Management of an adult after resolution of hyperosmolar hyperglycaemia

Management of an adult with diabetes after resolution of hyperosmolar hyperglycaemia must be individualised. Many patients with hyperosmolar hyperglycaemia are older and have multiple comorbidities, and recovery will be influenced by their previous functional level and the underlying precipitant of the hyperosmolar hyperglycaemia. Confusion may last for several days after other signs and symptoms of hyperosmolar hyperglycaemia have resolved.

Early mobilisation and good nutrition are important after resolution of hyperosmolar hyperglycaemia. When patients are eating and drinking normally, most should be changed from intravenous insulin infusion to subcutaneous insulin. For patients with previously undiagnosed diabetes, or in whom glycaemic targets had been achieved with noninsulin antihyperglycaemic drugs, a change from insulin to a noninsulin antihyperglycaemic drug may be considered after a period of stability (weeks to months). See Approach to antihyperglycaemic treatment for adults with type 2 diabetes for further information. Consideration should be given to ongoing management of underlying causes, such as cardiovascular disease or infection.

All patients should have follow-up by a multidisciplinary diabetes team. This should include education to reduce risk of recurrence of hyperosmolar hyperglycaemia and to prevent chronic complications of diabetes.