When to go to the Emergency Room (ER) for hyperglycemia?

From the Guidelines

You should go to the emergency room for hyperglycemia if your blood glucose is consistently >250 mg/dL (>13.9 mmol/L) within a 24-h period, accompanied by a significant change in clinical status, or if you have symptoms like confusion, extreme thirst, frequent urination, fruity-smelling breath, nausea, vomiting, abdominal pain, weakness, fatigue, or shortness of breath, as these may indicate diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), which are life-threatening emergencies 1.

Key Considerations

• Hyperglycemia becomes dangerous because excessive glucose in the bloodstream can lead to dehydration, electrolyte imbalances, and acid buildup in the blood.
• If you have diabetes, it's essential to have a sick day plan discussed with your healthcare provider that includes specific blood glucose thresholds for seeking emergency care based on your individual health situation.
• Don't wait if you're experiencing severe symptoms, as prompt treatment can prevent serious complications.

When to Seek Emergency Care

• If your blood glucose is consistently >250 mg/dL (>13.9 mmol/L) within a 24-h period, accompanied by a significant change in clinical status.
• If you have symptoms like confusion, extreme thirst, frequent urination, fruity-smelling breath, nausea, vomiting, abdominal pain, weakness, fatigue, or shortness of breath.
• If you have high blood sugar with fever, if you can't keep fluids down, or if your blood sugar remains elevated despite taking medication as prescribed.

Importance of Prompt Treatment

• Prompt treatment can prevent serious complications, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).
• Hyperglycemia can lead to dehydration, electrolyte imbalances, and acid buildup in the blood, which can be life-threatening if left untreated.

Individualized Care

• It's crucial to work with your healthcare provider to develop a personalized plan for managing hyperglycemia and seeking emergency care when necessary.
• Your healthcare provider can help you determine the best course of action based on your individual health situation and medical history.

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. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency) 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. With DKA, blood and urine tests show large amounts of glucose and ketones. Heavy breathing and a rapid pulse are more severe symptoms If uncorrected, prolonged hyperglycemia or DKA can lead to nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death. Therefore, it is important that you obtain medical assistance immediately.

You should go to the Emergency Room (ER) for hyperglycemia if you are experiencing symptoms of Diabetic Ketoacidosis (DKA), such as:

• Drowsy feeling
• Flushed face
• Thirst
• Loss of appetite
• Fruity odor on the breath
• Heavy breathing
• Rapid pulse
• Nausea
• Vomiting
• Stomach pain
• Dehydration
• Loss of consciousness You should also seek immediate medical attention if you have severe hyperglycemia that is not responding to treatment, or if you are experiencing any other severe symptoms 2.

From the Research

When to Go to the Emergency Room (ER) for Hyperglycemia

• Hyperglycemia is a common finding in patients presenting to the emergency department (ED) 3
• A new diagnosis of type 2 diabetes can be established in the ED by the American Diabetes Association (ADA) criteria in patients with a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) and symptoms of hyperglycemia 3
• Patients with an elevation in random blood glucose > 140 mg/dL (7.8 mmol/L) should be considered for a diagnosis of hyperglycemia 3
• Hyperglycemic crisis is one of the complications of diabetes mellitus, which is common in hospitalized diabetic patients with intercurrent illness, requiring immediate action to control blood glucose 4
• Infection conditions are the most common factor for hyperglycemia crisis 4
• A blood glucose value of ≥200 mg/dL (11.1 mmol/L) has a positive predictive value of 68% and a negative predictive value of 90% for a diagnosis of diabetes 5
• Hyperglycemia in hospital is common but does not necessarily indicate a patient has diabetes, and it can lead to treatment with diabetes medications with potential harm 5
• An HbA1c threshold above which most patients show hyperglycemic symptoms was 10.05% for patients with diabetes type 1 and 8.9% for patients with type 2 6
• Elevated HbA1c levels are found in ED patients with elevated random plasma glucose values, and ED patients with hyperglycemia may warrant referral for diabetes testing 7

Symptoms of Hyperglycemia

• Symptoms of hyperglycemia include frequent urination, tiredness, and others 6
• The total hyperglycemia symptom score (THSS) showed a positive correlation with age and HbA1c 6
• Hyperglycemia symptoms are subject to many influencing factors, and an adjustment of therapy should always be carried out in combination with the requested hyperglycemia symptoms and HbA1c value 6

Treatment of Hyperglycemia

• Treatment options for hyperglycemia include metformin, long-acting insulin, or deferring for close outpatient management 3
• Intravenous insulin therapy can be used to control blood glucose in hyperglycemic crisis 4
• The dosage of insulin varied from 4 to 10 units per hour, intravenously, with a frequency of 1-4 times 4