6.0.0.0 IN­TER­CUR­RENT ILL­NESS

For fur­ther in­for­ma­tion on man­age­ment of pa­tients with hy­per­glycemia in the hos­pi­tal, please refer to Sec­tion 15 “Di­a­betes Care in the Hos­pi­tal.

Stress­ful events (e.g., ill­ness, trau­ma, surgery, etc.) may wors­en glycemic con­trol and pre­cip­i­tate di­a­bet­ic ke­toaci­do­sis or non­ke­tot­ic hy­per­glycemic hy­per­os­mo­lar state, life-‍threat­en­ing con­di­tions that re­quire im­me­di­ate med­i­cal care to pre­vent com­pli­ca­tions and death. Any con­di­tion lead­ing to de­te­ri­o­ra­tion in glycemic con­trol ne­ces­si­tates more fre­quent mon­i­tor­ing of blood glu­cose; ke­to­sis-‍prone pa­tients also re­quire urine or blood ke­tone mon­i­tor­ing. If ac­com­pa­nied by ke­to­sis, vom­it­ing, or al­ter­ation in the level of con­sciousness, marked hy­per­glycemia re­quires tem­po­rary ad­just­ment of the treat­ment reg­i­men and im­me­di­ate interac­tion with the di­a­betes care team. The pa­tient treat­ed with nonin­sulin ther­a­pies or med­i­cal nu­tri­tion ther­a­py alone may re­quire in­sulin. Ad­e­quate fluid and caloric in­take must be en­sured. In­fec­tion or de­hy­dra­tion is more like­ly to ne­ces­si­tate hos­pi­tal­iza­tion of the per­son with di­a­betes than the per­son with­out di­a­betes.

A physi­cian with ex­pertise in di­a­betes man­age­ment should treat the hos­pi­talized pa­tient. For fur­ther in­for­ma­tion on the man­age­ment of di­a­bet­ic ke­toaci­do­sis and the non­ke­tot­ic hy­per­glycemic hy­per­os­mo­lar state, please refer to the ADA con­sen­sus re­port “Hy­per­glycemic Crises in Adult Pa­tients With Di­a­betes” (60).