Hyperglycaemia

In hospital, the capillary blood glucose (CBG) target is 6-12 mmol/L. 

In the community people will have individualised CBG targets.

If CBG is consistently >12 mmol/L, this needs assessed and addressed, and treated urgently if >16.

Are they unwell? If so:

Contact GP team urgently

Care home or GP team to undertake as able:

• Check capillary ketones (>1 raised, >3 very raised) and VBG, U+E, bicarbonate
• Consider and treat underlying illness (commonly infection, dehydration, acute vascular event)
• Consider any new medications which might be contributing (e.g. steroids)
• Consider hyperglycaemic emergencies - DKA or HHS (see separate protocols)

Further information on management can be found here

If patient well:

• If T1DM still check capillary ketones - if these are >1 contact GP team urgently
• Is hyperglycaemia new or longstanding - check old charts / patient meter
  • if new then contact GP within daytime hours for review within 24h
  • If longstanding contact GP within daytime hours for non-urgent review
    
    
• Consider
  • diet changes
  • look for lipohypertrophy (lumpy areas of tissue around injection sites - avoid injecting into these)

Further information on management can be found here

• Concern regarding clinical condition
• You feel the patient needs to start regular insulin
• Initial medication changes are unsuccessful
• Starting gliclazide if patient does not have a CBG meter
• Concern starting new medications with comorbidities