Primary prevention

In the majority of patients, HHS evolves over several days and so frequent blood glucose monitoring may help to recognize patients at risk, especially in older patients and in those in long-term care facilities.

Many episodes could be prevented through education and effective outpatient treatment programs. Patients and family members should be educated about the following:[1]

  • Symptoms or blood sugar readings that should prompt the patient to contact the diabetes care team

  • The importance of insulin use during an illness, and never discontinuing insulin without contacting their healthcare provider

  • Frequent monitoring of blood sugars (i.e., at least every 3-4 hours including overnight; this is especially important in children)[40]

  • Blood glucose goals and the use of supplemental short- or rapid-acting insulins to correct elevated blood sugars

  • Initiation of an easily-digestible, liquid carbohydrate diet when nauseated

  • Availability of antipyretics and medication to treat infection.

All patients with diabetes, as well as patients with HIV or schizophrenia, and their caregivers should receive education about medications that may cause or worsen hyperglycemia.[29][32]

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