Tag: hypergly

July 17, 2020

Covid-19 (Hyperglycaemia)

Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK

GLUCOSE MONITORING

Target glucose 6.0 -10.0 mmol/L (up to 12.0 mmol/L is acceptable)

January 13, 2020

Hyperosmolar Hyperglycaemic State (HHS)

HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.

Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.

Definition

Hypovolaemia
Hyperglycaemia – generally ≥30mmol/l
High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
& NOT:
- Acidotic – pH >7.3, HCO3 >15mmol/l
- Ketotic – blood <3mmol/l, Urine <2+

November 28, 2019

DKA – Adult

Things to remember

Give 0.9%NaCl
Actrapid “Fixed Rate” 0.1unit/kg/hr
Basal Insulin (lantus/levemir) give this too – usual time and dose
Potassium – if below 5.5 will need KCl infusion (see guide)
BM <14 – Start 10% Dextrose 125ml/hr
BEWARE SGLT-2 inhibitors chance of Euglycaemic DKA

September 20, 2019

Diabetic Hyperglycaemia (Kids)

Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)

Paeds have produced some advice to follow:

Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission