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Introduction

Significant hyperglycaemia can present as:

  • Diabetic Ketoacidosis (DKA) – normally seen in Type 1
  • Hyperosmolar Hyperglycaemic State (HHS) – normally seen in Type 2.

Causes:

  • Illness
  • Infections
  • Stress
  • Excess carbohydrate
  • Inadequate / non-compliant with medication
  • Insulin pump failure
  • Medicines (e.g. steroids)
Clinical Presentation
  • Polydipsia
  • Polyuria
  • Fatigue
  • Blurred vision
  • Nausea/vomiting
  • BGL usually > 16mmol/L
  • Ketone breath (DKA)
  • Kussmaul breathing (DKA)
  • Tachycardia
  • Hypotension
  • Dehydration, dry skin, sunken eyes
  • Altered conscious state
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • HHS usually presents in older patients with type 2 diabetes mellitus and carries a higher mortality rate than, and is less common than DKA.
  • Ketoacidosis is not normally seen with type 2 diabetic patients as they have some insulin production preventing severe lipolysis.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Consider applying cardiac monitor if trained and authorised
  • Allowing the conscious patient to self-administer insulin:
    • NEVER assist a drowsy patient to self-administer insulin
    • DO NOT administer the insulin yourself
    • You may however assist a patient with physical / visual impairment
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Apply cardiac monitoring
  • Establish vascular access
  • Administer fluid therapy as per CPG
  • Allowing the conscious patient to self-administer insulin:
    • NEVER assist a drowsy patient to self-administer insulin
    • DO NOT administer the insulin yourself
    • You may however assist a patient with physical / visual impairment
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Severe dehydration
  • Electrolyte imbalance
  • Coma
  • Death

References
References
Key Terms & Links
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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

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