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?

Tags: blood, emergency, high, hyperglycemia, ketone, sugar

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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
1) three days in a row over 270 (or 15 mmol)
20) 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
I got about the same answer a year ago, when I had moderate ketones and >200 BS a whole night. He said, I could go to the hospoital if I didn't feel secure enough to cope on my own, otherwise he would be fine with letting me go home. So I went to the hospital, which made me feel much safer.

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