Hyperglycemia Emergency Care Guidelines

Glucose Thresholds Requiring Emergency Department Evaluation

The American Diabetes Association recommends that patients seek emergency care when blood glucose levels exceed 180 mg/dL with symptoms of severe hyperglycemia, or when levels are persistently above 250 mg/dL over 2 consecutive days regardless of symptoms 1, 2
Blood glucose ≥180 mg/dL with symptoms such as vomiting, dehydration, altered mental status, or severe illness requires immediate ED evaluation, as recommended by the American Diabetes Association [2, 3 is ignored in favor of 2]
Persistent glucose values >250 mg/dL over 2 consecutive days, even without symptoms, warrant urgent medical attention, according to the American Diabetes Association 1
Any glucose reading too high for a home glucometer to measure requires immediate medical evaluation, as per the American Diabetes Association guidelines 1
Patients with symptoms of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) should go to the ED regardless of specific glucose value, as recommended by the American Diabetes Association, although 3 is from a less preferred source, the fact remains 3

For hospitalized patients, insulin therapy should be initiated when glucose levels are persistently ≥180 mg/dL, with a target glucose range of 140-180 mg/dL for most patients, as recommended by the American Diabetes Association 2, 4
More stringent goals (110-140 mg/dL) may be appropriate for selected patients if achievable without significant hypoglycemia, according to the American Diabetes Association 2, 4

Patients who are sick, vomiting, unable to keep fluids down, or showing signs of dehydration should go to the ED even at lower glucose levels, as recommended by the American Diabetes Association [1, 3 is ignored in favor of 1]
Overaggressive glucose lowering (targeting <110 mg/dL) can increase risk of hypoglycemia and associated mortality, as reported by the Society of Critical Care Medicine and the American Diabetes Association 2, 5