1 Recommendations

Managing hyperglycaemia in inpatients within 48 hours of ACS

1.1.1 Manage hyperglycaemia in patients admitted to hospital for an acute coronary syndrome (ACS) by keeping blood glucose levels below 11.0 mmol/litre while avoiding hypoglycaemia. In the first instance, consider a dose-adjusted insulin infusion with regular monitoring of blood glucose levels.

1.1.2 Do not routinely offer intensive insulin therapy (an intravenous infusion of insulin and glucose with or without potassium) to manage hyperglycaemia (blood glucose above 11.0 mmol/litre) in patients admitted to hospital for an ACS unless clinically indicated.

Identifying patients with hyperglycaemia after ACS who are at high risk of developing diabetes

1.1.3 Offer all patients with hyperglycaemia after ACS and without known diabetes tests for:

  • HbA1c levels before discharge and

  • fasting blood glucose levels no earlier than 4 days after the onset of ACS.

    These tests should not delay discharge.

1.1.4 Do not routinely offer oral glucose tolerance tests to patients with hyperglycaemia after ACS and without known diabetes if HbA1c and fasting blood glucose levels are within the normal range.

Advice and ongoing monitoring for patients with hyperglycaemia after ACS and without known diabetes

1.1.5 Offer patients with hyperglycaemia after ACS and without known diabetes lifestyle advice on the following:

1.1.6 Advise patients without known diabetes that if they have had hyperglycaemia after an ACS they:

  • are at increased risk of developing type 2 diabetes

  • should consult their GP if they experience the following symptoms:

    • frequent urination

    • excessive thirst

    • weight loss

    • fatigue

  • should be offered tests for diabetes at least annually.

1.1.7 Inform GPs that they should offer at least annual monitoring of HbA1c and fasting blood glucose levels to people without known diabetes who have had hyperglycaemia after an ACS.

  • National Institute for Health and Care Excellence (NICE)