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Critically ill patients with hyperglycemia present differently compared with otherwise healthy diabetic patients. In a critically ill patient, polyuria, polydipsia, and other common symptoms of hyperglycemia may not be present. Patients may present with acute kidney injury and decreased urine output. Due to the severity of illness, including delirium and mechanical ventilation, patients may not be able to communicate their symptoms. Moreover, given the acuity of glucose change, the physical exam may be equivocal and therefore routine blood tests are essential for diagnosis.