Recognising Hyperglycaemia for Student Nurses
Learn how to recognise high blood glucose, identify common symptoms and understand when hyperglycaemia may form part of a more serious pattern of patient deterioration.
What is hyperglycaemia?
Hyperglycaemia means that the concentration of glucose in the blood is higher than the patient's intended range. The significance depends on the result, the patient's usual glucose control, symptoms and clinical context.
Increased thirst
The patient may report being unusually thirsty or drinking more frequently.
Passing urine more often
Increased urinary frequency may occur when blood glucose is significantly elevated.
Fatigue or weakness
The patient may feel tired, weak or generally unwell as glucose control worsens.
Symptoms may develop gradually
Unlike some acute emergencies, hyperglycaemia may evolve over hours or days. Comparing the current situation with the patient's previous glucose levels and condition can therefore be important.
Look for more than the glucose number
| Finding | What you may notice | Why it matters |
|---|---|---|
| Persistent thirst | The patient reports drinking much more than usual. | This can accompany significant hyperglycaemia and fluid loss. |
| Frequent urination | The patient passes urine more often than usual. | Increased urinary losses can contribute to dehydration. |
| Dryness or dehydration | Dry mouth, thirst, weakness or other signs of fluid depletion. | Dehydration can contribute to wider physiological deterioration. |
| Nausea or vomiting | The patient becomes nauseated or begins vomiting. | Gastrointestinal symptoms alongside hyperglycaemia increase concern. |
| Altered breathing | Respiratory rate or breathing pattern changes. | Abnormal breathing alongside significant hyperglycaemia requires prompt assessment. |
| Altered consciousness | New confusion, drowsiness or reduced responsiveness. | Neurological deterioration requires urgent clinical review. |
Build the clinical picture
Check blood glucose
Measure glucose when indicated and within your competence and local procedure.
Ask about symptoms
Ask about thirst, urinary frequency, nausea, vomiting, weakness and changes in general wellbeing.
Review observations
Assess respiratory rate, pulse, blood pressure, temperature, oxygen saturation and consciousness as appropriate.
Consider hydration
Look for fluid loss, reduced intake and signs that the patient may be becoming dehydrated.
Review context
Consider diabetes treatment, recent food intake, illness and other factors relevant to the clinical team.
Escalate concerns
Communicate significant hyperglycaemia or associated deterioration according to local diabetes and emergency guidance.
Assess significant deterioration systematically
Airway
Confirm the airway is patent, particularly if consciousness is reduced.
Breathing
Assess respiratory rate, pattern, oxygen saturation and work of breathing.
Circulation
Assess pulse, blood pressure, peripheral perfusion and possible signs of dehydration.
Disability
Assess consciousness and blood glucose and recognise new confusion or drowsiness.
Exposure
Consider temperature, infection, fluid loss and other relevant clinical findings.
Escalate
Obtain appropriate registered or emergency support when the patient shows significant deterioration.
Why might blood glucose rise?
Hyperglycaemia can occur for many reasons. Student nurses should focus on recognising the abnormal pattern and communicating relevant context rather than trying to determine the exact cause independently.
Acute physiological stress
Infection and other acute illnesses can make glucose levels harder to control.
Treatment changes
Missed or altered diabetes treatment and some medicines may contribute to raised glucose.
Changing intake
Food intake, enteral or parenteral nutrition and other changes may affect glucose levels.
When should hyperglycaemia concern you?
- Blood glucose is significantly outside the patient's prescribed or expected range.
- The glucose level is continuing to rise on repeat measurements.
- The patient develops marked thirst and frequent urination.
- There are signs of dehydration or poor oral intake.
- Nausea, vomiting or abdominal pain develops.
- Respiratory rate or breathing pattern changes.
- The patient becomes increasingly weak or drowsy.
- New confusion or reduced consciousness develops.
- Hyperglycaemia occurs alongside infection or wider deterioration.
Think glucose + patient + pattern
The clinical significance of hyperglycaemia is determined by more than a number. Look for symptoms, dehydration, observation changes, neurological deterioration and the trend over time.
Watch how the picture develops
Patient stable
Glucose is above the patient's usual target but the patient feels well and observations are stable.
Symptoms develop
Glucose rises further and the patient reports increasing thirst and urinary frequency.
Wider deterioration
The patient becomes nauseated, weak and drowsy with changing physiological observations.
The trajectory matters
Persistent or worsening hyperglycaemia accompanied by new symptoms is more concerning than an isolated elevated result in an otherwise stable patient.
Putting the findings together
Example
A patient with diabetes has had raised glucose readings during the shift and is being monitored.
They now report intense thirst and say they have been passing urine much more frequently. Later, they become nauseated and increasingly drowsy.
Their respiratory rate has also risen compared with earlier observations.
The concern is the combined pattern of persistent hyperglycaemia, fluid-loss symptoms, neurological change and altered breathing.
As a student nurse, recognise the deterioration, continue an appropriate ABCDE assessment within your competence and promptly communicate the findings to the registered nurse or clinical team.
Hyperglycaemia assessment errors to avoid
- Looking only at the glucose number. Assess symptoms and the whole patient.
- Ignoring thirst and urinary frequency. They may indicate worsening hyperglycaemia and fluid loss.
- Missing dehydration. Review intake, output and circulatory findings.
- Ignoring a rising trend. Repeated results provide useful clinical context.
- Failing to recognise altered breathing. Respiratory change alongside significant hyperglycaemia is important.
- Assuming confusion is unrelated. Neurological deterioration requires assessment.
- Trying to diagnose the exact metabolic emergency yourself. Recognise, assess and escalate.
Report the glucose trend and the clinical change
Example escalation
“I'm concerned about Mr Brown. His blood glucose has remained high and has risen further during the shift. He is now very thirsty, passing urine frequently, feeling nauseated and becoming drowsy. His respiratory rate has also increased.”
This communicates the glucose trend, symptoms and associated physiological deterioration.
Recognise → assess → communicate → escalate
Identify the pattern
Notice raised glucose alongside thirst, increased urination, dehydration or worsening symptoms.
Look at the whole patient
Assess glucose, hydration, breathing, circulation and consciousness within ABCDE.
Report deterioration
Communicate significant glucose changes, symptoms and observation trends promptly.
Build your acute-assessment skills
Continue developing your ability to recognise physiological change, assess deterioration systematically and communicate concerns through the NurseNet Clinical Confidence pathway.
Explore Clinical Confidence →