Assessment of the clinical outcome of a symptom-based outpatient hyperglycemia protocol

Acute hyperglycemia (blood glucose [BG] ≥400 mg/dL) is common in primary care. An outpatient protocol was developed to streamline the treatment of acute hyperglycemia. The objective was to determine if an outpatient hyperglycemia protocol could achieve a BG level of <300 mg/dL within 4 hours.

Adult diabetic patients with acute symptomatic hyperglycemia (>400 mg/dL) without acute illness were recruited. Enrolled patients were managed with a protocol that included administration of 0.15 units/kg rapid-acting insulin given subcutaneously, hydration, hourly fingerstick blood sugars (FSBS), laboratory assessment, tailored diabetes education, and follow-up within 72 hours. Independent variables for data analysis included age, baseline FSBS, sodium, potassium, chloride, blood urea nitrogen, serum creatinine, CO(2), venous glucose, and etiology (medications, diet, personal stress).

For the 27 patients enrolled, the average initial FSBS level (n=23) was 484 mg/dL, the average final FSBS level (n=27) was 274 mg/dL, and average time to achieve BG levels of <300 mg/dL was 2.35 hours. The protocol was successful in 20 patients (74%). The causes for seven protocol failures were nonclinical in nature. The patients' weight and total time to goal were significantly associated with odds of protocol success. Personal stress significantly correlated with protocol failure. The protocol success group had a higher sodium level than the failure group (P=0.01). Weight and baseline BG showed decreased odds of protocol success (P=0.05 and P=0.04, respectively).

Results of this pilot study suggest acute hyperglycemia without other acute illness can be managed on an outpatient basis. Outpatient interventions to addres s acute hyperglycemia need further investigation. Managing acute hyperglycemia in the outpatient setting could potentially decrease hospital admissions for hyperglycemic hyperosmolar syndrome and mild diabetic ketoacidosis.