When to seek hospital admission for hyperglycemia (high blood sugar)?

From the Guidelines

You should seek hospital admission for hyperglycemia if your blood glucose level exceeds 180 mg/dL, as indicated by the American Diabetes Association standards of medical care in diabetes 1. When considering hospital admission for high blood sugar, it's crucial to evaluate the severity of hyperglycemia and the presence of symptoms that may indicate complications such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).

Key Considerations for Hospital Admission

• Blood glucose levels above 180 mg/dL, especially if persistent despite medication
• Presence of ketones in the urine
• Symptoms such as extreme thirst, frequent urination, confusion, shortness of breath, fruity-smelling breath, nausea and vomiting, abdominal pain, weakness, or loss of consciousness
• Inability to keep fluids down or persistent hyperglycemia despite taking prescribed medications

Management of Hyperglycemia in the Hospital

According to the American College of Physicians guideline on the use of intensive insulin therapy for the management of glycemic control in hospitalized patients, a target blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) is recommended if insulin therapy is used in SICU/MICU patients 1. However, the most recent and highest quality study from the American Diabetes Association standards of medical care in diabetes recommends inpatient glucose targets of 7.8 to 10 mmol/L (140 to 180 mg/dL) for most noncritical and critically ill patients 1.

Prioritizing Morbidity, Mortality, and Quality of Life

Given the potential complications of untreated hyperglycemia, including dehydration, acid buildup in the blood, and increased risk of coma or death, it is essential to prioritize seeking medical attention if blood sugar levels are not well-controlled. People with diabetes should work with their healthcare provider to develop a sick day plan that includes specific blood sugar thresholds for seeking emergency care and should always have ketone testing supplies available at home. The primary goal is to prevent morbidity, mortality, and reduce the impact of hyperglycemia on quality of life, which can be achieved by seeking hospital admission when blood glucose levels exceed safe thresholds or when symptoms of complications arise 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. 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 seek hospital admission for hyperglycemia (high blood sugar) if you experience:

• Severe symptoms such as heavy breathing, rapid pulse, nausea, vomiting, stomach pain, dehydration, loss of consciousness
• DKA symptoms such as drowsy feeling, flushed face, thirst, loss of appetite, fruity odor on the breath
• Prolonged hyperglycemia that is not responding to treatment You should obtain medical assistance immediately if you are experiencing any of these symptoms 2

From the Research

Hyperglycemia Management

When to seek hospital admission for hyperglycemia (high blood sugar) is a critical decision that depends on various factors. The following points highlight the key considerations:

• Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) require immediate hospital admission 3.
• The presence of hyperglycemia increases the mortality and morbidity associated with the primary condition, and hospital admission rates and costs are also elevated 3.
• Evidence suggests that better management of hyperglycemia in the emergency department with proper follow-up improves clinical outcomes and prevents readmission 3.

Hospital Admission Criteria

The decision to admit a patient with hyperglycemia to the hospital depends on several factors, including:

• The severity of hyperglycemia and the presence of symptoms such as vomiting, abdominal pain, or altered mental status 3.
• The presence of comorbidities such as cardiovascular disease, kidney disease, or respiratory disease 4.
• The patient's ability to manage their diabetes and hyperglycemia at home, including access to medication, food, and social support 5.

Management Strategies

The management of hyperglycemia in hospitalized patients involves a multidisciplinary approach, including:

• Insulin therapy, including basal and prandial insulin regimens 4.
• Non-insulin therapies, such as metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors 6, 4.
• Continuous glucose monitoring and insulin pump therapy may be considered in certain patients 4.
• Diabetes self-management education and support are essential for patients with hyperglycemia, including those with newly recognized or stress-induced hyperglycemia 4.