Is there a hard and fast rule as to when you should be seen in emergency for blood glucose being too high? Is there anything the hospital can do if your blood sugar is really high that you can’t do on your own? Is high bg without ketones serious? Or is ketones what is the real cause for concern?
I had this question as well. I wasn’t feeling well this week and my blood sugars were running high (in the 200s) and I had trace to moderate ketones. I just drank a ton of water and that did the trick, but I was wondering how bad is bad to warrant a visit to the ER?
I have had some severely high blood sugars (reading high 20s or HI) and large ketones when I have pump problems (no delivery or a bent cannula), and have never gone to the hospital even though it makes me feel pretty sick. I think I would go to the hospital if I could not hold down food or liquid and had very high or low blood sugar, and/or a really high BG and ketones that lasted more than a few hours despite efforts to lower it (insulin, drinking water, etc.).
This is what I commonly see some Endo’s recommend. If you are too sick to hold fluids down it is time for the hospital. The other thing you might want to factor in is why the blood sugars are too high. If it is from an infusion set problem it is probably something you can take care of. If it is from an infection it may not be so easy to deal with and this circumstance would probably warrant an ER visit.
A hospital becomes necessary when you start to exhibit symtoms of DKA. If you are spilling ketones in a small amount, that’s not too bad. If you are sick, can’t keep anything down you should get thee to the hospital. Otherwise, you can use correction boluses to bring yourself back into range.
Agree with Pete.
I would say if your bg was very high with more than moderate ketones and it wasn’t coming down within about 4-5 hours of insulin and lots of water especially if you have any of the signs of DKA.
Thanks everyone. This is really good advice. I should’ve prefaced this discussion by saying I’m not sick right now. But I was about a month ago and had unexplained high blood sugars high teens to 20s for almost a week but no ketones. I took more insulin, etc., and it just went away.
you might double check this with your endo
- three days in a row over 270 (or 15 mmol)
- over 400 (22 mmol) and not coming down
High doesn’t concern me too much (even a HI on the meter, which I had recently due to downing 3 not-so-diet cokes at a restaurant without realizing they were regular) as long as I have caught the problem fairly quickly and I can both bring down the BG and flush out the ketones… but any # with large ketones that I can’t bring down on my own, then I’ll go in… which means that I’ve even gone in with relatively normal BG, but if I’ve had high ketones for more than about 8 hours, that is my threshold and I’ll go to the ER for fluids (which is usually all it takes to get rid of the ketones - it almost always happens when I have a stomach virus, because the lack of food + vomiting leaves me very dehydrated, and the ketones cause MORE nausea… it’s a nasty cycle and I’ve found it very difficult to break on my own).
If I had high ketones + high BG and didn’t feel I could manage it myself (such as if I were already pretty sick), I would go in sooner.
I should also add that in 10+ years of T1, I’ve only gone to the ER for fluids 4 times… and never for full-blown DKA. Honestly there’s no harm in going in if you aren’t in DKA - if that move actually prevents DKA. I would rather do that than get sicker first 
Kelly,
Hi bd you can work with. Ketones is a different story and if you can’t control them you will end up with an IV. You will start vomiting and not able to hold down food or fluids and become dehydrated. KETOACIDOSIS or DKA bad bad bad
As a diabetic with numerous decades of experience, my answer will likely be radically different than a beginners.
The simple answer to all your questions, if you do not believe you can cope with what is happening… THEN GO.
If you think you can cope, stay put.
Insulin requires time to work against either ketones or sugar. It works no faster at the ER than it does at home. If you are becoming disoriented, vomiting endlessly, go. If not see sentence two above!
Stuart
Ketones are definitely the immediate concern. You can try for a while to bring them down, but if you start feeling sick or they aren’t clearing and/or continue to rise after 6 hours or so then you should consider an emergency walk-in clinic or ER if your doctor can’t see you or isn’t set up to manage your situation.
High bg isn’t an immediate concern, but it can become one. Very high bg without ketones can still cause a hyperosmolar hyperglycemic state that can lead to a coma. Once your meter reads high, you can’t really be sure where you’re at. You still have time to bring it down on your own, but anything more than the usual signs of a high and you should seek help, especially if you have trouble staying awake.
