Treatment of severe hyperglycaemia in adults

Guidelines for the emergency management of hyperglycaemia in primary care are available from The Australian Diabetes Society (ADS) website.

If ketones are present in adults with severe hyperglycaemia, see Diabetic ketoacidosis in adults.

If ketones are not present in adults with severe hyperglycaemia, but significant dehydration has developed over many days, see Hyperosmolar hyperglycaemia.

In all other adults with severe hyperglycaemia (eg blood glucose concentration more than 20 mmol/L or glycated haemoglobin [HbA1c] more than 86 mmol/mol [10%]), even if they are asymptomatic, insulin treatment should be strongly considered from the outset. See General principles for starting insulin in adults with type 2 diabetes for information about starting insulin.

If type 2 diabetes is suspected, lifestyle modifications (dietary intake and physical activity) and metformin should be started at the same time as the insulin. In type 2 diabetes, once blood glucose concentrations are nearer to the target, insulin can sometimes be withdrawn. Seek specialist advice; an assessment of adequacy of endogenous insulin production (measured via a C-peptide matched with a glucose) may be useful.

If insulin is withdrawn, metformin and lifestyle modifications should be continued for patients with type 2 diabetes. Other noninsulin antihyperglycaemic drugs may need to be added to maintain glycaemic targets; see Glycaemic targets for adults with type 2 diabetes and Approach to antihyperglycaemic treatment for adults with type 2 diabetes for further information. Seek specialist advice if there is uncertainty about the diagnosis or appropriateness of insulin withdrawal.

Short-term insulin treatment may be required in patients who are acutely unwell or are taking short courses of drugs that induce hyperglycaemia (eg high-dose glucocorticoids); see Glucocorticoid-induced hyperglycaemia.