Materiały źródłowe

• #1 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  Diabetes is the most prevalent metabolic disorder, and in 2021, the International Diabetes Federation estimated that it affected 537 million adults globally. […] Hyperglycemia, defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l), is reported in 22-46% of non-critically ill hospitalized patients. […] Extensive data indicates that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is associated with an increased risk of complications and mortality. […] In 2025, the American Diabetes Association (ADA) recommends that once therapy is initiated, a glycemic goal of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most critically ill (ICU) individuals with hyperglycemia. […] Insulin remains the best way to control hyperglycemia in the inpatient setting, especially in critically ill patients.

• #1 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  The use of GLP-1 receptor agonists was not recommended in previous guidelines because of the need for more safety and efficacy studies in the inpatient setting. However, increasing evidence indicates that treatment with oral agents such as DPP4 inhibitors, alone or combined with basal insulin, is safe and effective in general medicine and surgery patients with mild to moderate hyperglycemia. […] This chapter reviews the pathophysiology of hyperglycemia during illness, the mechanisms for increased complications and mortality due to hyperglycemia and hypoglycemia, and the evidence supporting different therapies and approaches for the management of inpatient diabetes and hyperglycemia in critical care, general medicine, and surgical settings. […] The American Diabetes Association (ADA) and American Association of Clinical Endocrinology (AACE) task force on inpatient glycemic control and other groups recommended differing glycemic targets in the ICU setting.

• #1 Management of Diabetes and Hyperglycemia in Hospitalized Patients – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279093/

  These guidelines suggest targeting a BG level between 140 and 180 mg/dl (7.8 and 10.0 mmol/l) for the majority of ICU patients and a lower glucose target between 110 and 140 mg/dl (6.1 and 7.8 mmol/l) in selected ICU patients. […] Insulin therapy should be initiated for the treatment of persistent hyperglycemia 180 mg/dL (10.0 mmol/L) and targeted to a glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) for most critically ill patients. […] The recommended total daily insulin dose should start between 0.3 to 0.5 units per Kg for most people with diabetes. […] The use of oral antidiabetic agents was not recommended in previous guidelines because of the need for more safety and efficacy studies in the inpatient setting. However, increasing evidence indicates that treatment with DPP4 inhibitors, alone or in combination with basal insulin, is safe and effective in general medicine and surgery with mild to moderate hyperglycemia.

• #2 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  Initial management of hyperglycemia in adults with type 2 diabetes mellitus […] Treatment of patients with type 2 diabetes mellitus includes education, evaluation for micro- and macrovascular complications, attempts to achieve near normoglycemia, minimization of cardiovascular and other long-term risk factors, and avoidance of drugs that can exacerbate abnormalities of insulin or lipid metabolism. […] Treatments to improve glycemic management work by increasing insulin availability (either through direct insulin administration or through agents that promote insulin secretion), improving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, increasing urinary glucose excretion, or a combination of these approaches. […] Glycemic management—Target glycated hemoglobin (A1C) levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy.

• #3 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  A reasonable goal of therapy is an A1C value of ≤7 percent (53.0 mmol/mol) for most patients. […] Improved glycemic management lowers the risk of microvascular complications in patients with type 2 diabetes. […] Cardiovascular risk factor management—In addition to glycemic management, vigorous cardiac risk reduction (smoking cessation; blood pressure control; reduction in serum lipids with a statin; diet, exercise, and weight loss or maintenance; and aspirin for those with established atherosclerotic cardiovascular disease [ASCVD] or after shared decision-making) should be a top priority for all patients with type 2 diabetes. […] Medical nutrition therapy—Medical nutrition therapy (MNT) is the process by which a dietary plan is tailored for people with diabetes, based on medical, lifestyle, and personal factors.

• #3 Initial management of hyperglycemia in adults with type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

  For patients with type 2 diabetes, body weight management should be considered as a therapeutic target in addition to glycemia. […] Pharmacologic therapy—Pharmacotherapy targeted solely for weight management is effective in patients with type 2 diabetes. […] Metformin is the preferred initial therapy because of glycemic efficacy, promotion of modest weight loss, very low incidence of hypoglycemia, general tolerability, and very low cost. […] Insulin, rather than oral hypoglycemic agents, is often indicated for initial treatment of symptomatic or severe hyperglycemia. […] For patients presenting with severe hyperglycemia (fasting plasma glucose >250 mg/dL [13.9 mmol/L], random glucose consistently >300 mg/dL [16.7 mmol/L], A1C >9 percent [74.9 mmol/mol]) but without ketonuria or spontaneous weight loss, in whom type 1 diabetes is not likely, insulin or injectable GLP-1 receptor agonists may be used (with or without metformin, depending on contraindications or intolerance).

• #4 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  For most patients, we add a second medication when the individualized glycemic treatment goal is not achieved within three months with metformin plus lifestyle intervention. This is consistent with guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guideline for medical management of hyperglycemia and underscores the importance of avoiding delay in treatment intensification. […] In some patients, early combination therapy is warranted for the kidney or heart protective benefit imparted by selected classes of glucose-lowering medications. […] Glycemic goals — Target A1C goals in patients with type 2 diabetes should be tailored to the individual, balancing the prospect of reduced microvascular complications with the adverse effects and cost of added treatments. Most younger patients (eg, aged <65 years) without established complications should have an A1C goal of <7 percent (53 mmol/mol), if this can be achieved without significant hypoglycemia, other side effects, or excessive medication burden (due to complexity or cost that may limit adherence). Older adults and those with comorbid conditions or limited life expectancy may have A1C targets up to 8 percent (64 mmol/mol), 8.5 percent (69 mmol/mol), or even higher due to limited likelihood of benefit from intensive therapy balanced against the side effects of medications. Glycemic targets are reviewed in more detail separately.

• #4 Management of persistent hyperglycemia in type 2 diabetes mellitus – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus

  Management of persistent hyperglycemia in type 2 diabetes mellitus […] Initial treatment of patients with type 2 diabetes mellitus includes lifestyle changes focusing on diet, increased physical activity and exercise, and weight reduction, reinforced by consultation with a registered dietitian and diabetes self-management education, when possible. Monotherapy with metformin is indicated for most patients, and insulin may be indicated as initial treatment for those who present with catabolic features (polyuria, polydipsia, weight loss in the setting of very high glucose levels, eg, glycated hemoglobin [A1C] >9 percent). The natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time, requiring therapy intensification. […] Treatments for hyperglycemia that fails to respond to initial monotherapy or long-term medication use in type 2 diabetes are reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately.

• #5 Glycemic control in hospitalized patients – EMCrit Project

  https://emcrit.org/ibcc/glucose/

  Stress hyperglycemia refers to elevation of glucose as part of the stress response. […] Management needs to account for four general dimensions discussed below: possible benefits of stress hyperglycemia, possible harms of stress hyperglycemia, risks of hypoglycemia, and other side effects of insulin. […] The best evidence suggests that overly aggressive glycemic control causes harm (e.g., VISEP and NICE-SUGAR). […] Clinicians should target a blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) if insulin therapy is used in SICU/MICU patients. […] Insulin should be started or intensified for persistent glucose 180 mg/dL for the majority of critically ill patients. […] Once therapy is initiated, a glycemic goal of 140-180 is recommended for most critically ill individuals with hyperglycemia.

