Persistent BG >180 mg/dL without DKA/HHS criteria; common in poorly controlled diabetes.
History taking
- • Adherence, diet, infection
- • New steroids, illness
- • Symptoms of DKA/HHS
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Ketonuria + acidotic breathing → DKA
- • Drowsiness, severe dehydration → HHS
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Random BG, urinary ketones
- • VBG if symptomatic
- • HbA1c, infection workup
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Hydration, identify trigger
- • Up-titrate / restart insulin
- • Treat infection
Drug therapy
- • Add basal insulin 0.1–0.2 U/kg if HbA1c >9%
- • SGLT2i / GLP-1 RA as add-on
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Admit if DKA / HHS / vomiting
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
