From the Guidelines
For hyperglycemia without ketones in an emergency clinic setting, the initial treatment should focus on lowering blood glucose levels with insulin therapy, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach involves several key steps:
- Administering intravenous fluids, typically normal saline at 15-20 mL/kg/hr for the first hour if the patient is dehydrated, then adjusting based on hydration status.
- Administering regular insulin intravenously, beginning with a 0.1 units/kg bolus followed by a continuous infusion at 0.1 units/kg/hour, as this method allows for precise control of glucose levels 1.
- Monitoring blood glucose hourly and adjusting the insulin rate to achieve a gradual decrease of 50-75 mg/dL per hour.
- Once blood glucose reaches 250 mg/dL, adding dextrose to IV fluids (D5W or D10W) to prevent hypoglycemia while continuing insulin to normalize glucose levels.
Underlying Cause Identification
Simultaneously, it is crucial to identify and treat the underlying cause of hyperglycemia, which may include:
- Infection
- Medication non-adherence
- New-onset diabetes Electrolytes, particularly potassium, should be monitored and replaced as needed to prevent complications.
Transition to Subcutaneous Insulin or Oral Medications
After stabilization, the patient should be transitioned to subcutaneous insulin or oral medications based on their usual regimen or new requirements, considering the use of a basal-plus approach with or without non-insulin agents for patients with mild-to-moderate hyperglycemia 1.
Key Considerations
The goal is to achieve a balance between controlling hyperglycemia and minimizing the risk of hypoglycemia, while also addressing the underlying cause of the condition and providing patient-centered care.
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. Therefore, it is important that you obtain medical assistance immediately.
The treatment for hyperglycemia (high blood sugar) without ketosis in an emergency clinic setting is not explicitly stated in the provided drug label. However, it can be inferred that administering insulin may be a part of the treatment, as hyperglycemia can develop if the body has too little insulin 2.
- Medical assistance should be obtained immediately to address hyperglycemia.
- The exact treatment approach may depend on various factors, including the severity of hyperglycemia and the individual's overall health status.
From the Research
Treatment for Hyperglycemia without Ketosis
The treatment for hyperglycemia (high blood sugar) without ketosis in an emergency clinic setting involves several key components:
- Administration of insulin and intravenous fluids to reduce glucose levels 3
- Fluid resuscitation and correction of electrolyte abnormalities 4, 5
- Monitoring of patients to avoid overcorrection of osmolality, sodium, and other electrolytes 4
- Consideration of the patient's history and risk factors for diabetes, as well as the severity of hyperglycemia 6
Medications and Fluids
The following medications and fluids may be used to treat hyperglycemia without ketosis:
- Insulin: 10 units of subcutaneous insulin can be associated with a 33 mg/dL glucose reduction 3
- Intravenous fluids: 1 liter of intravenous fluid can be associated with a 27 mg/dL glucose reduction, but may also increase the length of stay in the emergency department 3
- Hypotonic fluids: may be used to correct hypertonic dehydration 5
- Potassium and other electrolytes: may need to be replaced due to significant depletion 5
Patient Evaluation and Management
The evaluation and management of patients with hyperglycemia without ketosis in the emergency department involves: