Diabetes Mellitus in Hospitalized Patients

General Principles

Diabetes-specific Indications for Hospitalization

  • Diabetic ketoacidosis (DKA) is characterized by a plasma glucose level of >250 mg/dL (13.9 mmol/L) in association with an arterial pH <7.30 or serum bicarbonate level of <15 mEq/L and moderate ketonemia or ketonuria; however, patients may present with ketoacidosis and lower glucose levels.
  • Hyperosmolar hyperglycemic state (HHS) includes marked hyperglycemia (≥600 mg/dL [33.3 mmol/L]) and elevated serum osmolality (>320 mOsm/kg), often accompanied by impaired mental status.1
  • Hypoglycemia is an indication for hospitalization if it is induced by a sulfonylurea (SFU) medication, is due to a deliberate drug overdose, or results in coma, seizure, injury, or persistent neurologic change.
  • Newly diagnosed T1DM or newly recognized GDM can be indications for hospitalization, even in the absence of ketoacidosis.
  • Patients with T2DM are rarely admitted to the hospital for initiation or change in insulin therapy unless hyperglycemia is severe and associated with mental status change or other organ dysfunction.

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