Diabetes Mellitus | Guidelines for Hospital Admission

 

Laboratory definitions for problems in glycemic control:

(1) hypoglycemia: < 50 mg/dL (2.8 mmol/L)

(2) fasting hyperglycemia: > 300 mg/dL (> 16.7 mmol/L)

 

Conditions justifying hospital admission for a diabetic:

(1) acute metabolic complications of diabetes mellitus (diabetes ketoacidosis, hyperosmolar nonketotic state, hypoglycemia with neuroglycopenia)

(2) uncontrolled diabetes

(3) complications of diabetes or when an acute medical condition affects glycemic control

(4) special management situations

 

Diabetic ketoacidosis - all of the following:

(1) plasma glucose > 250 mg/dL (> 13.9 mmol/L)

(2) arterial pH < 7.30

(3) serum bicarbonate < 18 mEq/L

(4) ketonuria and/or ketonemia

 

Hyperosmolar nonketotic state - all of the following:

(1) impaired mental status

(2) elevated plasma osmolality (> 320 mOsm/kg)

(3) severe hyperglycemia (> 600 mg/dL; > 33.3 mmol/L)

 

Hypoglycemia with neuroglycopenia - hypoglycemia plus one or more of the following:

(1) treatment of hypoglycemia has not resulted in prompt recovery of the sensorium

(2) coma, seizures or altered behavior

(3) a responsible adult cannot be with the patient for the next 12 hours (observation status)

(4) hypoglycemia caused by a sulfonylurea drug

 

Uncontrolled diabetes - one or more of the following:

(1) hyperglycemia associated with volume depletion

(2) persistent refractory hyperglycemia associated with metabolic deterioration

(3) recurrent fasting hyperglycemia refractory to outpatient therapy or with a glycated hemoglobin >= 100% above the upper limit of normal (>= 2 times ULN)

(4) recurring episodes of severe hypoglycemia despite interventions

(5) metabolic instability manifested by frequent swings between hypoglycemia and fasting hyperglycemia

(6) recurring diabetic ketoacidosis without precipitating infection or trauma

(7) repeated absence from work or school due to severe psychosocial problems causing poor metabolic control that cannot be managed as an outpatient basis

 

Complications of diabetes:

(1) another condition with diabetes as a confounding factor

(2) rapid initiation of rigorous control of diabetes can improve outcome, such as diabetes during pregnancy

(3) an underlying condition or its management may result in major deterioration of diabetic control

(4) acute onset of a diabetic complication (retinal, renal, neurological, cardiovascular)

(5) end-stage chronic organ dysfunction (end stage renal failure, cardiomyopathy): admission criteria are based on the end organ damage

 

Other:

(1) newly diagnosed diabetes in children and adolescents

(2) institution of insulin pump therapy