Case history
Case history #1
A 56-year-old woman with no known history of diabetes is admitted to hospital for shortness of breath, fever, and a productive cough. Her vital signs are as follows: temperature 38.5°C (101.4°F); blood pressure 90/60 mmHg; pulse 110 beats per minute (bpm); respiratory rate 22 breaths per minute; and oxygen saturation 89% on ambient air. Chest x-ray obtained in the emergency department reveals a right lower lobe consolidation. Intravenous hydration and appropriate antibiotics for empirical treatment of lobar pneumonia are initiated. Her admission metabolic panel reveals a glucose level of 14.0 mmol/L (252 mg/dL).
Case history #2
A 55-year-old man presents to the emergency department with a 1-day history of intermittent chest discomfort. It is characterised as sharp and radiating down his left arm. He has obesity, but there are no other notable findings on examination. An ST-elevation myocardial infarction is diagnosed, and he is taken to the catheterisation lab, where he undergoes successful percutaneous coronary intervention. Post-procedure, he is admitted to the cardiac care unit for further care. His laboratory results are notable for a random glucose of 11.2 mmol/L (201 mg/dL) on admission. Two days later, fasting blood glucose is 6.4 mmol/L (115 mg/dL), and HbA1c is 43 mmol/mol (6.2%).
Other presentations
Inpatient hyperglycaemia can present in various clinical contexts. Some patients have a known history of diabetes prior to admission. Others may be newly diagnosed during hospitalisation, with hyperglycaemia that persists even after the presumed trigger has resolved. In some cases, hyperglycaemia is transient and related to specific factors such as corticosteroid therapy.
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