Hyperglycaemia - a Diabetes Emergency
Published: 29 July 2019
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Published: 29 July 2019
It is common for people not to experience the symptoms of hyperglycaemia until their blood sugar levels reach this extremely high level (Diabetes Australia).
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).
Diabetic ketoacidosis and hyperosmolar hyperglycaemic state - extreme manifestations of impaired carbohydrate regulation that can occur in people with diabetes.
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).
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).
(RACGP 2019; Royal College of Nursing 2019; Better Health 2014; Health Direct 2018)
(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)
People who fall into the following categories should be closely monitored:
(RACGP 2019)
A clinical assessment may include the following:
(RACGP 2019)
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:
(Kitabchi et al. 2001)
If acute illness or stress have brought on a state of hyperglycaemia, the first steps must be:
(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).
(Correct answers below.)
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Great Session thank you
Clear and concise. Good description of conditions.
Learnt few extra info in a short time
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.
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.
good
a good reminder of the symptoms of hyperglycaemia and how important they are to be identified to save lives
great for ongoing education
Great article, clear, easy to understand.
Basic useful information which is relevant to an increasing diabetes population
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