In the majority of patients, hyperosmolar hyperglycaemic state evolves over days to weeks, and so frequent blood glucose monitoring may help recognition of patients at risk, especially in older people and in those in long-term care facilities.
In the UK, intermittently scanned continuous glucose monitoring (isCGM, or 'flash' monitoring) should be offered to patients with type 2 diabetes if:[44]
They have recurrent hypoglycaemia or severe hypoglycaemia
They have impaired hypoglycaemia awareness
They have a condition or disability that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them), or
They would otherwise be advised to self-measure at least eight times a day.
Many episodes could be prevented through education and effective outpatient treatment programmes. Patients and family members should be educated about the following:[1]
Which symptoms or blood sugar readings 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 2-4 hours if they are unwell)[4]
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.
All patients with diabetes, as well as patients with HIV or schizophrenia, and their carers should receive education about medications that may cause or worsen hyperglycaemia.[1][11][45]