Hyperglycaemic emergencies

Introduction
Hyperglycemia doesn't cause symptoms until glucose values are significantly elevated — above 200 milligrams per deciliter (mg/dL), or 11 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious the symptoms become. However, some people who've had type 2 diabetes for a long time may not show any symptoms despite elevated blood sugars.

It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as a diabetic coma. In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting to the eyes, kidneys, nerves and heart.

Presentation

Signs & symptoms

·         Frequent urination

·         BGL > 15mmol 

·         Increased thirst

·         Blurred vision

·         Fatigue

·         Headache

·         Fruity-smelling breath

·         Nausea and vomiting

·         Shortness of breath

·         Dry mouth

·         Weakness

·         Confusion

·         Coma

·         Abdominal pain  (Mayoclinic 2015)

Causes

·         Not using enough insulin or oral diabetes medication

·         Not injecting insulin properly or using expired insulin

·         Not following your diabetes eating plan

·         Being inactive

·         Having an illness or infection

·         Using certain medications, such as steroids

·         Being injured or having surgery

·         Experiencing emotional stress, such as family conflict or workplace challenges

Investigations

Collect blood for FBC 

Urinalysis for ketone bodies and glucose

ABGs/venous blood gas 

HbA₁C to detect the level of control with regard to high glucose levels (Mayoclinic 2015).

BGL 

Management

Assess airway patency.

Assess any breathing assess needed if so ventilation and oxygenation.

IV cannulation if signs of dehydration or if SBP less than 90 mmHg give IV 0.9% Sodium

Chloride 500 mL bolus stat. (repeat once if signs of dehydration persist or SBP remains less than 90 mmHg)

Monitor LOC frequently.

Capillary glucose levels every 30 minutes.

Consider insulin therapy but not before a serum potassium is known and not before advice from a Medical Officer (Rural Emergency clinical guidelines 2012). 

 

Emergency treatment for severe hyperglycemia

Emergency treatment can lower blood sugar to a normal range. Treatment usually includes:

·         Fluid replacement. 

·         Electrolyte replacement. 

·         Insulin therapy. 

References

Jeannette, G & Jeremy, G 2014, 'Hyperglycaemic emergencies inadults',retrieved 16th of March 2015, http://guidelines.diabetes.ca/browse/Chapter15

Mayoclinic 2015, 'Hyperglycaemia in diabetes' ,retrieved 16th of March 2015,http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/symptoms/con-20034795