Hyperglycaemia - a Diabetes Emergency

Published on the 29 July 2019

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Hyperglycaemia - a Diabetes Emergency

CPD

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Date Published: 29 July 2019

Author: Ausmed Editorial Team

Cover image for article: Hyperglycaemia - a Diabetes Emergency

Hyperglycaemia is the medical condition in which a patient presents with an abnormally high level of glucose circulating in their bloodstream (Better Health Channel 2014).

It is common for people not to experience the symptoms of hyperglycaemia until their blood sugar levels reach this extremely high level (Diabetes Australia).

Patients with hyperglycaemia are suffering the complications of too much glucose circulating in their blood. Hypoglycaemia, on the other hand, presents when someone has dangerously low blood glucose levels.

What are the Risks?

Prompt treatment is essential – regularly having high levels of glucose can affect vital organs including kidneys, eyes and nerves (Better Health Channel 2014; Diabetes.co.uk 2019).

Hyperglycaemic emergencies require urgent assessment and management to reduce preventable morbidity. They may appear as the first case of diabetes (undiagnosed) as well as a crisis for those with known diabetes (RACGP 2019; Kitabchi et al. 2001).

Hyperglycemic emergencies continue to be prominent causes death in patients with diabetes, despite considerable advances in the understanding of their pathogenesis and agreement as to their diagnosis and treatment (Kitabchi et a.l 2001).

Hyperglycaemia Emergencies Fall into Two Distinct Categories:

Diabetic ketoacidosis and hyperosmolar hyperglycaemic state - extreme manifestations of impaired carbohydrate regulation that can occur in people with diabetes.

1. Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (or DKA as it is known) is a life-threatening complication in patients with untreated diabetes or mismanaged diabetes.

It is prevalent in people who have type 1 diabetes, particularly among children – though it can also occur in people with type 2 diabetes.

Experiences may include an altered state of consciousness and should be monitored for rapid deterioration (RACGP 2019; Royal College of Nursing 2016).

2. Hyperosmolar Hyperglycaemic States (HHS)

Persistent hyperglycaemia is known as hyperosmolar hyperglycaemia state (HHS), in ketosis’s absence. Intense dehydration will often accompany this condition.

HHS is more closely associated with type 2 diabetes and typically affects older patients.

It is common in patients who are also going through acute sepsis, who have just had a cardiovascular event or in people with renal dysfunction. Coma may develop in some patients who have recently undergone surgery (RACGP 2019).

Both of these conditions are classified as an emergency. However, mortality is higher in HHS than in DKA – as it often relates to the precipitating condition (RACGP 2019).

Symptoms of DKA and HHS

Possible Symptoms of crisis associated with DKA

  • Extreme thirst;
  • Extreme fatigue;
  • Nausea and or vomiting;
  • Abdominal pain;
  • Oral thrush or yeast infection;
  • Muscle wasting;
  • Constant urination;
  • Weight loss; and
  • Altered conscious state.

(RACGP 2019; Royal College of Nursing 2019; Better Health 2014; Health Direct 2018)

Possible Symptoms of crisis associated with HHS

  • Atypical symptoms including:
    • Pain; and
    • Fever.
  • Dry mouth;
  • Cool extremities;
  • Rapid pulse;
  • Extreme hydration;
  • Reduced urination; and
  • An altered state of consciousness.

(RACGP 2019; American Family Physician 2017; Better Health 2014; Health Direct 2018)

Mental status can vary from full alertness to intense lethargy; though around 20% of patients with DKA or HHS are hospitalised with loss of consciousness (Kitabchi et al. 2001)

Who is at Risk of Hyperglycaemia?

People who fall into the following categories should be closely monitored:

  • Pregnant women;
  • Children and young people with type 1 diabetes;
  • People who have unstable glycaemia control;
  • People omitting diabetes-related medication: especially insulin;
  • People who use an insulin pump;
  • People who have had DKA in the past;
  • People with pancreatitis;
  • Those who have suffered:
    • Trauma;
    • Surgery;
    • Burns;
    • Acute infection; and
    • Sepsis.
  • People with high-rates of alcohol or recreational drug consumption;,
  • Elderly people; and
  • People taking certain medications.

(RACGP 2019)

Hyperglycaemia Assessment

A clinical assessment may include the following:

  • Blood glucose and ketone levels;
  • Temperature checks;
  • Blood pressure monitoring;
  • Heart rate monitoring;
  • Respiratory rate monitoring;
  • Neurological assessments such as the Glasgow Coma Scale; and
  • Urgent point-of-care assessment.

(RACGP 2019)

Preventative Measures

Inadequate insulin treatment (and noncompliance) and infection are the two major precipitating factors in the development of DKA (Kitabchi et al. 2001).

In many cases, these events may be prevented by:

  • Better access to medical care;
  • Intensive patient education; and
  • Effective communication with a healthcare provider during acute illnesses.

(Kitabchi et al. 2001)

If acute illness or stress have brought on a state of hyperglycaemia, the first steps must be:

  • Controlling insulin levels;
  • Decreasing excess stress hormone secretion;
  • Avoiding prolonged fasting state; and
  • Preventing severe dehydration.

(Kitabchi et al. 2001)

An educational program should be provided to review illness management with direct information on the administration of short-acting insulin, including frequency of insulin administration, blood glucose goals during illness, methods to suppress fever and treat infection, and initiation of an easily digestible liquid diet containing carbohydrates and salt (Kitabchi et al. 2001).

It is crucial to note, the patient should never discontinue insulin and must seek professional advice early in the course of the illness (Kitabchi et al. 2001; Better Health Channel 2014). It is vital that people with diabetes have a sick day plan and checklist so as to provide information on managing their diabetes while unwell (Diabetes Australia 2016).

Additional Resources

Multiple Choice questions

Q1. True or false: excessive thirst is a symptom of DKA?

  1. True
  2. False

Q2. True or false: there are three main hyperglycaemic emergencies.

  1. True
  2. False

Q3. Who among the following is not listed as being most at risk of hyperglycaemia?

  1. Teenage girls.
  2. Pregnant women.
  3. People with infections and co-existing illness.
  4. People who exercise regularly.

(Correct answers below.)

References

(Answers: a, b, d.)

Author

Portrait of Ausmed  Editorial Team

Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date.

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Learner Reviews

4.3

16 Total Rating(s)

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Genevieve Moller
11 Aug 2019

Ausmed is always informative and this particular Diabetic information reinforces my existing knowledge and assists to making me more aware when we admit patients with diabetes. I feel confident in passing on the knowledge gained to the students i facilitate through the hospital.

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Adele Hainsworth
04 Aug 2019

Good resource, for me I still need to go away & refresh on the BSL. What is acceptable levels/normal and what readings are ok for biabetic people. What levels concern should start and at what level would you start treatment to adjust.

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Vivian Poignet
03 Aug 2019

good

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Claire Phillips
03 Aug 2019

a good reminder of the symptoms of hyperglycaemia and how important they are to be identified to save lives

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Michelle Lupton
03 Aug 2019

great for ongoing education

Portrait of Julia Slade
Julia Slade
03 Aug 2019

Great article, clear, easy to understand.

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Eleise Roslyn Muller
03 Aug 2019

Basic useful information which is relevant to an increasing diabetes population

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Patrick Craig Annesley
02 Aug 2019

It contained all the relevant information in regards Hyperglycemia.

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Brooke HIRA
31 Jul 2019

Good overview of this topic. General refresher.

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Jia-Ci Spencer
31 Jul 2019

This resource delivers clear general information in terms of characteristics of hyperglycaemic emergency, symptoms, risk groups and management.