• #5 Glycemic control in hospitalized patients – EMCrit Project

  https://emcrit.org/ibcc/glucose/

  Continuous tube feeding or TPN: Since patients are in a continuous postprandial state, efforts to bring glucose levels to 140 mg/dL substantially increase the risk of hypoglycemia. […] Glycemic levels up to 250 mg/dL may be acceptable in selected populations of hospitalized patients (advanced kidney failure, high risk for hypoglycemia, labile glucose excursions). […] 140-200 mg/dL is a reasonable general glucose target for most critically ill patients (consistent with ACP and SCCM guidelines). […] Permissive hyperglycemia up to 250 mg/dL may be reasonable for carefully selected patients, with targets tailored to the specific patient. […] Fasting glucose 100 mg/dL has been associated with future hypoglycemic events, which should be an early indicator of overly aggressive management.

• #6 Type 2 Diabetes Mellitus: Outpatient Insulin Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0101/p29.html

  Consider initiating insulin replacement therapy when the blood glucose level is 300 to 350 mg per dL (16.7 to 19.4 mmol per L) or more or the A1C is more than 10% to 12%. […] The ADA suggests insulin replacement therapy with basal and rapid-acting prandial (basal-bolus) insulin when the blood glucose level is 300 to 350 mg per dL (16.7 to 19.4 mmol per L) or more or the A1C is more than 10% to 12%. […] Insulin analogues may be used to reduce the risk of hypoglycemia. […] The ADA recommends that an insulin regimen be adjusted once or twice weekly (or every three or four days) until self-monitoring of blood glucose (SMBG) targets are reached. […] The ADA suggests a target A1C of less than 7% for most nonpregnant patients with type 2 diabetes. […] An A1C goal of less than 6.5% may be appropriate for patients with short duration of type 2 diabetes that is treated with lifestyle changes or metformin only, a long life expectancy, and no significant cardiovascular disease, as long as significant hypoglycemia or other adverse effects do not occur. […] For patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbidities, or long duration of type 2 diabetes, an A1C goal of less than 8% or more may be appropriate.

• #6 Type 2 Diabetes Mellitus: Outpatient Insulin Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0101/p29.html

  In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. […] The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like peptide 1 receptor agonist when the A1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. […] Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached. […] Consider initiating basal insulin to augment therapy with one or two oral agents or one oral agent plus a GLP-1 receptor agonist when the A1C is 9% or more, especially if symptoms of hyperglycemia or catabolism are present.

• #7 Hyperglycemia | High Blood Sugar | Diabetes | MedlinePlus

  https://medlineplus.gov/hyperglycemia.html

  Hyperglycemia means high blood glucose. It most often affects people who have diabetes. When you have diabetes, your body doesn’t make enough insulin or can’t use it the right way. Too much glucose stays in your blood and doesn’t reach your cells. […] A key part of managing diabetes is controlling your blood glucose levels. To do this, you need to follow a diabetes meal plan and get regular physical activity. You might also need to take diabetes medicines. You have to balance all of these to keep your blood glucose at the right levels. […] If you are diabetic and you often have high blood glucose levels or the symptoms of hyperglycemia, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or diabetes medicines. […] If you have diabetes and often have high blood glucose, your health care team may make changes to your diabetes meal plan, physical activity plan, and/or diabetes medicines.

• #7 Hyperglycemia | High Blood Sugar | Diabetes | MedlinePlus

  https://medlineplus.gov/hyperglycemia.html

  If you have severe hyperglycemia and are having symptoms of DKA, you will need treatment at the hospital. The treatment often includes I.V. (intravenous) fluids and insulin. […] If you have diabetes, managing your diabetes can help prevent hyperglycemia. To manage your diabetes, it’s important to: Follow your diabetes meal plan, Get regular physical activity, If you need diabetes medicines, take them correctly, Regularly check your blood glucose level, Get regular checkups with your health care team.

• #8 Hyperglycemia Management (Ambulatory)

  https://elsevier.health/en-US/preview/hyperglycemia-management-ambulatory

  Untreated hyperglycemia can lead to diabetic coma caused by ketoacidosis, a life-threatening condition that requires immediate treatment. […] Successful management of hyperglycemia begins with comprehensive education about the disease process, potential complications, and methods to control blood glucose levels. Pharmacologic management for reduction of glucose levels is done under a health care practitioners direction. […] Educate the patient about adopting a low glycemic index diet by reducing the consumption of carbohydrates. […] Teach the patient that improved glucose control lowers the incidence of cardiovascular events, thereby reducing morbidity. […] If the patient is insulin dependent and has an elevated blood glucose level, treat the patient with sliding scale insulin coverage as ordered.

• #8 Hyperglycemia Management (Ambulatory)

  https://elsevier.health/en-US/preview/hyperglycemia-management-ambulatory

  Determine the patients compliance with the medication regimen. Educate the patient about the use of oral antidiabetic agents or subcutaneous insulin therapy as prescribed by the practitioner. […] Older adult patients should avoid tightly controlling blood glucose because of the potential for hypoglycemia.

• #9 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  A key component in managing hyperglycemia is dietary modification. Carbohydrate counting is crucial, as carbohydrates directly impact blood sugar levels. It involves keeping track of the amount of carbohydrates consumed at each meal and adjusting insulin accordingly. Adopting a balanced diet is equally important. A diet rich in fruits, vegetables, whole grains, and lean proteins, with limited intake of processed foods, refined sugars, and saturated fats, can help maintain stable blood sugar levels. […] Regular Physical ActivityPhysical activity is beneficial for blood sugar control as it increases insulin sensitivity, meaning your cells are better able to use the available sugar in your bloodstream. Regular exercise such as brisk walking, cycling, swimming, or any other aerobic activity for at least 150 minutes per week is recommended.

• #9 Hyperglycemia Treatment: Several Options And IV Fluids

  https://diabetesmantra.com/diabetes/treatment/hyperglycemia-treatment/

  Regularly checking blood sugar levels is crucial in managing hyperglycemia. This can be done using a traditional blood glucose meter, which involves pricking the finger to get a blood sample, or through continuous glucose monitoring systems (CGMs) that provide real-time blood sugar readings. Monitoring helps in making informed decisions about diet, exercise, and medication. […] For those with Type 2 diabetes or at risk of developing it, maintaining a healthy weight can significantly improve the bodys ability to regulate blood sugar and respond to insulin. Even a modest weight loss of 5-10% can have a considerable impact on blood sugar control. […] Stress has a significant impact on blood sugar levels. When stressed, the body releases hormones like cortisol and adrenaline, which can cause blood sugar levels to rise.

• #10 High blood sugar (hyperglycaemia)

  https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/

  High blood sugar (hyperglycaemia) is where the level of sugar in your blood is too high. It mainly affects people with diabetes and can be serious if not treated. […] If you have diabetes, it’s important to try to stop your blood sugar level getting too high. […] take any diabetes medicine you’ve been prescribed, as advised by your doctor or care team […] avoid eating too much sugary or starchy food […] try to find ways to manage stress […] exercise regularly […] lose weight if you’re overweight […] follow advice from your doctor or care team about what to do while you’re ill (sometimes called „sick day rules”) […] do not skip or change doses of your diabetes medicine unless advised by your doctor or care team. […] If you have high blood sugar, your doctor or care team may ask you to test your blood or pee to check for ketones. A high level of ketones is a sign of diabetic ketoacidosis.

