose concentrations between 200-260 mg/dL, intravenous insulin can be considered.

• The initial dose of 0.5 U/h of intravenous Humulin R U-100 was used in the study.
• The dose was adjusted to maintain blood glucose concentrations near normoglycemia (100 to 160 mg/dL) 2. It is essential to note that the provided study does not directly address glucose levels in the 600s, and therefore, the treatment should be approached with caution and under close medical supervision.

From the Research

Treatment Overview

The treatment for acute hyperglycemia with glucose levels in the 600s (milligrams per deciliter) involves several key components:

• Restoration of circulating volume through fluid replacement 3, 4, 5
• Insulin therapy to lower blood glucose levels 3, 4, 5
• Electrolyte replacement to correct imbalances 3, 4
• Treatment of any underlying precipitating event 3, 4

Specific Treatment Strategies

For patients with hyperosmolar hyperglycemic state (HHS), the following treatment strategies are recommended:

• Intravenous 0.9% sodium chloride to restore circulating volume 5
• Fixed rate intravenous insulin infusion (FRIII) to lower blood glucose levels 5
• Glucose infusion (5% or 10%) to maintain blood glucose levels once they fall below 14 mmol/L 5
• Potassium replacement according to potassium levels 5

Resolution Criteria

Resolution of HHS is defined by the following criteria:

• Osmolality <300 mOsm/kg 5
• Hypovolaemia corrected (urine output ≥0.5 ml/kg/h) 5
• Cognitive status returned to pre-morbid state 5
• Blood glucose <15 mmol/L 5

Importance of Early Treatment

Early diagnosis and management of acute hyperglycemia are crucial to improve patient outcomes and prevent morbidity and mortality 3, 6, 4.