Managing hyperglycaemia in dental practice

Hyperglycaemia in the absence of symptoms is rarely a medical emergency. Advise patients to take their usual medications for diabetes and to seek medical review if their blood glucose concentration remains high. Patients with associated symptoms such as abdominal pain, nausea, vomiting, fatigue, shortness of breath or an altered conscious state may have diabetic ketoacidosis (DKA) or hyperglycaemic hyperosmolar state (HHS); the onset is usually over a number of hours. If a patient with known diabetes appears unwell, seek medical advice, call 000 or start basic life support as appropriate (for ‘Basic life support flow chart’, see Basic life support flow chart).

Patients taking a sodium-glucose co-transporter 2 (SGLT2) inhibitor (eg dapagliflozin, empagliflozin, ertugliflozin) may develop diabetic ketoacidosis with a normal blood glucose concentration—call 000 if they develop any symptoms of diabetic ketoacidosis.