Hyperglycemia

src: care.diabetesjournals.org

Hyperglycemia , or high blood sugar (also spelled hyperglycemia or hyperglycÃÆ'Â|mia ) is a condition in which excessive amounts of glucose circulating in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to look up to higher values ​​such as 15-20 mmol/l (~ 250-300 mg/dl). A subject with a consistent range between ~ 5.6 and ~ 7 mmol/l (100-126 mg/dl) (American Diabetes Association guidelines) is considered to be slightly hyperglycemic, while above 7 mmol/l (126 mg/dl) commonly held for diabetes. For diabetics, glucose levels that are considered too hyperglycemic can vary from person to person, especially because of the glucose glucose threshold and overall glucose tolerance. However, on average, chronic levels above 10-12 mmol/L (180-216 mg/dl) may produce significant organ damage over time.

Video Hyperglycemia

Signs and symptoms

The degree of hyperglycemia may change over time depending on the cause of metabolism, for example, impaired glucose tolerance or fasting glucose, and it may depend on treatment. Temporary hyperglycaemia is often benign and asymptomatic. Blood glucose levels may rise significantly above normal and cause pathological and functional changes for significant periods without producing permanent effects or symptoms. During this asymptomatic period, abnormalities in carbohydrate metabolism can occur which can be tested by measuring plasma glucose. However, chronic hyperglycemia at above normal levels can produce serious serious complications for several years, including kidney damage, neurological damage, cardiovascular damage, retinal damage or damage to the feet and feet. Diabetic neuropathy may be caused by long-term hyperglycemia. Impaired growth and susceptibility to certain infections may occur as a result of chronic hyperglycemia.

Acute hyperglycemia involving very high levels of glucose is a medical emergency and can quickly produce serious complications (such as fluid loss through osmotic diuresis). This is most often seen in people who have uncontrolled insulin-dependent diabetes.

The following symptoms may be associated with acute or chronic hyperglycaemia, with the first three composing a classic hyperglycemic triad:

• Polyphagia - often hungry, especially hunger spoken
• Polydipsia - often thirsty, especially excessive thirst
• Polyuria - increase the volume of urination (not increased urination)
• Blurred vision
• Fatigue
• Restless
• Weight
• Wound healing is bad (cuts, scratches, etc.)
• Dry mouth
• Dry or itchy skin
• Tingling in the legs or heels
• Erectile dysfunction
• Recurrent infections, external ear infections (swimmer's ear)
• Cardiac arrhythmia
• Stupor
• Comes
• Seizures

Often hungry without other symptoms can also show that blood sugar levels are too low. This may happen when people with diabetes take too much oral hypoglycemic or insulin medication for the amount of food they eat. A decrease in blood sugar levels produced to below the normal range encourages a hunger response.

Polydipsia and polyuria occur when blood glucose levels rise high enough to produce excessive glucose excretion through the kidneys, leading to the presence of glucose in the urine. This produces osmotic diuresis.

Signs and symptoms of diabetic ketoacidosis may include:

• Ketoacidosis
• Kussmaul hypnosis (deep breathing, fast)
• Confusion or decreased awareness
• Dehydration due to glycosuria and osmotic diuresis
• Increases thirst
• 'Fruity' smells breath
• Nausea and vomiting
• Impaired cognitive function, along with increased sadness and anxiety
• Weight

Hyperglycemia causes decreased cognitive performance, particularly in processing speed, executive function, and performance. Decreased cognitive performance can lead to forgetfulness and loss of concentration.

Complications

In untreated hyperglycemia, a condition called ketoacidosis can develop because decreased insulin levels increase the activity of sensitive hormone lipase. Triacylglyceride degradation by hormone-sensitive lipases produces free fatty acids which are eventually converted to acetyl-coA by beta-oxidation.

Ketoacidosis is a life-threatening condition that requires immediate treatment. The symptoms include: shortness of breath, fruit-smelling breath (such as pear drops), nausea and vomiting, and very dry mouth. Chronic hyperglycemia (high blood sugar) injures the heart in patients without a history of heart disease or diabetes and is strongly associated with heart attacks and death in subjects who do not have coronary heart disease or a history of heart failure.

Also, the life-threatening consequences of hyperglycemia are non-skin hyperosmolar syndrome.

Maps Hyperglycemia

Cause

Diabetes mellitus

Chronic hyperglycaemia that persists even in fasting countries is most commonly caused by diabetes mellitus. In fact, chronic hyperglycemia is a hallmark of the disease. Intermittent hyperglycemia may be present in prediabetic countries. Acute episodes of hyperglycaemia without a clear cause may indicate the development of diabetes or predisposition of the disorder.

In diabetes mellitus, hyperglycemia is usually caused by low insulin levels (Diabetes mellitus type 1) and/or by insulin resistance at the cellular level (Diabetes mellitus type 2), depending on the type and condition of the disease. Low insulin levels and/or insulin resistance prevent the body from converting glucose to glycogen (a source of energy like starch stored largely in the liver), which in turn makes it difficult or impossible to remove the excess glucose from the blood. With normal glucose levels, the total amount of glucose in the blood at a given moment is just enough to energize the body for 20-30 minutes, so that glucose levels must be properly guarded by the body's internal control mechanisms. When the mechanism fails in a way that allows glucose to rise to an abnormal level, hyperglycemia is the result.

