Hyperglycaemia 📈
Clinical guide for managing hyperglycaemia in hospital patients. Blood glucose targets, insulin sliding scales, DKA prevention, and diabetes management for NCHDs.
🧠 Definition
- Hyperglycaemia is a blood glucose >11.1 mmol/L (random) or >7 mmol/L (fasting), commonly due to diabetes, missed meds, infection, steroids, or stress.
- Complications include diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS).
📞 What to Ask on the Phone
- Known diabetes (Type 1 or 2)?
- Current treatment (insulin/oral hypoglycaemics)?
- Compliance with treatment?
- Signs of infection or steroid use?
- Any symptoms: weight loss, polyuria, nausea, drowsiness?
- Current CBG and presence of ketones?
- Alertness and hydration status?
- Has a VBG been done?
🧾 History
- Duration of hyperglycaemia and any missed meds
- Recent infections, steroids, or high-carb intake
- Symptoms: polyuria, polydipsia, blurred vision, weight loss
🩺 Examination
- Vitals and EWS
- Neurological status: alert, drowsy, confused
- Signs of DKA: Kussmaul breathing, abdo pain
- Signs of dehydration or sepsis
🔍 Investigations
- CBG, VBG, blood/urine ketones
- U&Es, CRP, cultures if infection suspected
💊 Management
- CBG 15–20 mmol/L: oral hydration, ketone check, recheck in 2h
- CBG >20 with ketones <3: VBG, IV fluids, stat insulin, hourly CBGs
- If ketones ≥3 or unwell: start DKA protocol
- Consider sliding scale or insulin dose adjustment
- Escalate to Endocrine/CNS if needed
📝 Notes
- Correction dose = (current BGL - target) ÷ (100 ÷ total daily insulin dose)
- Avoid correction <2h after mealtime insulin; add to usual dose instead
- Basal-bolus: adjust insulin based on patterns (↑ by 10%)
- BD regimens: adjust morning/evening dose depending on trend