Hyperglycaemia

Phone Call/Presentation Questions

• Type 1 or Type 2 diabetic?
  • If type 2, are they normally on insulin
• What medications?
• What have they eaten?
• Reason for admission?
• Otherwise well? Other vitals?

Common Causes (Corridor thoughts)

• Patient adherence to diet
• Steroids
• TPN/PPN
• NG feeds
• Poorly controlled diabetes at home
• Withholding regular antiglycaemics

Assessment

• Read the patient ntoes as there may be a hyperglycaemia plan documented with a short-acting insulin (usaully Novorapid) sliding scale charted or JMO specific instructions
• The thinksulin app can guide on charting insulin if the patient is hyperglycaemic with no insulin PRN charted
• Check ketones if BSL >20
• Consider if the patient has been recently commenced on steroids (e.g. respiratory conditions)
• Ask the nurses to check BSLs again in 2 hours as Novorapid half life of 2-4 hours

Management

• Use thinksulin app
• Short term
  • Start novorapid
• Medium term
  • Sliding scale during period on steroids
  • ? Endo r/v if not well controlled
• Long term
  • Does the patient need more PO medications?
  • Does the patient need to change insulin regime?
  • Who is follow up diabetes management
  • What is his Hba1c
• Other considerations
  • If renal function is low, insulin takes longer to act
  • If type 1 diabetic, always measure ketones
    • If ketones are high, do a VBG to assess if they are acidotic