Hyperglycemia

Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. The term is from Greek: hyper-, prefix meaning "too much"; -glyc-, root meaning "sweet";  -emia, suffix meaning "of the blood".

Diabetes
Hyperglycemia is one of the classic symptoms of diabetes mellitus, the others being frequent and excessive thirst accompanied by frequent and excessive urination. But hyperglycemia is not exclusive to diabetes mellitus, and can often occur independently in the context of many other medical conditions.

Diabetes mellitus occurs in two forms: Type I, which is an auto-immune disease of unknown cause, in which the body's own antibodies attack and destroy the insulin-producing Beta-cells in the Islets of Langerhans (specialised endocrine cells within the pancreas). Type II, is due to a combination of defective insulin secretion and defective responsiveness to insulin (often termed reduced insulin sensitivity).

Non-organic diabetes mellitus can be caused by accidental damage to the pancreas itself, or by other diseases affecting the pancreas, such as pancreatic cancer and other causes of pancreatic failure (which, thus, causes the islets to fail); or by surgical removal of the pancreas (thus, of the islets), usually for one of the reasons noted above.

Non-diabetic hyperglycemia
The most common cause of chronic non-diabetic hyperglycemia is obesity, the cure for which is proper diet and exercise to reduce the body's excess white fat reserves. The presence of excessive white fat reserves interferes with the body's ability to properly absorb and use insulin that is otherwise produced in sufficient quantity. Chronic non-diabetic hyperglycemia can produce some of the same complications as diabetic hyperglycemia; however, some of the complications of diabetes mellitus (especially juvenile-onset diabetes mellitus) can occur even if blood sugar levels are kept under control, because the disease operates beyond just the condition of hyperglycemia.

Certain eating disorders can produce acute non-diabetic hyperglycemia, as in the binge phase of bulimia nervosa, when the subject consumes an incredible number of calories at once, frequently from foods that are high in both simple and complex carbohydrates - the body simply having a fierce craving for the energy that carbohydrates provide.

History
Diabetes is Greek for "passing through" (i.e., frequent and excessive thirst and urination; and Mellitus is Latin for "honey-sweet.") Historically, diabetes was a collective name for a number of diseases, each of which affected a different endocrine gland but all of which had in common the classic symptoms of frequent and excessive thirst accompanied by frequent and excessive urination. Except for diabetes mellitus and diabetes insipidus, the other diabetic diseases have been renamed.

Measurement
Glucose levels are measured in either:

1. Milligrams per deciliter (mg/dL), in the United States and other countries (Myanmar, Liberia) that do not yet use the International or "Metric" System of measurement; or,

2. Millimoles per liter (mmol/L) in the rest of the "metrified world."

Comparatively:


 * 72 mg/dL = 4 mmol/L
 * 90 mg/dL = 5 mmol/L
 * 108 mg/dL = 6 mmol/L
 * 126 mg/dL = 7 mmol/L

Glucose levels vary before and after meals, and at various times of day; and what is "normal" varies among medical professionals, and can vary between patients. (As in other facets of life, the "average patient" does not exist as a real person.) In general, the "home" normal range for most people is about 80 to 120 mg/dL or 4 to 7 mmol/L.

A subject with a "home" range above 126 mg/dL or 7 mmol/L is generally held to have hyperglycemia, whereas a "home" range below 70 mg/dL or 4 mmol/L is considered hypoglycemic.

In fasting adults, blood plasma glucose should not exceed 126 mg/dL or 7 mmol/L. Sustained higher levels of blood sugar cause damage to the blood vessels and to the organs they supply, leading to the complications of diabetes.

Common Symptoms of Diabetic Hyperglycemia
If you have diabetes mellitus, the presence of these symptoms can indicate that blood sugar levels are too high:


 * Polyphagia (frequent hunger, especially pronounced hunger)
 * Polydipsia (frequent thirst, especially excessive thirst)
 * Polyuria (frequent urination, especially excessive urination)

But caution: Frequent hunger without the other two symptoms (which invariably occur together, absent renal complications, bladder infections, etc.), can also indicate that blood sugar levels are too low. This commonly occurs when people who have type 2 diabetes mellitus take too much oral hypoglycemic medication for the amount of food they eat. The resulting drop in blood sugar level to below the normal range prompts a hunger response. This hunger is not usually as pronounced as in type 1 diabetes mellitus (especially the juvenile onset form).

People with chronic non-diabetic hyperglycemia who take oral hypoglycemic medication can have the same problem (again, not as pronounced a hunger. In particular, if the hyperglycemia is caused by obesity, prescription of oral hypoglycemic medication can be ill advised.  This is because the medication typically interferes with the subject's weight reduction plan by artificially lowering the blood sugar levels, so that a strong hunger response occurs when the subject attempts to naturally lower the blood sugar levels through a programme of proper diet and exercise.  A vicious cycle can result, in which the more the subject exercises to lose weight, the greater the hunger caused by the medication, so that subject eats more to compensate for the oral hypoglycemic and, thus, cannot lose weight.  The average blood sugar levels thus do not change, which can lead to an increase in the dosage of the oral hypglycemic medication, which only perpetuates the problem.

Other symptoms of diabetic hyperglycemia may include:
 * Blurred vision
 * Fatigue
 * Weight loss
 * Poor wound healing (cuts, scrapes, etc.)
 * Dry mouth
 * Dry or itchy skin
 * Impotence (male)
 * Recurrent infections such as vaginal yeast infections, groin rash, or external ear infections (swimmers ear)

These symptoms do not normally occur with acute non-diabetic hyperglycemia (it just doesn't last long enough), but some of them can occur in chronic non-diabetic hyperglycemia. The notable exception is weight loss, which almost never happens in chronic non-diabetic hyperglycemia - especially if the hyperglycemia is caused by obesity. Instead, the subject either maintains a stable obese weight, or gains weight. This is one of the ways non-diabetic hyperglycemia can be distinguished from diabetic hyperglycemia.

Nursing Intervention
Hyperglycemia
 * Seek urgent medical advice
 * Give fluids without sugar
 * Continue insulin
 * Continue tests