• #11 Your Guide to Hyperglycemia (High Blood Sugar): Causes, Symptoms, Diagnosis, and Treatment Options

  https://www.rupahealth.com/post/your-guide-to-hyperglycemia-high-blood-sugar-causes-symptoms-diagnosis-and-treatment-options

  Because dietary carbohydrates are broken down into glucose, they are the primary driver of blood sugar levels. Therefore, eating a healthy diet and monitoring carbohydrate intake is essential for maintaining stable blood sugar levels. The ADA recommends the Diabetes Plate Method for balancing blood sugar. This method is a simple visual tool for managing portion sizes and promoting balanced meals, where half the plate is filled with non-starchy vegetables, a quarter with lean proteins, and the remaining quarter with complex carbohydrates (e.g., whole grains or starchy vegetables). […] The natural stress response increases blood sugar levels because stress hormones, such as cortisol and adrenaline, stimulate the liver to release glucose into the bloodstream for immediate energy, which is necessary for the body’s „fight-or-flight” reaction. Managing stress with various techniques, such as cognitive behavioral therapy, effectively lowers blood sugar levels.

• #11 Your Guide to Hyperglycemia (High Blood Sugar): Causes, Symptoms, Diagnosis, and Treatment Options

  https://www.rupahealth.com/post/your-guide-to-hyperglycemia-high-blood-sugar-causes-symptoms-diagnosis-and-treatment-options

  How to Treat Hyperglycemia […] Basic lifestyle habits can prevent unwanted blood sugar spikes: […] Blood sugar monitoring enables personalized blood sugar management by helping patients understand how different foods, activities, and medications affect their blood sugar levels. It also helps healthcare providers make informed decisions about treatment recommendations and modifications. Patients should follow their doctor’s instructions on how to track their blood sugar levels. Typical times for blood sugar monitoring are when you wake up, before meals, two hours after meals, before and after exercise, and before bed. (5) […] Studies show that regular exercise improves blood sugar levels and insulin resistance. The ADA recommends that adults with type 2 diabetes engage in aerobic and resistance exercise training, aiming for at least 150 minutes of physical activity weekly, and should decrease their daily sedentary behaviors. (15)

• #12 Hyperglycemia (high blood sugar): Symptoms, treatments, and more

  https://www.medicalnewstoday.com/articles/323699

  Hyperglycemia refers to high levels of sugar, or glucose, in the blood. […] This article looks at how to recognize hyperglycemia, how to treat the condition, and possible causes and complications. […] A person with diabetes can take steps to reduce, prevent, and treat blood glucose spikes. These approaches include: Blood sugar monitoring: It is essential for a person with diabetes to track their blood sugar levels as a doctor recommends. Blood glucose tests help detect hyperglycemia before it becomes a problem. […] Exercise: Physical activity uses excess glucose in the blood. However, people need to avoid exercise if they have severe hyperglycemia and find ketones in their urine. […] Diet changes: Controlling portions during mealtimes and snacking less helps keep the amount of glucose at a manageable level.

• #12 Hyperglycemia (high blood sugar): Symptoms, treatments, and more

  https://www.medicalnewstoday.com/articles/323699

  Medication alterations: If a persons blood sugar levels remain elevated, a doctor may recommend changing the timing or types of medication and insulin they take. […] Stress management: High stress levels can affect hormones and blood sugar levels. It is important for people with diabetes to find ways to manage stress, such as prioritizing sleep and trying relaxation techniques, such as meditation. […] Managing diabetes is an ongoing and often lifelong endeavor. Typically, a doctor can look at a persons self-monitored results, identify issues, and help them find ways to prevent severe spikes. […] Treatment may include adjustments in diabetes medication, exercise, and eating less during meals. Wearing a medical ID is essential for people with diabetes, as this can affect other treatments.

• #13 Hyperglycemia (High Blood Glucose) | American Diabetes Association

  https://diabetes.org/living-with-diabetes/treatment-care/hyperglycemia

  Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly. […] Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your glucose sugar levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia. […] You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise. […] Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don’t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

• #14 Hyperglycemia (High Blood Sugar): Symptoms, Causes, Treatments

  https://www.webmd.com/diabetes/diabetes-hyperglycemia

  Hyperglycemia Treatment […] If you have diabetes and notice any of the early signs of high blood sugar, test your blood sugar and call the doctor. They may ask you for the results of several readings. They could recommend the following changes: […] Drink more water. Water helps remove extra sugar from your blood through urine, and it helps you avoid dehydration. […] Exercise more. Working out can help lower your blood sugar. But under certain conditions, it can make blood sugar go even higher. Ask your doctor what kind of exercise is right for you. […] Caution: If you have type 1 diabetes and your blood sugar is high, you need to check your urine for ketones. When you have ketones, do NOT exercise. If you have type 2 diabetes and your blood sugar is high, you must also be sure that you have no ketones in your urine and that you are well-hydrated. Then your doctor might give you the OK to exercise with caution as long as you feel up to it.

• #14 Hyperglycemia (High Blood Sugar): Symptoms, Causes, Treatments

  https://www.webmd.com/diabetes/diabetes-hyperglycemia

  Test your blood sugar regularly. […] Tell your doctor if you have repeated abnormal blood sugar readings. […] Wear medical identification to let people know you have diabetes in case of an emergency. […] […] […] Takeaways […] Blood sugar control is crucial in managing diabetes since high blood sugar can lead to health problems. Track your blood sugar, take insulin or other medicines as prescribed by your doctor, keep a balanced diet, stay hydrated, and exercise routinely to manage high blood sugar. If you notice symptoms of hyperglycemia, talk to your doctor about your diabetes management plan.

• #15 6 tips to lower your blood sugar | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/how-to-lower-your-blood-sugar–follow-these-steps.h00-159623379.html

  High blood sugar, or hyperglycemia, is common in people who have diabetes. A persons blood sugar can be high when the pancreas doesnt produce enough insulin, or if the body becomes resistant to insulin. […] Type 1 diabetes occurs when the pancreas does not produce insulin. It can only be treated with insulin given as an injection or delivered through an insulin pump. Lack of insulin can lead to a life-threatening condition called diabetic ketoacidosis. […] If you have Type 2 diabetes, you can usually manage high blood sugar with diet, exercise and medication. […] If your blood sugar is consistently elevated over 200 mg/dL, there might be something else going on. Reach out to your doctor or care team as you may need a medication adjustment. […] Drinking water and staying hydrated is important for managing blood sugar, also known as blood glucose.

• #16 6 tips to lower your blood sugar | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/how-to-lower-your-blood-sugar–follow-these-steps.h00-159623379.html

  Water helps your kidneys filter out excess sugar through urine, says Khan. So, the more hydrated you are, the more urine production youll have, which flushes out sugar in the body. […] Exercise is good for your health and can help lower your blood sugar. […] When you exercise, your muscles take up the glucose and use it for energy, says Khan. […] When asked if there are ways to lower blood sugar quickly, Khan says a combination of hydration, exercise and a decrease in sugars and carbs could help. […] One of the best ways to lower blood sugar is to take steps to prevent high blood sugar in the first place, says Khan. […] Some medications like steroids can increase your blood sugar. Contact your team if you are started on this medication to see if you should begin monitoring your blood sugar and if medication to control blood sugar is indicated. […] By checking your blood sugar regularly, you can detect hyperglycemia early, and it can be managed appropriately, says Khan. Its the best thing our patients can do. It provides us with a lot of information, and we can look at trends over time and decide on appropriate therapy.

