Management of Hyperglycemia and Ataxia

Initial Assessment and Treatment

The American Diabetes Association recommends immediate assessment for life-threatening hyperglycemic emergencies, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state, in patients presenting with hyperglycemia and ataxia, as marked hyperglycemia with altered mental status requires immediate medical intervention to prevent complications and death 1
Check for signs of DKA or hyperosmolar hyperglycemic state, including altered mental status, dehydration, ketosis, vomiting, or drowsiness, and measure blood glucose, electrolytes, ketones, arterial or venous pH, and serum osmolality urgently 1, 2

The American College of Clinical Endocrinologists recommends beginning immediate fluid resuscitation with 0.9% sodium chloride at 15-20 mL/kg/hour during the first hour to restore circulatory volume and tissue perfusion in patients with hyperglycemic emergencies 2
Administer intravenous insulin bolus of 0.1 units/kg body weight, followed by continuous infusion at 0.1 units/kg/hour, and monitor blood glucose every 2-4 hours and draw blood every 2-4 hours for electrolytes, glucose, BUN, creatinine, osmolality, and venous pH 2

The Endocrine Society recommends transitioning from intravenous to subcutaneous insulin 2-4 hours before stopping intravenous insulin to prevent rebound hyperglycemia, and targeting pre-meal glucose <7.8 mmol/L (140 mg/dL) and random glucose <10.0 mmol/L (180 mg/dL) for non-critically ill patients 2, 4
Develop a structured discharge plan that addresses the underlying cause, ensures patient education on sick-day management, and establishes close follow-up, and never discontinue insulin during intercurrent illness, as this can precipitate DKA 1, 2, 5