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Home | Articles | Diabetes and Endocrinology | In-patient Hyperglycaemia Management

In-patient Hyperglycaemia Management

Last updated 24th April 2024

BG>13 and Ketones <1.5

  1. Patients will often know their own correction doses in T1DM but if not, can use the principle of 1 unit of rapid acting insulin (Novorapid, Humalog, Fiasp) lowers blood glucose by 3mmol/L. – Actrapid should only be used in VRII
  2. BG 13-18: 2 units rapid-acting insulin
  3. BG 18-25: 4 units rapid-acting insulin
  4. BG >25: 6 units rapid-acting insulin

BG>13 and Ketones 1.5 – 3.0

  1. If eating and drinking can administer 10% of total daily dose as rapid acting insulin every 2 hours (monitor BG and ketones every 2 hours)
  2. If not eating and drinking consider need for a VRII

BG>13 and Ketones >3.0

  1. Check for DKA and if present, follow DKA protocol
  2. If not in DKA and eating & drinking, can administer 20% of total daily dose as rapid acting insulin every 2 hours (monitor BG and ketones every 2 hours)
  3. If not in DKA but not eating and drinking, consider need for a VRII

Additional Notes

  1. Always consider cause of hyperglycaemia when deciding on management. Sepsis/diet/steroids/lipohypertrophy etc. 
  2. If tight glycaemic control not required or appropriate (for e.g. frail or palliative patients), will not require correction doses if BG ≤25; above this can administer 10% of TDD as rapid acting insulin every 4 hours and monitor BG and ketones every 2 hours
  3. In patients on SGLT2 inhibitors (e.g. Dapagliflozin & Empagliflozin) who develop high ketones always suspend until resolved. Consider discontinuing. Always discontinue permanently if in DKA
  4. In patients with sustained hyperglycaemia always consider changing their regular regime as well as assessing for correction doses

Steroid Induced Hyperglycaemia

  1. Note usual steroid pattern of marked hyperglycaemia through the day with a drop to baseline overnight. Gliclazide can be commenced at 40-80mg with breakfast titrated to a maximum of 240mg with breakfast not exceeding a daily total of 320mg . If on steroid treatment more than once daily, please refer to Diabetes Team
  2. If not successful/not tolerated can change to Humulin I starting at 10 units or 0.1-0.2 units/kg and involve Diabetes Team

Closed Loop Pumps

  1. The principles are the same but the advice is slightly different
  2. If ketones <1.5mmol/l with minor illness then patient can stay in closed loop mode
  3. If ketones >1.5mmol/l with more severe illness then patient should exit closed loop mode
  4. Click here for flowchart which will show you what to do next.

Content by the Diabetes & Endocrinology Team