At what blood glucose level should you seek hospital care?

When to Seek Hospital Care for Blood Sugar Levels

You should seek immediate hospital care when your blood glucose level is persistently above 180 mg/dL (10.0 mmol/L) and not responding to treatment, or if it's below 70 mg/dL (3.9 mmol/L) with symptoms of hypoglycemia. 1

High Blood Glucose Thresholds for Hospital Care

Hyperglycemia Requiring Immediate Medical Attention:

• ≥250 mg/dL (13.9 mmol/L) with symptoms such as:
  • Severe vomiting
  • Abdominal pain
  • Altered mental status
  • Signs of dehydration 2

Critical Hyperglycemia Requiring Emergency Care:

• ≥180 mg/dL (10.0 mmol/L) when persistent and accompanied by:
  • Symptoms of diabetic ketoacidosis (DKA)
  • Hyperglycemic hyperosmolar state (HHS)
  • Inability to take oral fluids 1

Low Blood Glucose Thresholds for Hospital Care

Hypoglycemia Requiring Medical Attention:

• ≤70 mg/dL (3.9 mmol/L) - hypoglycemia alert value 1
• <54 mg/dL (3.0 mmol/L) - clinically significant hypoglycemia 1
• Any low glucose level with severe cognitive impairment, seizures, or unconsciousness 1

Decision Algorithm for Hospital Care

1. Severe Hyperglycemia (>250 mg/dL)

   • If accompanied by symptoms (vomiting, abdominal pain, altered mental status) → Seek immediate emergency care 2
   • If persistent despite home treatment → Go to hospital 3

2. Moderate Hyperglycemia (180-250 mg/dL)

   • If persistent for >24 hours despite medication adjustments → Seek medical care
   • If accompanied by illness, inability to eat/drink → Go to hospital 1

3. Hypoglycemia (<70 mg/dL)

   • If unable to consume oral carbohydrates → Seek emergency care
   • If not responding to treatment or recurrent episodes → Go to hospital
   • If accompanied by altered consciousness → Call emergency services immediately 1, 4

Hospital Management Expectations

When hospitalized for blood glucose abnormalities, expect:

• For hyperglycemia: Insulin therapy will be initiated for persistent levels ≥180 mg/dL (10.0 mmol/L) 1
• Target glucose range: 140-180 mg/dL (7.8-10.0 mmol/L) for most hospitalized patients 1
• For critical illness: Intravenous insulin infusion with frequent monitoring (every 30 min to 2 hours) 1
• For non-critical illness: Basal-bolus insulin regimen rather than sliding scale alone 1

Common Pitfalls to Avoid

• Delaying care for severe hyperglycemia - Infections and inadequate insulin dosing are common precipitating factors for DKA 2
• Ignoring hypoglycemia - Even mild hypoglycemia (40-69 mg/dL) can deteriorate to severe episodes with adverse outcomes 1
• Relying solely on glucose readings - Point-of-care meters may be less accurate in certain conditions (anemia, hypoperfusion) 5
• Not recognizing the danger of hypoglycemia with sepsis - Hypoglycemia with septic shock is associated with 2.5 times higher mortality 4

Special Considerations

• Type 1 diabetes: Lower threshold for seeking care as they're at higher risk for DKA
• Elderly patients: May have atypical presentations of hyper/hypoglycemia
• Patients on insulin: Should seek care sooner if unable to manage glucose levels at home
• Patients with comorbidities: Lower threshold for hospital care, especially with kidney disease or infection 6

Remember that early intervention for severe glucose abnormalities can prevent progression to life-threatening conditions and improve outcomes.