What to do if a person with type 2 diabetes (Diabetes Mellitus Type 2) has severe hyperglycemia?

From the Guidelines

If a person with type 2 diabetes has a blood glucose level of 600 mg/dL (33.3 mmol/L in European scale), this is a medical emergency requiring immediate hospital care, as indicated by the most recent guidelines 1.

Key Considerations

• The extremely high glucose level indicates a diabetic hyperglycemic crisis, which can lead to diabetic ketoacidosis or hyperosmolar hyperglycemic state.
• Treatment typically involves intravenous fluids to rehydrate, insulin therapy to lower blood glucose, and electrolyte replacement, particularly potassium, as recommended by recent studies 2, 3.
• Do not attempt to manage this at home with oral medications or regular insulin doses.

Immediate Actions

• Call emergency services or go to the nearest emergency room immediately.
• While waiting for medical help, the person should drink water if conscious and able to swallow safely, to help prevent dehydration.

Long-term Management

• After the acute crisis is managed, healthcare providers will adjust the diabetes management plan, which may include insulin therapy, oral medications like metformin, lifestyle modifications, and more frequent blood glucose monitoring, as suggested by recent guidelines 1.
• The choice of insulin and other glucose-lowering agents should be based on the individual's specific needs and comorbidities, with consideration of the latest evidence on the effectiveness and safety of different treatments 2.

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)

If a diabetic type 2 person has a glucose level at 600 (on the European scale, which is equivalent to mg/dL), they should obtain medical assistance immediately. This is because prolonged hyperglycemia can lead to Diabetic Ketoacidosis (DKA), a life-threatening emergency.

• The patient should contact their doctor to discuss possible changes in therapy, meal plans, and/or exercise programs to help avoid hyperglycemia.
• Medical assistance is necessary to prevent complications such as nausea, vomiting, stomach pain, dehydration, loss of consciousness, or death 4.

From the Research

Immediate Actions for Diabetic Type 2 Person with Glucose at 600 Europe Scale

• The first step is to seek immediate medical attention, as a glucose level of 600 is considered a medical emergency 5.
• In the emergency department, the patient will likely receive insulin and intravenous fluids to reduce glucose levels 5.
• The administration of 10 units of subcutaneous insulin and 1 liter of intravenous fluid has been associated with a modest glucose reduction of 33 mg/dL and 27 mg/dL, respectively 5.

Long-term Management

• For patients with type 2 diabetes, the American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with oral glycemic medications or as insulin replacement therapy when the A1C level is 9% or more 6.
• Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached, with a fasting and premeal blood glucose goal of 80 to 130 mg per dL and a two-hour postprandial goal of less than 180 mg per dL 6.
• Metformin is a commonly used medication for the management of type 2 diabetes, and it has been shown to be effective in lowering blood glucose levels without increasing the risk of hypoglycemia 7.

Insulin Therapy

• Insulin therapy may be necessary for patients with type 2 diabetes who are not achieving good glucose control with oral medications alone 8.
• The choice of insulin therapy should be individualized based on factors such as age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life 6.
• Newer insulin formulations, such as insulin analogs, have been shown to be effective in lowering A1C levels with a lower risk of hypoglycemia, but they may have a higher cost 8.