Should I admit?

Individual illnesses which may complicate diabetes have their own admission criteria, this page aims to define the criteria relating to diabetes itself which merit acute hospital assessment with/ without admission

Insulin using patient unable to eat and drink because of nausea/vomiting greater than 12hours (will usually require intravenous therapy – even if short-term)

Possibility of impending hyperglycaemic emergency diabetes ketoacidosis (DKA) or hyper osmolar nonketotic coma (HONK) (see High sugars section)

Spreading sepsis in diabetic patient

Hypoglycaemia – severe (requiring assistance from others) poorly responsive to first line measures or persistent (especially if any persisting impairment of Glasgow Coma Scale), severe hypoglycaemia (especially if with coma) arising in oral-treated diabetes (risk of recurrence). Hypoglycaemia occurring in the setting of impaired renal function/ addisons disease / hypothyroidism

Hyperglycaemia – the level of glucose above normal is rarely an admission trigger on its own, unless the individual is significantly unwell clinically.

Acute blood glucose elevations above 25 associated with any systemic symptoms should however prompt urgent biochemical assessment with/without assessment for ketones (in type 1). See table for biochemical admission triggers.

Admit or Send immediately for Hospital Assessment:
Any patient with Type 1 diabetes vomiting and unable to keep down fluids for >12hrs
Any Patient with Type 1 diabetes vomiting and with impaired conscious level
Any Patient with Type 1 diabetes vomiting and with urine ketones 2+ or greater (or plasma ketones > 3mmol/L)
Biochemical Triggers for Admission (on assessment of an ill patient with Diabetes)
Glucose	Plasma Ketones	pH	Bicarb	Na
>25	>3	<7.2	<15	<120 >150
One such value is a trigger to consider admission
Two such values should always result in admission