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Hyperglycaemic Emergency

If the individual suspected of having diabetes at presentation is unwell consider hyperglycaemic emergencies like diabetic ketoacidosis (DKA) or hyperosmolar non-ketosis (if untreated these can lead to coma and death).

Assess for symptoms and signs of DKA or hyperosmolar non-ketosis (HONK)

  • Short history of hyperglycaemia symptoms like polyuria, polydipsia, weight loss and tiredness

  • Signs of dehydration (dry mucous membrane, tachycardia, hypotension, reduced urine output)

  • Vomiting and/or abdominal pain

  • Worsening confusion

  • Significant hyperglycaemia (blood glucose in the euglycaemic range does not exclude DKA)

  • Ketonuria (moderate to large) in DKA and usually absent in HONK (dehydrated patient may not be able to provide a urine sample)

Urgent Hospital admission:
Admission to the emergence unit is recommended if DKA or HONK is suspected.
Severe symptoms like vomiting, dehydration, confusion should prompt urgent admission to hospital for intravenous rehydration and insulin therapy.

Urgent referral to the Diabetes specialist team:

Diabetes specialist team at New Cross hospital should be contacted on the same day through WUCTAS or directly on 01902 695310 (9:00 to 5:00 PM).
During out of hours and weekends contact the on-call medical team at New Cross Hospital.

Investigations

Diagnostic Criteria for Diabetes

The diagnosis of diabetes must be made according to the WHO criteria

Symptomatic:           In the presence of symptoms of diabetes, 1 diagnostic test is required

Asymptomatic:        2 diagnostic tests are required to establish the diagnosis

Diagnostic test:        Fasting blood glucose ≥7.0 or
                                Random blood glucose ≥ 11.1 or
                                HbA1c ≥ 6.5