Management of Hyperglycemia with UTI in Uncontrolled Diabetes Mellitus

Initial Assessment and Management

The American Diabetes Association recommends evaluating for severity of hyperglycemia and presence of complications such as diabetic ketoacidosis (DKA) by checking mental status, hydration status, and laboratory values in patients with uncontrolled diabetes presenting with hyperglycemia and UTI 3
Obtain laboratory tests including complete metabolic panel, serum ketones, urinalysis, and urine culture to confirm UTI and rule out DKA in patients with uncontrolled diabetes, as recommended by the American Diabetes Association 2, 3
Assess for other precipitating factors such as missed medication doses or other concurrent illnesses in patients with uncontrolled diabetes and UTI, as suggested by the American Diabetes Association 4

The American Diabetes Association recommends that for blood glucose >250 mg/dL with infection, insulin therapy should be strongly considered in patients with uncontrolled diabetes 1, 5
Target glucose range of 140-180 mg/dL to avoid both hyperglycemia and hypoglycemia in patients with uncontrolled diabetes and UTI, as recommended by the American College of Physicians and the American Diabetes Association 6, 7
Use a basal-bolus insulin regimen rather than sliding scale insulin alone, which is ineffective and not recommended, in patients with uncontrolled diabetes and UTI, as suggested by the American Diabetes Association 8, 6

Calculate total daily insulin dose at 0.5-0.8 units/kg/day based on patient's weight in patients with uncontrolled diabetes and UTI, as recommended by the American Diabetes Association 5
Divide total daily dose into basal insulin (50%) and prandial insulin (50%) in patients with uncontrolled diabetes and UTI, as suggested by the American Diabetes Association 7

Monitor blood glucose every 4-6 hours during acute illness in patients with uncontrolled diabetes and UTI, as recommended by the American Diabetes Association 4
Adjust insulin doses daily based on glucose monitoring results in patients with uncontrolled diabetes and UTI, as suggested by the American Diabetes Association 7
Once acute infection is controlled and patient is eating regularly, consider transitioning to oral agents if appropriate in patients with uncontrolled diabetes and UTI, as recommended by the American Diabetes Association 1, 5

Develop a structured discharge plan tailored to the individual patient with uncontrolled diabetes and UTI, as recommended by the American Diabetes Association 7
Provide diabetes self-management education focusing on medication adherence, glucose monitoring, and sick-day management in patients with uncontrolled diabetes and UTI, as suggested by the American Diabetes Association 4, 3

Do not use sliding-scale insulin as monotherapy, as this approach is ineffective and may lead to wide glucose fluctuations in patients with uncontrolled diabetes and UTI, as warned by the American Diabetes Association and the American College of Physicians 8, 6
Avoid oral hypoglycemic agents during acute illness, especially if patient has impaired oral intake, in patients with uncontrolled diabetes and UTI, as recommended by the American Diabetes Association 2
Never discontinue insulin completely in patients with type 1 diabetes, even when infection resolves, as warned by the American Diabetes Association 4, 3
Avoid targeting overly strict glycemic control (<140 mg/dL) during acute illness as this increases risk of hypoglycemia in patients with uncontrolled diabetes and UTI, as warned by the American College of Physicians and the American Diabetes Association 6, 7