• #17 Hyperglycaemia (high blood sugar) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar/

  You may also be advised to monitor your blood sugar level more closely, or test your blood or urine for substances called ketones (associated with diabetic ketoacidosis). […] Contact your diabetes care team immediately if you have a high blood sugar level and experience the following symptoms: feeling or being sick, abdominal (tummy) pain, rapid, deep breathing, signs of dehydration, such as a headache, dry skin and a weak, rapid heartbeat, difficulty staying awake. […] There are simple ways to reduce your risk of severe or prolonged hyperglycaemia: Be careful what you eat be particularly aware of how snacking and eating sugary foods or carbohydrates can affect your blood sugar level. […] Stick to your treatment plan remember to take your insulin or other diabetes medications as recommended by your care team.

• #18

  https://www.jci.org/articles/view/142243

  ACCORD trial. […] The primary outcome was first occurrence of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death (MACE-3). […] Microvascular complications. DCCT (4, 5) and UKPDS (68) demonstrated that enhanced glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). […] Long-term follow up in DCCT/EDIC (4, 5) and UKPDS (68) strongly supports the conclusion that intensive glycemic control can in the fullness of time improve cardiovascular outcomes. […] Twelve classes of drugs are approved to treat T2D: biguanides (e.g., metformin), sulfonylureas, thiazolidinediones (TZDs), DPP4is, SGLT2is, GLP1RAs, insulins, -glucosidase inhibitors, dopaminergic antagonists, bile acid sequestrants, meglitinides, and amylinomimetics.

• #19 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications in type 2 diabetes. […] Drug classes used for the treatment of type 2 diabetes include the following: Biguanides, Sulfonylureas, Meglitinide derivatives, Alpha-glucosidase inhibitors, Thiazolidinediones (TZDs), Glucagonlike peptide1 (GLP-1) agonists, GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonists, Dipeptidyl peptidase IV (DPP-4) inhibitors, Selective sodium-glucose transporter2 (SGLT-2) inhibitors, Nonsteroidal mineralocorticoid receptor (MR) antagonists, Insulins, Amylinomimetics, Bile acid sequestrants, Dopamine agonists. […] Metformin is the only biguanide in clinical use. […] Metformin lowers basal and postprandial plasma glucose levels.

• #19 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Patients on metformin have shown significant improvements in hemoglobin A1c and their lipid profile, especially when baseline values are abnormally elevated. […] In January 2017, the American College of Physicians (ACP) released a guideline update recommending the use of metformin as a first-line treatment for type 2 diabetes. […] A study by Vashisht et al that examined data from more than 246.5 million patients found that when used along with metformin therapy for type 2 diabetes, treatment with sulfonylureas, DPP-4 inhibitors, or thiazolidinediones was equally effective in reducing the HbA1c level to 7% or below that of total hemoglobin. […] Kooy et al found improvements in body weight, glycemic control, and insulin requirements when metformin was added to insulin in patients with type 2 diabetes mellitus.

• #19 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  The AHRQ concluded that metformin decreased LDL cholesterol levels relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors. […] Unfavorable effects on weight were greater with TZDs and sulfonylureas than with metformin. […] Risk of mild or moderate hypoglycemia was 4-fold higher with sulfonylureas than with metformin alone. […] Risk of heart failure was higher with TZDs than with sulfonylureas. […] Risk of bone fractures was higher with TZDs than with metformin. […] The frequency of hypoglycemia reported with premixed insulin analogues is similar to that with premixed human insulin and higher than that with oral antidiabetic agents. […] Long-acting insulins used in the United States include insulin glargine (Lantus, Toujeo) and insulin detemir (Levemir). […] Insulin glargine has no peak and produces a relatively stable level lasting more than 24 hours.

• #20 Type 2 diabetes – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199

  Living with type 2 diabetes involves learning about the condition and lifestyle changes. Diabetes education is an important part of managing the condition. Management includes: […] Diabetes medicine or insulin therapy if needed. […] If you can’t stay at your target blood sugar level with diet and exercise, your healthcare team may prescribe diabetes medicines that help lower glucose levels. Or you may start insulin therapy. Medicines for type 2 diabetes include the following. […] Metformin (Fortamet, Glumetza, others) is most often the first medicine prescribed for type 2 diabetes. It works mainly in two ways. It lowers the amount of glucose the liver makes. And it helps the body use insulin better. […] Some people who take metformin, may get B-12 deficiency and may need to take supplements.

• #21 Hyperglycemia – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/hyperglycemia_treatment/

  Hyperglycemia – Treatment […] Treatment of DKA and HHS is focused on fluid resuscitation, addressing potassium imbalances, correcting ketoacidosis (in DKA), normalizing glucose and other electrolyte levels, addressing the underlying precipitant, and preventing complications. […] Severe and symptomatic hyperglycemia – administer insulin (both a low dose of regular or rapid-acting insulin and long-acting insulin) – consult endocrine or internal medicine. […] Type 2 Diabetes (T2DM) diagnosed in ED – control acute symptoms, address any underlying precipitant/cause and consider prescribing metformin 500mg BID (contraindicated if GFR < 30mL/min) and/or referring to primary care provider for urgent follow-up. [...] Severe hyperglycemia in T2DM Give fluids and IV insulin, correct electrolyte imbalances and address any underlying cause. [...] The treatment is similar to DKA. Individualized IV fluid administration is recommended as older patients. Potassium can be managed as per DKA. IV insulin (at similar doses to DKA) is still recommended; however, the role of insulin is primarily to help normalize glucose levels. [...] Administration of an initial insulin bolus (lack of evidence in adults). [...] Routine phosphate therapy in DKA (lack of evidence). [...] Routine administration of bicarbonate (associated risks). [...] Hypoglycemia (most common complication of treatment). [...] Most patients diagnosed with DKA or HHS require admission. [...] Acute hyperglycemia that is not resolving with treatment or is associated with significant volume depletion. [...] Patients with newly identified severe/symptomatic hyperglycemia (or consider observation unit). [...] Evidence and protocols regarding appropriate glucose levels for the safe ED discharge of noncritically ill patients with hyperglycemia are lacking. [...] Patients with stress-induced hyperglycemia should be closely followed once discharged, as they are at increased risk of developing incident type 2 diabetes.

• #22 Recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes. Consensus document | Nefrología

  https://revistanefrologia.com/en-recommendations-for-pharmacologic-treatment-hyperglycemia-articulo-X2013251411051293

  Nowadays we have a series of drugs for treating diabetes, such as metformin, sulphonylureas, glinides, thiazolidinediones, disaccharidase inhibitors, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists. […] The initial drug treatment will vary depending on the previous degree of control, the patient’s age, whether there are associated diseases, and the concomitant use of other medication. […] In some cases glucose control goals (HbA1c14 although this is not always effective, since it depends on the characteristics of the patients and their level of compliance with the recommendations. […] The following alternatives are proposed to treatment with metformin in the event of contraindication or intolerance: First alternative: sulphonylureas. […] In patients with severe hyperglycaemia (cardinal symptoms and/or weight loss) on the onset, it is often necessary to begin insulin treatment, alone or in combination with metformin.