If it’s during the day, I’d definitely recommend checking with your PCP/endo or going to an emergency walk-in clinic. Depending on the severity of the case, they may be able to treat you onsite without the waits and hassles that the ER brings. My brother was treated with iv saline and insulin at his PCPs office for a mild case. The fact that they can administer both insulin and fluids iv is a pretty compelling reason to go when you start feeling uncomfortable.
Actually, insulin does work faster at the hospital, provided they give it to you intravaneously…I just got out yesterday morning after not being able to get my blood sugar under 200 all day Tuesday. I stopped eating at noon after realizing my numbers weren’t going down, started drinking water, changed my pod, opened a new vial of insulin and changed pods again, kept cranking up the insulin amounts…nothing was working. I wasn’t spilling any ketones at all, but I felt horrible and by late afternoon I was vomiting. Went to the ER, and after waiting 2.5 hours finally got a finger stick from them which was 227 (consistent with what it had been all day, ranging from 200-270) and a pee test (still 0 ketones)…they gave me a saline drip and 2 units of insulin via IV, and I was at 109 in 1/2 hour. (The doc had ordered 6 units but I told them I’m usually extremely insulin sensitive (1 unit usually drops me 100 pts) so they only gave me the 2 to start, and it ended up being all it took. Thank goodness I asked about it!)
Anyway, if you’re feeling lousy and you can’t get it to come down on your own after a long enough time period, go to the hospital, regardless of whether or not you’re spilling ketones yet.
Jeska, I see your on the POD. I’ve been on the minimed pump for 6 years and was thinking about changing to the POD. Can you share how the POD has worked for you? I hear so much good and bad stuff about it…
I’d add that I used to do IV R shots pretty regularly and, like Jeska, they’d buzz me down from 300 to 70 in like 1/2 hour. I presume that it is very dangerous to do this w/o doctors, etc. around however I was always very frustrated with the pace of R s-l-o-w-l-y dropping BG when they were high.
I’d probably fight highs for at least a couple of days before I’d think about going to a hospital/ doctor/ ER for it.
I’m confused. In 36 years I don’t think I’ve ever been sick from too high of a blood glucose. It’s been as high as 300 or more but I don’t ever remember being sick? Does this happen a lot or are you talking about high in the 500 or 600’s ??? When I was diagnosed at over 600 I don’t think I was “sick” Just felt like crap and drinking and peeing a lot. Does this happen often? I never test for ketones I just try and get my BG down as quickly as possible. I would never even consider going to the hospital for 200’s it would have to be that high for weeks and then probably just call my endo before going to the ER.
I’ve been Type 1, on insulin since I was four years old in 1959. I have only been to the hospital once for diabetes and that was when I was diagnosed in '59. I have had one rescue squad visit only because I had the flu and my BG dropped (below 20 so the squad said) after several days of not eating. I have never checked for Ketones since they can only affect you over long periods of time. So if I go high into the upper 200s or 300 I take insulin and bring it back down within several hours. No biggie for me.
Well, Dr. Bernstein actually tells you how to do intramuscular injection for correction. While not intravenous, it does significantly increase the rapidity of onset. Here is a video of him showing how to do an IM injection. Remember, this technique is suggested for correction, not bolus injections.
I love it. I’ll be the first to admit that I’m incredibly vain, so I didn’t want tubing hanging all over and belt clips and extra pockets sewn on my clothes…and I almost didn’t go for the Pod, either because it’s so bulky. BUT I’m glad I did. My numbers have impoved dramatically, from an a1c of 11+% on injections (I have a pretty nasty phobia that prevented me from doing my injections a lot of the time, even after swutching from syringes to pens) to hovering just over 8% since going on the Pod 7 months ago. Still not where I want it, but MUCH better. I love the fact that it’s tubeless and waterproof (for my intents and purposes - I don’t scuba dive or anything lol). My only issue is that I’m allergic to the material the cannula is made of, so I have to change Pods every 2 days in order to keep the reaction in check. Not a big deal. Love love LOVE the Pod.