Case of the Month #47 A Sugar High

Published 21/03/2024


Theme: Diabetes, endocrinology, hyperglycaemia 

A 61-year-old gentleman presents to the Emergency Department with increased urinary frequency, thirst, nausea and is drowsy. The patient has recently been discharged from the hospital following an admission for a bilateral pneumonia. He has a past medical history of type 2 diabetes, COPD and hypertension.   


On assessment his observations are as follows  

HR 120  

BP 100/65mmHg    

SpO2 94% Room Air  

GCS 13/15 (E3 V4 M6)  

Temp 37.1  

He appears clinically dry and has a prolonged CRT (4 secs).   


A Venous Blood Gas demonstrates the following abnormalities.  

pH 7.30  

Glucose 46 mmol/l  

Blood Ketones are recorded as 0.1mmol/l.  


His wife says he has recently been started on insulin, after several years of treatment with oral hypoglycaemic agents, however she feels he has not been very compliant with his treatment.   

A critical care opinion is requested by the ED Team.