• #22 Recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes. Consensus document | Nefrología

  https://revistanefrologia.com/en-recommendations-for-pharmacologic-treatment-hyperglycemia-articulo-X2013251411051293

  The second step involves adding a second synergistic drug. […] The treatment is divided into three treatment steps. First, if the hyperglycaemia is not severe (HbA1c: 6.5%-8.5%), metformin is the medication of choice. […] If blood glucose levels are high (HbA1c8.5%), the initial treatment must begin with several oral drugs in combination or with insulin.

• #23 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  Dipeptidyl peptidase inhibitors can be used in combination with correction insulin in selected patients with type 2 diabetes who have milder degrees of hyperglycemia provided there are no contraindications to the use of these agents. […] In adult patients who are hospitalized for non-critical illness and experience hyperglycemia while receiving glucocorticoids (GCs), we suggest glycemic management with either neutral protamine Hagedorn (NPH)-based insulin or basal-bolus insulin (BBI) regimens. […] In adult patients using insulin pump therapy for diabetes management prior to admission for non-critical illness, we suggest that these patients continue insulin pump therapy rather than changing to subcutaneous (SC) BBI therapy in hospitals with access to personnel with expertise in insulin pump therapy.

• #23 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  The 2022 guideline on management of hyperglycemia in hospitalized adult patients in non-critical care settings: […] Focuses on the treatment of hyperglycemia in non-critically ill hospitalized adult patients with diabetes and/or with newly recognized or stress-induced hyperglycemia. […] Emphasizes the use of emerging diabetes technology and insulin therapy for glycemic management and inpatient diabetes self-management education. […] Patients receiving glucocorticoid therapy or enteral nutrition are at high risk for hyperglycemia and require scheduled insulin therapy in the hospital. […] Patients with newly recognized hyperglycemia or well-managed diabetes on non-insulin therapy may be treated with correctional insulin alone as initial therapy at hospital admission. […] Scheduled insulin therapy is preferred for patients experiencing persistent blood glucose values 180 mg/dL.

• #23 Inpatient Hyperglycemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/inpatient-hyperglycemia-guideline-resources

  In adult patients with diabetes who are hospitalized for non-critical illness, we suggest providing inpatient diabetes education as part of a comprehensive diabetes discharge-planning process, rather than not providing inpatient diabetes education. […] For adult patients with diabetes undergoing elective surgical procedures, we suggest targeting preoperative hemoglobin A1c (HbA1c) levels 8% (63.9 mmol/mol) and BG concentrations 100-180 mg/dL (5.6-10 mmol/L). […] In adult patients hospitalized for non-critical illness who are receiving enteral nutrition with diabetes-specific and non-specific formulations, we suggest using NPH-based or basal bolus regimens. […] In most adult patients with hyperglycemia (with or without known type 2 diabetes [T2D]) hospitalized for a non-critical illness, we suggest that scheduled insulin therapy be used instead of non-insulin therapies for glycemic management.

• #24 Treatment Strategies for Hyperglycemia

  https://www.ajmc.com/view/treatment-strategies-for-hyperglycemia

  Traditionally, if they have cardiovascular risk, I like to go with a GLP1 receptor agonist. If they have chronic kidney disease or heart failure risk, I like to go with an SGLT2. […] I dont care for sulfonylureas that much. Thats the last resort for me. We have better therapies that do more than lower blood sugar. […] Its not just to reduce cardiovascular or kidney risk, its also because these medicines have little to no inherent risk of causing hyperglycemia, and they often provide favorable effects on weight.

• #25 Hyperglycemia: Symptoms, Causes, and Treatments > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/hyperglycemia-symptoms-causes-treatments

  Hyperglycemia occurs when the level of blood glucose gets too high. […] Treatment includes medication, lifestyle changes, and monitoring blood glucose levels. […] The treatment depends on the cause of hyperglycemia, and may include the following: Insulin. For people with type 1 diabetes, insulin is the main treatment for hyperglycemia. In some cases, it may also be used to treat people with type 2 diabetes. […] Glucose-lowering medications. Various drugs such as metformin may be used to lower blood glucose levels. […] Glucose monitoring. People with diabetes should monitor their blood glucose levels as instructed by their doctor. […] Lifestyle changes. People with diabetes can reduce the risk of developing hyperglycemia or treat existing hyperglycemia by getting regular exercise, following a nutritious diet, and maintaining a healthy weight.

• #25 Hyperglycemia: Symptoms, Causes, and Treatments > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/hyperglycemia-symptoms-causes-treatments

  DKA and HHS are medical emergencies. They are treated with intravenous fluids, electrolytes, and insulin. […] With appropriate treatment and regular monitoring of blood glucose levels, people can reduce the risk of hyperglycemia, lower their chances of having serious complications, and live healthy lives. […] Our multidisciplinary approach ensures people with blood glucose problems get self-management skills and knowledge to achieve and maintain long-term optimal blood glucose control. We focus on lifestyle interventions, including healthy diet and exercise. Our patients have access to the most advanced medical care, including the latest medications and technologies to prevent hyperglycemic complications and maintain better health throughout their lives.

• #26 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  Transitioning from insulin to metformin and other non-insulin antihyperglycemic medications may be considered if the patient initially presented with an A1c 10% and if the patient is able to achieve a reasonable A1c goal that is corroborated by the SMBG data while using a total daily insulin dose that is low. […] Among the non-insulin antihyperglycemic medications, clinicians should be aware of the risk of DKA associated with the sodium-glucose cotransporter 2 (SGLT2) inhibitors, which provide insulin-independent glucose lowering by blocking the SGLT2s glucose reabsorption in the proximal renal tubule.

• #26 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  Insulin therapy is the initial management choice for patients presenting with hyperglycemia and catabolic symptoms including weight loss. […] If laboratory abnormalities suggest concurrent DKA or HHS, these must be treated emergently with aggressive saline rehydration, intravenous insulin, potassium and other electrolyte replacement according to protocols. […] For a severely hyperglycemic patient, with a catabolic presentation that usually includes moderate to severe volume depletion, the first therapeutic step is rehydration, usually with intravenous saline. […] After adequate hydration, therapy with physiologic doses of insulin (0.3-0.4 units per kilogram body weight daily) is recommended. […] The ideal treatment regimen would be a combination of a long-acting basal insulin plus multiple premeal prandial bolus injections to manage meal-related insulin requirements and correction of pre-meal hyperglycemia, referred to as basal-bolus insulin therapy.

• #26 Initial Management of Severe Hyperglycemia in Type 2 Diabetes – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK278997/

  A good starting place is to prescribe half the total daily insulin dose as basal and the other half as bolus. […] The combination of a long- or an intermediate-acting insulin (e.g. insulin glargine, insulin determir, insulin degludec, or insulin NPH) and a rapid acting analogue are good options for basal-bolus therapy. […] Until more education is possible, the need to limit high glycemic-load carbohydrate intake (such as with sweetened beverages and juice) should be strongly reinforced with counseling. […] Initial diabetes therapy includes counseling for lifestyle and diabetic nutritional interventions. […] In the absence of contraindications, starting therapy with metformin is recommended as an adjunctive therapy with insulin to reduce insulin requirements and minimize weight gain in patients with type 2 diabetes.