Ketoacidosis may be the first symptom of immune-mediated diabetes, especially in children and adolescents. Also, patients with immune-mediated diabetes may change from simple fasting hyperglycaemia to severe hyperglycemia and even ketoacidosis as a result of stress or infection.

Drugs

Certain drugs increase the risk of hyperglycemia, including corticosteroids, octreotides, beta blockers, epinephrine, thiazide diuretics, statins, niacin, pentamidine, protease inhibitors, L-asparaginase, and antipsychotics. Acute stimulants such as amphetamine usually produce hyperglycemia; Chronic use, however, produces hypoglycemia. Some newer psychiatric drugs, such as Zyprexa (Olanzapine) and Cymbalta (Duloxetine), can also cause significant hyperglycemia.

Thiazides are used to treat type 2 diabetes but also cause severe hyperglycemia.

Critical illness

Most patients suffering from acute stress such as stroke or myocardial infarction may develop hyperglycemia, even without the diagnosis of diabetes. (Or possibly a myocardial stroke or infarction caused by undiagnosed hyperglycemia and diabetes.) Human and animal studies show that this is not benign, and that stress-induced hyperglycemia is associated with a high risk of death after stroke and myocardial infarction.

Somatostatinoma and aldosteronoma-induced hypokalemia may cause hyperglycemia but usually disappear after removal of the tumor.

Stress

The following conditions can also cause hyperglycemia without diabetes. 1) Thyroid, adrenal, and pituitary dysfunction 2) Many diseases of the pancreas 3) A sharp rise in blood glucose can be seen in sepsis and certain infections. 4) Intracranial disease (often neglected) can also cause hyperglycemia. Encephalitis, a brain tumor (especially located near the pituitary gland), cerebral hemorrhage, and meningitis are prime examples. 5) Mild to high blood sugar levels are often seen in seizures and terminal stages of many diseases. Long, large surgery can raise glucose levels for a while. Some forms of severe stress and physical trauma can increase rates for a short time and also rarely exceed 6.6 mmol/l (120 mg/dl).

Mechanism

Hormones such as growth hormone, glucagon, cortisol and catecholamines, can cause hyperglycemia when they are present in the body in excessive amounts. Also, elevated proinflammatory cytokines that interfere with carbohydrate metabolism, leading to excessive glucose production and reduced tissue uptake, can lead to hyperglycemia.

src: care.diabetesjournals.org

Diagnosis

Monitoring

It is important for patients who monitor glucose levels at home to find out the unit of measurement used by their test kits. Glucose levels are measured either:

1. Millimoles per liter (mmol/l) is the SI standard unit used in most countries around the world.
2. Miligram per deciliter (mg/dl) is used in some countries such as the United States, Japan, France, Egypt, and Colombia.

Scientific journals are moving towards using mmol/l; some journals now use mmol/l as the main unit but cite mg/dl in parentheses.

Glucose levels vary before and after meals, and at various times of the day; the definition of "normal" varies among medical professionals. In general, the normal range for most people (fasting adults) is about 4 to 6 mmol/l or 80-110 mg/dl. (where 4 mmol/l or 80 mg/dl is "optimal".) A subject with a consistent range above 7 mmol/l or 126 mg/dl is generally performed for hyperglycemia, whereas a consistent range below 4 mmol/l or 70 mg/dl is considered hypoglycemic. In fasting adults, blood plasma glucose should not exceed 7 mmol/l or 126 mg/dL. Increased levels of higher blood sugar cause damage to blood vessels and organs they supply, leading to complications of diabetes.

Chronic hyperglycemia can be measured by HbA1c test. The definition of acute hyperglycemia varied according to the study, with mmol/l levels from 8 to 15 (mg/dl levels from 144 to 270).

Defects in insulin secretion, insulin action, or both, produce hyperglycemia.

src: stroke.ahajournals.org

Treatment

Treatment of hyperglycemia requires elimination of underlying causes, such as diabetes. Acute hyperglycemia can be treated by direct insulin administration in many cases. Severe hyperglycemia can be treated with oral hypoglycemic therapy and lifestyle modification.

In diabetes mellitus (which is the most common cause of chronic hyperglycemia), treatment aims to maintain blood glucose at a level as close to normal as possible, to avoid these serious long-term complications. This is done with a combination of proper diet, regular exercise, and insulin or other medications such as metformin, etc.

Those with hyperglycemia can be treated using sulfonylureas or metformin or both. These medications help by increasing glycemic control. Dipeptidyl peptidase 4 inhibitors alone or in combination with basal insulin can be used as a treatment for hyperglycemia with patients who are still in the hospital.

src: care.diabetesjournals.org

Etymology

The origin of the term is Greek: prefix ???? - hyper - "over-", ?????? glycos "sweet wine, should be", ???? haima "blood", - ??, - ??? -ia suffix for feminine gender abstract nouns.

src: diabetes.diabetesjournals.org

See also

• Prediabetes
• Reference range for blood tests

src: care.diabetesjournals.org

References

src: diabetes.diabetesjournals.org

External links

• Hyperglycemia in infants - from MedlinePlus

Source of the article : Wikipedia