Very high BGL .... thoughts?

KitkatPRN · Nov 13, 2012

I'm thinking cancer, too. The family (wife, mainly) is wish-washy in regards to starting comfort measures, which has been brought up to her many times by the NP, MD & nurse manager. When I worked last night, he was in the 550's, given 10 units regular insulin, 3 hours later was still in the mid 500's, had not eaten anything & was taking in fluids. It's just so frustrating not to at least get the blood sugars where they need to be for him. I'm hoping the tests show something today but I'm not holding my breath. Thanks for the input !! :down:

Esme12, ASN, BSN, RN · Nov 13, 2012

I'm thinking cancer, too. The family (wife, mainly) is wish-washy in regards to starting comfort measures, which has been brought up to her many times by the NP, MD & nurse manager. When I worked last night, he was in the 550's, given 10 units regular insulin, 3 hours later was still in the mid 500's, had not eaten anything & was taking in fluids. It's just so frustrating not to at least get the blood sugars where they need to be for him. I'm hoping the tests show something today but I'm not holding my breath. Thanks for the input !!

What is he drinking? What liquid is he drinking that can elevate his glucose?

As someone has already said..the elderly are more prone to HHS -- hyperosmolar hyperglycemic state. The cause of his diaeties is just that his body and it's systems are old and don't work anymore.

Hyperosmolar hyperglycemic state is a complication of diabetes mellitus (usually Type II) in which high blood sugars cause severe dehydration, increases in osmolarity (relative concentration of solute) and a high risk of complications, coma and death. It is related to diabetic ketoacidosis (DKA), another complication of diabetes more often (but not exclusively) encountered in people with type 1 diabetes; they are differentiated with measurement of ketones, that are the underlying driver for DKA but are usually not detectable in HHS.

The treatment of HHS consists of correction of the dehydration with intravenous fluids, reduction of the blood sugar levels with insulin, and management of any underlying conditions that might have precipitated the illness, such as an acute infection.Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - American Diabetes Association

Older names for HHS are hyperosmolar non-ketotic coma (HONK), nonketotic hyperosmolar coma, hyperosmolar hyperglycemic nonketotic syndrome (favored by the American Diabetes Association

The increasing hemoconcentration and volume depletion can result in:

Disordered mental functioning.
Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flaccidity, depressed reflexes, tremors or fasciculations.
Hyperviscosity and increased risk of thrombosis
Ultimately, if untreated, will lead to death

Is his dementia really dementia or a symptom of undiagnosed HHS from untreated Type II Diabeties

Hyperosmolar hyperglycemic state (HHS) Medscape: Medscape Access medscape requires registration but it is FREE and an excellent resource.

HHS most commonly occurs in patients with type 2 DM who have some concomitant illness that leads to reduced fluid intake. Infection is the most common preceding illness, but many other conditions can cause altered mentation, dehydration, or both. Once HHS has developed, it may be difficult to differentiate it from the antecedent illness. The concomitant illness may not be identifiable. (See Etiology.) HHS has also been reported in patients with type 1 DM, in whom DKA is more common.
HHS usually presents in older patients with type 2 DM and carries a higher mortality than DKA, estimated at approximately 10-20%

DSkelton711 · Nov 14, 2012

I had a resident who was diagnosed late in life, also. Her blood sugars would be in the 400s to 600s everyday for weeks. Kept calling the doctor, who repied "thanks". All of a sudden her blood sugars were in the 200 range and going lower. Don't know how to explain it, but glad we didn't over do it and end up with critical low values. Not saying this is what is happening with your resident, but just sharing. Hope something isn't being missed. Keep on calling the doc and monitoring for concerning symptoms.

Trekfan · Nov 14, 2012

When I worked last night, he was in the 550's, given 10 units regular insulin,

You might want to call an endo doc .10 units is nothing! I just used 26 units for bs of 250.

sapphire18 · Nov 14, 2012

You might want to call an endo doc .10 units is nothing! I just used 26 units for bs of 250.

Whoa.

KitkatPRN · Nov 14, 2012

The dementia was diagnosed ten years ago and is lewy body dementia. He has only been drinking supplement drinks lately. NP saw him today, upped his sliding scale. He had a lot of his meds d/c'd today with comfort focused care. Labs today show high sodium, not a surprise with the high blood sugars. There will be no more testing for underlying problems (cancer, etc). Thanks agian for the input, everyone !! (BGLs tonight in the mid 100's, thank goodness)

Anna Flaxis, BSN, RN · Nov 14, 2012

Thank you for the update, and I'm glad he's getting palliative care! It really sounds like the right thing for this gentleman.

Esme12, ASN, BSN, RN · Nov 14, 2012

I know Lewy Body Dementia....thanks of the update..... I like it when postes come back and let us know.

squatmunkie_RN · Nov 14, 2012

Novolog TID with meals usually solves that.

ClearBlueOctoberSky · Nov 18, 2012

Are the supplementals sugar free? Even if they are, they might still cause increases in the BGLs.

KitkatPRN · Nov 19, 2012

Thank you for the responses. This gentleman did pass peacefully yesterday. His care was comfort focused for the last week, with family and MD making this choice.

Esme12, ASN, BSN, RN · Nov 20, 2012

Ahhhh....may thoughts are for his family. Bless you for caring so much!