• #27 Hyperglycemia (High Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar

  If you take insulin to manage diabetes, injected insulin is the main way to treat hyperglycemia episodes. Everyone requires different insulin doses. You and your healthcare provider will determine which dose is best for you to treat and prevent high blood sugar. Dietary changes and exercise plans can also help manage your blood sugar to prevent hyperglycemia. […] For people with Type 2 diabetes who dont require injected insulin, lifestyle changes, such as dietary changes and exercise, as well as oral diabetes medications, can help manage hyperglycemia. You and your provider will determine the plan thats best for you.

• #28 About Insulin for Diabetes or Treatment-Related Hyperglycemia | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/about-insulin-for-diabetes-or-treatment-related-hyperglycemia

  Rapid-acting insulin starts working within about 15 minutes to lower your blood glucose. It can be used to lower your blood glucose during meals. It can also be used to treat high blood glucose when you’re not eating. […] Intermediate-acting insulin is often used to manage steroid-induced hyperglycemia. This is hyperglycemia caused by steroids, such as prednisone or dexamethasone. […] Long-acting insulin works to keep glucose levels stable when you’re not eating, such as between meals or while you sleep. Long-acting insulin is not used to control the quick rise in glucose caused by eating. […] Uncontrolled high blood glucose over long periods of time can cause loss of eyesight. It can affect how well your kidneys work. You may lose your fingers, toes, and legs. […] It’s best to manage your blood glucose right away, before other health problems start.

• #29 Hyperglycemia | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/hyperglycemia

  Insulin is the most reliable treatment for HBG in the hospital. This is true even if you do not have diabetes or if you do not use insulin at home. Insulin injection is the most effective way to control blood sugar. […] Hospital patients with HBG usually receive insulin shots under the skin (subcutaneous injections). Basal (long- or intermediate-acting) insulin is given once or twice a day to keep blood sugar levels steady between meals or if not eating. The effect of these injections tends to be over 24 hours and should not be skipped if you do not eat, although doses may need to be adjusted if you are not eating. Before meals, getting bolus (rapid-acting) insulin helps prevent blood sugar levels from going too high after eating. […] Besides mealtime insulin, some patients with HBG may need additional insulin injections. This scheduled insulin treatment prevents HBG, or, in some patients, a dangerous health problem called diabetic ketoacidosis (when acids and substances called ketones build up in the blood due to lack of insulin). Intravenous insulin is another way that HBG is treated in the hospital. This is used when the blood sugar is too high or unstable, not responding to subcutaneous injections, or if you have DKA. IV insulin is most frequently used for very sick patients who are not able to eat. This is a temporary way of treating HBG and is usually replaced by subcutaneous insulin when blood glucose levels are better or hospital discharge is anticipated.

• #30 Insulin for type 2 diabetes – NHS

  https://www.nhs.uk/medicines/insulin/insulin-for-type-2-diabetes/

  Insulin is a medicine that helps your body use glucose (sugar) for energy. […] You’ll need to be prescribed insulin for type 2 diabetes if other diabetes medicines no longer work well enough to keep your blood glucose within a healthy range. […] Insulin reduces the chances of getting the symptoms of high blood glucose (hyperglycaemia) and serious long-term problems that can damage your heart, kidneys, eyes and nerves. […] Your doctor or diabetes care team will discuss your treatment with you and recommend the insulin treatment they think is best for you. The type of insulin you take and your dose may change over time. […] If a long-acting or intermediate-acting insulin does not lower your blood glucose enough on its own, you’ll also need to take another type of insulin that works more quickly. You’ll take these types of insulin before meals. […] If you need both intermediate and rapid-acting insulin, your doctor or care team might recommend a mixed insulin instead of separate injections.

• #31 Hyperglycaemia – Mind The Bleep

  https://mindthebleep.com/hyperglycaemia/

  Increase the medications only if a patient has a raised blood sugar consistently over at least 2 days. […] As long as there are no contraindications, you can start or uptitrate metformin very easily. […] For gliclazide (the most commonly used sulphonylurea), you can increase in increments of 40 mg depending on when the hyperglycaemia is occurring. […] There are three commonly used regimes: Long-acting only (usually at bedtime), Mixed insulin twice daily (also known as biphasic) usually with breakfast dinner, Basal-bolus (short-acting with each meal long-acting usually at bedtime). […] If the fasting blood sugar is high, we will usually increase the long-acting insulin by about 10% at a time and wait at least 2 days before re-adjusting. […] Simply prescribing stat doses of short-acting insulin, doesnt address this. […] It is advised that you discuss correction doses of insulin with a senior. […] Short-acting insulin should be given with a meal to avoid the peak causing hypoglycaemia.

• #32 How Is Hyperglycemia Treated in the Hospital?

  https://www.healthline.com/health/hyperglycemia-treatment-in-hospital

  Hyperglycemia can be a medical emergency that requires hospital care. In the hospital, treatments such as insulin therapy, electrolytes, and fluid replacement, can bring blood sugar down. […] Hospitals can help lower high blood sugar levels with treatments such as fluid replacement, electrolyte replacement, and insulin therapy. […] Insulin therapy: Insulin reduces high blood sugar and reverses any buildup of ketones in your blood. […] Fluid replacement: Fluids can help dilute extra sugar in your blood. Receiving IV fluids can also help replace any fluids you might have lost through excessive urination. […] Electrolyte replacement: When your insulin levels are low, your electrolyte levels can also drop. Your body needs electrolytes so that tissues and organs can work correctly. You can receive replacement electrolytes through an IV at the hospital.

• #33 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  Correction of hyperglycemia with insulin […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained. […] The initial insulin dose is a continuous IV insulin infusion using an infusion pump, if available, at a rate of 0.1 U/kg/h. […] Sodium bicarbonate only is infused if decompensated acidosis starts to threaten the patient’s life, especially when associated with either sepsis or lactic acidosis. […] In the presence of infection, the administration of proper antibiotics is guided by the results of culture and sensitivity studies. […] An endocrinologist also may be consulted to assist with management after the patient has been stabilized adequately. […] Frequent blood glucose monitoring at home makes DKA less likely, as this allows them to promptly search for possible reasons for unexpectedly high blood sugar values before the condition progresses to DKA.

• #34 Hyperglycemia in the ED — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hyperglycemia-in-the-ed

  In 2016, a total of 16 million ED visits were reported with diabetes listed as a diagnosis, with 224,000 of these being for hyperglycemic crisis (1). In this post, we will explore the evaluation and treatment of various hyperglycemic etiologies in the ED through a series of clinical scenarios. […] Two of the most common hyperglycemic emergencies associated with diabetes mellitus are diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). Although both result in severe hyperglycemia, the underlying pathophysiology and clinical presentation can be vastly different. […] The foundation of treatment for both hyperglycemic emergencies is similar and include: Fluid replacement, Electrolyte replacement, Insulin therapy. […] Initial fluid therapy is aimed at expansion of intravascular, interstitial, and intracellular volume, all of which are decreased in DKA and HHS.

