Diabetes at the front door. A guideline for dealing with glucose related emergencies at the time of acute hospital admission from the Joint British Diabetes Society (JBDS) for Inpatient Care Group

People with diabetes account for nearly one‐fifth of all inpatients in English and Welsh hospitals; of these, up to 90% are admitted as an emergency. Most are admitted for a reason other than diabetes with only 8% requiring admission for a diabetes‐specific cause. Healthcare professionals working in emergency departments experience numerous clinical challenges, notwithstanding the need to know whether each individual with diabetes requires urgent admission. This document has been developed and written by experts in the field, and reviewed by the parent organizations of the Joint British Diabetes Societies for Inpatient Care—Diabetes UK, the Diabetes Inpatient Specialist Nurse Group and the Association of British Clinical Diabetologists. The document aims to support staff working in emergency departments and elsewhere by offering practical advice and tools for effective, appropriate and safe triage. Each section relates to the commonest diabetic specific emergencies and algorithms can be printed off to enable ease of access and use. What’s new? About one in six acute hospital beds in the UK is occupied by someone with diabetes, over 80% of whom are admitted as an emergency not related to their diabetes. This guideline is aimed at teams working in areas where acute admissions occur to help them appropriately manage glucose‐related emergencies. It looks at the acute management of those known to have diabetes and those at risk of developing dysglycaemia. Areas covered are hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, the diabetic foot, end of life care and how to deal with an unknown insulin regimen in an acutely unwell individual.