Diabetes Unscheduled Care Pathway - Hyperglycaemia

This is a visual flowchart of the pathway for more pathway information, such as details on assessment and diagnosis see the Clinical Guidance tab.

Patients currently known to secondary care should be referred back to the Diabetes Team at Gloucestershire Hospitals NHS Foundation Trust. - see 'Services and Referrals'


Hyperglycaemia - further pathway information - presentation, diagnosis and management

Hyperglycaemia Clinical Guidance consists of -

  • Overview
  • Presentation
  • Diagnosis
  • Management


Patients requiring hospital admission for hyperglycaemia should be stratified into one of the five groups detailed in the diagnosis below.This will better identify those patients who must be admitted to hospital and those who can be managed within the community.


  • Clinically unwell with hyperosmolar symptoms or ketones in their urine - Hyperglycaemia and acutely unwell Type 1
  • Clinically unwell,infection, (consider infection, underlying illness or missed medication doses) -Hyperglycaemia and acutely unwell Type 2
  • Unwell but are medically stable, these patients include those newly diagnosed with T1DM - Acute hyperglycaemia but medically well
  • clinically well with hyperglycaemia


Diagnosis of Hyperglycaemia - BM>13mmol/L


Hyperglycaemia and acutely unwell Type 1 -Advice should be sought from the on call team at GHNHSFT and admission may be required for assessment. This includes patients with symptoms of  Diabetic Ketoacidosis (DKA).

Hyperglycaemia and acutely unwell Type 2 -Consider discussion with on call team at GHNHSFT. Consider Hyperosmolar Hyperglycaemic State (HSS) in patients with infection and hyperglycaemia.

Acute hyperglycaemia but medically well -assessed by Acute Diabetes Team within 24 hours. If suitable the patient could be seen in outpatients. Contact the diabetes consultant secretary in working hours.  The protocol for this patient is for hospital diabetes review the same day or early the following day. Out of hours contact should be made with the medical registrar on call who can arrange follow up within 24 hours.

Hyperglycaemia in the frail/elderly and medically stable - pateints should remain within their current accommodation and may be referred to the Community Diabetes Service (CDS) who will support the GP in improving glycaemic management.

Hyperglycaemia but stable -Patients who are clinically well with hyperglycaemia should not be admitted to the GHNHSFT. Patients with raised glucose levels or suboptimal HbA1c should be managed by their GP team with or with support from the Community Diabetes Service.