• #34 Hyperglycemia in the ED — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hyperglycemia-in-the-ed

  To prevent hypokalemia, potassium replacement should be initiated after serum levels fall below the upper level of normal. […] Currently ADA guidelines recommend: Goyal et al prospectively compared the utility of the initial insulin bolus in 157 patients. […] The foundation of the treatment of HHS centers more around the replacement of fluids given the patients often large fluid deficit (9-12L). […] According to ADA guidelines (8), a diagnosis of diabetes can be made from the ED using the following criteria: Random plasma glucose 200 mg/dL AND classic symptoms of hyperglycemia or hyperglycemic crisis. […] Therefore, attaining a specific glucose goal before discharge in patients with hyperglycemia may be less important than originally thought. Management should focus on improving long-term glucose management and arranging good follow up.

• #35

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-endocrine-electrolytes/hyperglycemia

  In patients with an uncomplicated presentation associated with mild moderate hyperglycemia, often no urgent treatment is required, however in some cases, patients may requires intravenous fluids. […] Treatment for DKA and HHS is centered around correcting the intravascular volume depletion, management of electrolyte abnormalities, insulin replacement therapy and identification of and treatment of any underlying precipitants. […] Average fluid loss in DKA 3-6 liters and HHS 8-12 liters. […] Historically, isotonic saline (0.9%) at 15-20 ml/kg per hour for the first few hours has been the fluid of choice (in the average adult this will be approximately 1 liter/hr). […] Insulin therapy involves the administration of regular insulin via IV infusion or subcutaneous injections. […] IV infusion of regular insulin is preferred route because of short half-life and easy titration.

• #35

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-endocrine-electrolytes/hyperglycemia

  Insulin therapy should only be started after adequate fluid resuscitation. […] Potassium repletion is critical to avoid life-threatening arrhythmias and respiratory muscle weakness. […] Treatment goal is to maintain serum potassium between 4-5 mEq/L. […] Use of bicarbonate is controversial. […] Treat any other underlying infections or other disease processes. […] Patients with both DKA and HHS will require serial monitoring of: Blood glucose every hour until stable, then every 2-4 hours. […] All patients with DKA and HHS require hospital admission. Depending on disease severity some may require monitoring in the ICU.

• #36 Hyperosmolar Hyperglycemic State | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1201/p729.html

  Once urine output is established, potassium replacement should begin. […] In adults, insulin should be started with an initial intravenous bolus of 0.1 units per kg, followed by a continuous infusion of 0.1 units per kg per hour until the blood glucose level falls to 250 to 300 mg per dL. […] Children should not receive an initial bolus of insulin because it may increase the risk of cerebral edema. Instead, a continuous infusion of 0.1 units per kg per hour should be started. […] Routine antibiotics are not recommended for all patients with suspected infection. However, they are warranted while awaiting culture results in older patients or in those with hypotension.

• #36 Hyperosmolar Hyperglycemic State | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1201/p729.html

  Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. […] Treatment begins with intensive monitoring of the patient and laboratory values, especially glucose, sodium, and potassium levels. Vigorous correction of dehydration is critical, requiring an average of 9 L of 0.9% saline over 48 hours in adults. […] Insulin therapy should be initiated in patients with HHS once fluid replacement has been started. […] Treatment of HHS requires a four-pronged approach: (1) vigorous intravenous rehydration, (2) electrolyte management, (3) intravenous insulin, and (4) diagnosis and management of precipitating and coexisting problems. […] Aggressively replacing fluids is the first and most important step in treating HHS.

• #37 Diabetic hyperglycemic hyperosmolar syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000304.htm

  Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves an extremely high blood sugar (glucose) level without the presence of ketones. […] At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine output, and circulation. Blood sugar will also decrease. […] Fluids and potassium will be given through a vein (intravenously). This must be done carefully. A high glucose level may be treated with insulin given through a vein.

• #38 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  Steroids have a cumulative effect on blood sugar, so initiating insulin therapy on the same day as the initial steroid dose provides much better glycemic outcomes. […] Furthermore, steroids cause significant postprandial hyperglycemia. These patients usually require rapid-acting insulin with meals to combat this rise in blood glucose. […] Colo estimates that about 25 percent of her caseload involves providing education and support to patients experiencing steroid-induced hyperglycemia. […] Patients do better when we take the time to explain the effects of steroids and the benefits of insulin, says Colo. When we are able to keep blood glucose within target range as much as possible, patients feel better and heal faster.

• #38 Best Practices for Managing Steroid-Induced Hyperglycemia | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2024/03/best-practices-for-managing-steroid-induced-hyperglycemia

  According to a meta-analysis published in Nature Review Endocrinology, among patients with no prior history of DM who were prescribed steroids for a month or longer, the incidence of steroid-induced hyperglycemia was 32 percent. The incidence of developing DM was 19 percent. […] While not everyone will require insulin, Colo works with patients to build an understanding of steroid-induced hyperglycemia. […] Typically, glucose levels begin to improve but it does take time to get there. […] When patients at University Hospitals Cleveland Medical Center are at risk for steroid-induced hyperglycemia, the endocrinology team is typically consulted to help with glucose management because many of these patients are new to insulin and/or need frequent changes to their insulin regimen as their steroid dose changes.

• #39 Clozapine and Hyperglycaemia

  https://medsafe.govt.nz/profs/puarticles/cloz.htm

  Hyperglycaemia, sometimes leading to ketoacidosis or glycosuria, has been reported in association with clozapine. In some cases the condition has been of new onset, and in others exacerbation of pre-existing diabetes mellitus has occurred. Hyperglycaemia appears to be of early onset (2 weeks to 3 months after initiation of clozapine) and to occur without predisposing factors. Clozapine-induced hyperglycaemia may be serious leading to coma, but it is reversible on discontinuation of clozapine. In some cases continuation of clozapine is possible by controlling serum glucose levels with the use of hypoglycaemic agents. This approach may be useful in refractory schizophrenia responsive to clozapine. In those with diabetes mellitus, glucose monitoring should be conducted in conjunction with the obligatory haematological monitoring. All patients should be advised to report altered consciousness, polyuria or increased thirst.

• #39 Clozapine and Hyperglycaemia

  https://medsafe.govt.nz/profs/puarticles/cloz.htm

  Glycaemic control may be possible with hypoglycaemic agents […] In some cases clozapine was continued with a change in the measures to maintain glucose control, such as use of insulin for the first time. […] Hyperglycaemia may be serious but it is reversible with clozapine withdrawal […] Clozapine-induced hyperglycaemia can be serious, but it is fully reversible on withdrawal of clozapine. […] In some patients it is possible to continue clozapine therapy by controlling serum glucose levels with the use of hypoglycaemic agents. This option may be important for those with refractory schizophrenia and related disorders who are responsive to clozapine.

