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Diabetes Emergency / WUCTAS Pathway

WUCTAS Care Pathway

Information and Guidance

  • This algorithm is for the guidance only. Individual clinical situations may dictate alternative medical strategies and a senior opinion/review must be considered.

  • lf the patient upon presentation is unwell consider hyperglycaemic emergencies like diabetic ketoacidosis (DKA) or hyperosmolar non-ketosis (if untreated these can lead to coma and death).

  • Blood glucose in the normal (euglycaemic) range does not exclude DKA in an uwell patient. Testing urine for ketones is essential to establish need for urgent diabetes care

  • Osmotic (hyperglycaemic) symptoms include polyuria, thirst, weight loss and/or tiredness.

  • *Hyperglycaemia is often a sign of concurrent illness, consider;

    • Infection

    • Stroke

    • Myocardial infarction

**Management of Hypoglycaemia:

Hypoglycaemia (BG<4 mmol/L) can manifest as sweating, tremor, anxiety, palpitations, confusion, aggressive/inappropriate behaviour, seizures or coma.

Patient conscious:

  • Give oral glucose in form of 4 teaspoons sugar in water, 120mls lucozade, or Hypostop gel.

  • Follow this with a longer acting carbohydrate such as toast, biscuits.

Patient unconscious:

  • IV glucose, 100mls of 20% dextrose - if intravenous access available

  • 1mg Glucagon lM(S/C): if no intravenous access (Patients with marked cachexia, poor oral intake or repeated recent hypos may not respond to Glucagon)

lt may be necessary to commence 5% dextrose infusion if oral intake remains poor.
Monitor BGS thereafter and reduce or discontinue hypoglycaemic agents.

***Contact details:

Diabetes specialist team at New Cross Hospital: can be contacted Monday to Friday directly on 01902 695310 (9:00 to 5:00 PM) or through WUCTAS phone (9:00 to 7:0OPM)

Out of hours diabetes advice: contact the on-call medical team at New Cross Hospital via switchboard.