An elderly client with type 2 diabetes is admitted to the medical unit due to urosepsis

Sepsis and septic shock are medical emergencies and must be treated immediately.

It's likely you'll be admitted to an intensive care unit (ICU) for urgent treatment and to carefully monitor your progress. In some cases treatment may begin in the emergency department.

Oxygen therapy

To help you breathe more easily, you'll be given oxygen through a face mask, a tube inserted into your nose, or an endotracheal tube inserted into your mouth. If you have severe shortness of breath, a mechanical ventilator may be used.

Increasing blood flow

You'll probably be given fluids directly into a vein. This will help raise your blood pressure by increasing the amount of fluid in your blood.

To increase the blood flow to your vital organs, such as your brain, liver, kidneys and heart, you may be prescribed inotropic medicines or vasopressors.

Inotropic medicines 

Inotropic medicines (inotropes), such as dobutamine, stimulate your heart. They increase the strength of your heartbeat, which helps get oxygen-rich blood to your tissues and organs, where it's needed.

Vasopressors

Vasopressors include:

• dopamine
• adrenaline
• noradrenaline

These medicines will cause your blood vessels to narrow, increasing your blood pressure and the flow of blood around your body. This will allow your vital organs to start functioning properly.

Antibiotics

Antibiotics are often used to treat the associated bacterial infection. The type of antibiotic used depends on the type of bacterial infection and where in the body the infection started.

You may be started on antibiotics immediately to increase your chances of survival. Initially, two or three types of antibiotics may be used. The most effective type of antibiotic can be used once the bacterium responsible for the infection is identified.

Surgery

In severe cases of sepsis or septic shock, the large decrease in blood pressure and blood flow can kill organ tissue. If this happens, surgery may be required to remove the dead tissue.

Diagnosis

Your health care provider sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals:

• Between 80 and 120 milligrams per deciliter (mg/dL) (4.4 and 6.7 millimoles per liter (mmol/L)) for people age 59 and younger who have no medical conditions other than diabetes
• Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for:
  • People age 60 and older
  • Those who have other medical conditions, such as heart, lung or kidney disease
  • People who have a history of low blood sugar (hypoglycemia) or who have difficulty recognizing the symptoms of hypoglycemia

For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:

• Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals
• Less than 180 mg/dL (10 mmol/L) two hours after meals

Your target blood sugar range may differ, especially if you're pregnant or you have other health problems that are caused by diabetes. Your target blood sugar range may change as you get older. Sometimes, reaching your target blood sugar range can be a challenge.

Home blood sugar monitoring

Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your target range. Check your blood sugar as often as your health care provider recommends.

If you have any symptoms of severe hyperglycemia — even if they seem minor — check your blood sugar level right away.

If your blood sugar level is 240 mg/dL (13.3 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. Talk to your health care provider about how to lower your blood sugar level safely.

Hemoglobin A1C test

During an appointment, your health care provider may conduct an A1C test. This blood test shows your average blood sugar level for the past 2 to 3 months. It works by measuring the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells, called hemoglobin.

An A1C level of 7% or less means that your treatment plan is working and that your blood sugar was consistently within a healthy range. If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan.

For some people, especially older adults and those with certain medical conditions, a higher A1C level of 8% or more may be appropriate.

How often you need the A1C test depends on the type of diabetes you have and how well you're managing your blood sugar. Most people with diabetes receive this test 2 to 4 times a year.

Treatment

Home treatment

Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. Your health care provider may suggest the following:

• Get physical. Regular exercise is often an effective way to control blood sugar. But don't exercise if you have ketones in your urine. This can drive your blood sugar even higher.
• Take your medication as directed. If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication.
• Follow your diabetes eating plan. It helps to eat smaller portions and avoid sugary beverages and frequent snacking. If you're having trouble sticking to your meal plan, ask your health care provider or dietitian for help.
• Check your blood sugar. Monitor your blood glucose as directed by your health care provider. Check more often if you're sick or if you're concerned about severe hyperglycemia or hypoglycemia.
• Adjust your insulin doses. Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. A supplement is an extra dose of insulin used to help temporarily correct a high blood sugar level. Ask your health care provider how often you need an insulin supplement if you have high blood sugar.

Emergency treatment for severe hyperglycemia

If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital. (4p4) Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes:

• Fluid replacement. You'll receive fluids — usually through a vein (intravenously) — until your body has the fluids it needs. This replaces fluids you've lost through urination. It also helps dilute the extra sugar in your blood.
• Electrolyte replacement. Electrolytes are minerals in your blood that are necessary for your tissues to work properly. A lack of insulin can lower the level of electrolytes in your blood. You'll receive electrolytes through your veins to help keep your heart, muscles and nerve cells working the way they should.
• Insulin therapy. Insulin reverses the processes that cause ketones to build up in your blood. Along with fluids and electrolytes, you'll receive insulin therapy — usually through a vein.

As your body returns to normal, your health care provider will consider what may have triggered the severe hyperglycemia. Depending on the circumstances, you may need additional tests and treatment.

Preparing for your appointment

If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. Your provider can help you make changes to better manage your diabetes.

Here's information to help you get ready for your appointment and know what to expect from your health care provider.

What you can do

• Be aware of any pre-appointment restrictions. If your health care provider is going to test your blood sugar, you may need to stop eating or drinking anything but water for up to eight hours before your appointment. When you're making an appointment, ask if there are any restrictions on eating or drinking.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you take.
• Create a record of metered glucose values. Give your health care provider a written or printed record of your blood glucose values, times and medication. Using the record, your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.
• Write down questions to ask your health care provider. If you need more information about your diabetes management, be sure to ask.
• Check if you need prescription refills. Your health care provider can renew your prescriptions while you're at the appointment.

For hyperglycemia, questions you may want to ask include:

• How often do I need to monitor my blood sugar?
• What is my target range?
• How do diet and exercise affect my blood sugar?
• When do I test for ketones?
• How can I prevent high blood sugar?
• Do I need to worry about low blood sugar? What are the symptoms I need to watch for?
• Will I need follow-up care?

Sick-day planning

Illness or infections can cause your blood sugar to rise, so it's important to plan for these situations. Talk to your health care provider about creating a sick-day plan. Questions to ask include:

• How often should I monitor my blood sugar when I'm sick?
• Does my insulin injection or oral diabetes pill dose change when I'm sick?
• When should I test for ketones?
• What if I can't eat or drink?
• When should I seek medical help?

Aug. 20, 2022