• #40 Pediatric hyperglycemia (high blood sugar) – Children’s Health Endocrinology

  https://www.childrens.com/specialties-services/conditions/pediatric-hyperglycemia

  Hyperglycemia, or high blood glucose, means the blood glucose level is above target. It can be caused by too much food, not enough insulin, less activity than usual, stress or illness. Sometimes children outgrow their insulin dosage and have high glucose values. Be sure to discuss this with your childs endocrinologist and/or pediatrician. […] Encourage your child to drink lots of water. Extra rapid acting insulin can be given according to your correction scale. Use the correction scale only before meals and before the bedtime snack. […] Do not give extra insulin, such as mid-morning, mid-afternoon or during the night unless told to do so by the diabetes team or your provider. This can cause „stacking of insulin”, resulting in low blood sugar or glucose. […] High blood sugar does not mean that you are doing something wrong. It is information that can be used to improve your child’s diabetes control.

• #41 Pump therapy: Hyperglycaemia management

  https://www.rch.org.au/diabetes/Diabetes-technology/Pump_therapy__Hyperglycaemia_management/

  When BGL is 15.0mmol/L or higher AND BKL 0.6mmol/L or higher, you need to assume this is line failure requiring urgent management. […] High blood glucose levels AND high blood ketone levels = Not enough insulin in the body! […] Pump therapy carries a higher risk for developing ketones compared to other insulin regimens because only rapid acting insulin is used (i.e. no long acting insulin) and line failure or disconnection can happen. […] A ketone reading of 0.6mmol/L or higher, associated with BGL 15.0mmol/L or higher needs immediate treatment with an urgent dose of injected rapid acting insulin via pen/syringe. […] Calculate urgent dose by dividing your pump total daily dose (PTDD) of insulin by 6. […] Give urgent dose of rapid acting insulin via pen/syringe. DO NOT use the pump to give this urgent dose as we must assume your line is not working. […] Continue close monitoring and seek medical attention if you have any concerns.

• #42 Manage Blood Sugar | Diabetes | CDC

  https://www.cdc.gov/diabetes/treatment/index.html

  Many things can cause high blood sugar (hyperglycemia), including: […] If you’re sick and your blood sugar is 240 mg/dL or above, use an over-the-counter ketone test kit to check for ketones. Call your doctor if your ketones are high. High ketones can be an early sign of diabetic ketoacidosis (DKA). DKA is a medical emergency and needs to be treated immediately. […] Eating a healthy diet, maintaining a healthy weight, and getting regular physical activity can all help. Other tips include: […] Counting carbs in foods and drinks is an important tool for managing blood sugar levels. Make sure to talk to your health care team about the best carb goals for you.

• #43 High Blood Sugar (Hyperglycemia)

  https://www.veteranshealthlibrary.va.gov/3,82094

  Check your blood sugar more often, or as directed by your doctor. […] Drink plenty of sugar-free, caffeine-free liquids, such as water. Dont drink fruit juice. […] Follow your sick day plan for taking medicine. […] Check your blood or urine for ketones as directed by your doctor. If you have ketones, don’t exercise. This may make your blood sugar higher. […] Call your doctor if your blood sugar and ketones don’t go back to your target range. […] Preventing high blood sugar […] To help keep your blood sugar from getting too high: […] Control stress. […] When you’re ill, follow your sick day plan. […] Follow your meal plan. Eat only the amount of food on your meal plan. […] Stick to your exercise plan. […] Take your insulin or diabetes medicines as directed by your care team.

• #43 High Blood Sugar (Hyperglycemia)

  https://www.veteranshealthlibrary.va.gov/3,82094

  Insulin. Insulin helps your body use glucose. It also reverses the problem that led to DKA. […] Medicines. You may need medicine for an illness that caused DKA. This includes antibiotics for an infection. […] Recurring DKA is a serious concern for people with diabetes. By knowing the causes, recognizing symptoms, and using preventive strategies, you can greatly reduce the risk of DKA and maintain better overall health. Regular communication with doctors and ongoing education are key parts of effective diabetes management. […] When to get medical care […] Get medical care right away if you have: […] Blood sugar that stays high even after treatment. […] Symptoms of high blood sugar that don’t get better. […] Moderate or large amounts of ketones. […] Confusion. […] Shortness of breath or fast breathing. […] Breath that smells fruity. […] Vomiting or unable to eat or drink.

• #44 High blood sugar (hyperglycemia) and diabetic ketoacidosis

  https://www.diabinfo.de/en/living-with-diabetes/treatment/high-blood-sugar-hyperglycemia-and-diabetic-ketoacidosis.html

  High blood sugar (or hyperglycemia) causes the blood sugar level to rise above 250 mg/dl (13.9 mmol/l). Very high levels indicate an acute emergency. The result may be a life-threatening diabetic coma. […] As a rule, people with diabetes can compensate for high blood sugar levels themselves. Diabetes professionals often provide persons who inject insulin with a correction regimen. This regimen shows the blood sugar levels at which how much corrective insulin should be injected. […] Note: Do not correct with insulin too soon after a meal. This carries the risk of hypoglycemia because the insulin injected at mealtime is still working in the body. Ask your diabetes team at what point after a meal elevated blood sugar levels may be counteracted with insulin. […] Severe hyperglycemia as well as hypoglycemia can be prevented by certain measures. For example, you should always carry an emergency set with you. This emergency set contains all the of the devices you need for diabetes therapy, such as dextrose, insulin pen, an additional insulin ampoule and batteries for the insulin pump.

• #45 Hyperglycaemia (high blood sugar) – symptoms and management | healthdirect

  https://www.healthdirect.gov.au/hyperglycaemia-high-blood-sugar

  If you have hyperglycaemia and are worried about symptoms that are getting worse go to the emergency department at the nearest hospital or, call triple zero (000) and ask for an ambulance. […] If your high blood sugar doesn’t go down, or you can’t keep fluids down, see your doctor immediately, or go to your nearest emergency department. […] If you have diabetes, your doctor should have discussed with you a diabetes management plan or a 'sick day’ plan. Check your plan for what to do when your blood sugar is too high. […] If your blood glucose level remains high, even after following your diabetes management plan, you may need medical treatment with fluids, electrolytes or medicines. Call your health team for advice. […] If you have type 1 diabetes and your blood glucose level is high, you can develop diabetic ketoacidosis. […] Both conditions can be dangerous and need emergency medical treatment.

• #46 Hyperglycaemia – symptoms, risks and management | Diabetes Australia

  https://www.diabetesaustralia.com.au/blog/hyperglycaemia/

  If you have been experiencing elevated bloods glucose levels for some time, you need to consider your current management and what changes may be needed to bring your glucose levels back into target. […] Call 000 or emergency medical assistance if: You are sick and can’t keep any food or fluids down, Your blood glucose levels are persistently above 15 mmol/L and you have ketones, Your health is deteriorating, You are unable to continue to care for yourself/manage your diabetes. […] Hyperglycaemia cannot be avoided completely when you live with diabetes. The following tips may help you to keep your blood glucose levels in range: Follow a healthy meal plan for diabetes. An Accredited Practising Dietitian can help you to understand what to eat, and how much to eat for your body and lifestyle. Take your medication as prescribed by your doctor. Monitor your blood glucose regularly if it is outside of range, and have your doctor review it. Your doctor may need to modify the dose or change medications if hyperglycaemia persists. Move more. Regular, consistent physical activity will help your body to use glucose as well as making your body more sensitive to insulin. An Accredited Exercise Physiologist can help you to formulate a personal physical activity plan.

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