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{{DiseaseDisorder infobox |
 
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{{Infobox Disease
Name = Hyperglycemia |
 
ICD10 = R73.9 |
+
| Name = Hyperglycemia
ICD9 = {{ICD9|790.6}} |
+
| Image =
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| Caption =
  +
| DiseasesDB = 6234
  +
| ICD10 = R73.9
  +
| ICD9 = {{ICD9|790.29}}
  +
| ICDO =
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| OMIM =
  +
| MedlinePlus =
  +
| eMedicineSubj =
  +
| eMedicineTopic =
  +
| MeshID = D006943
 
}}
 
}}
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'''Hyperglycemia''' or '''Hyperglycæmia''', or '''high blood sugar''', is a [[metabolic disorder]] in which an excessive amount of [[glucose]] circulates in the [[blood plasma]]. This is generally a glucose level higher than (200 '''[[Blood_sugar#Units|mg/dl]]'''). [[Reference ranges for blood tests]] are 11.1 '''mmol/l''', but symptoms may not start to become noticeable until even higher values such as 250–300 mg/dl or 15–20  mmol/l. A subject with a consistent range between 100 and 126 (American Diabetes Association guidelines) is considered hyperglycemic, while above 126 mg/dl or 7 mmol/l is generally held to have Diabetes. Chronic levels exceeding 7 [[Reference ranges for blood tests|mmol/l]] (125 mg/dl) can produce organ damage.
'''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".
 
   
  +
The origin of the term is [[Greek language|Greek]]: ''hyper-'', meaning excessive; ''-glyc-'', meaning sweet; and ''-emia'', meaning ''of the blood''.
==Causes==
 
===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.
 
   
  +
==Definition==
[[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).
 
  +
It is critical for patients who monitor glucose levels at home to be aware of which units of measurement their testing kit uses.
 
Glucose levels are measured in either:
 
# Milligrams per decilitre (mg/dl), in the United States and other countries (e.g., Japan, France, Egypt, Colombia); or
  +
# Millimoles per litre (mmol/l), which can be acquired by dividing (mg/dl) by factor of 18.<ref>[http://www.childrenwithdiabetes.com/converter.htm Blood glucose converter-mg/dl to mmol/L and vice-versa-Children With Diabetes]</ref>
   
  +
Scientific journals are moving towards using mmol/l; some journals now use mmol/l as
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.
 
  +
the primary unit but quote mg/dl in parentheses.<ref>[http://www.faqs.org/faqs/diabetes/faq/part1/section-9.html What are mg/dl and mmol/l? How to convert?]</ref>
   
  +
Glucose levels vary before and after meals, and at various times of day; the definition of "normal" varies among medical professionals. In general, the normal range for most people (fasting adults) is about 80 to 110&nbsp;mg/dl or 4 to 6&nbsp;mmol/l. (where 80 mg/dl is "optimal".) A subject with a consistent range above 126&nbsp;mg/dl or 7&nbsp;mmol/l is generally held to have hyperglycemia, whereas a consistent range below 70&nbsp;mg/dl or 4&nbsp;mmol/l is considered [[hypoglycemic]]. In [[Fasting#Fasting for Medical Reasons|fasting]] adults, blood plasma glucose should not exceed 126 mg/dL. Sustained higher levels of [[blood sugar]] cause damage to the blood vessels and to the organs they supply, leading to the complications of diabetes.<ref>{{cite web |title=High Blood Sugar |url=http://www.totalhealthlife.com/Conditions/high-blood-sugar.html |author=Total Health Life |publisher=Total Health Institute |year=2005 |accessdate=May 4, 2011}}</ref>
===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.
 
   
  +
Chronic hyperglycemia can be measured via the [[HbA1c]] test. The definition of acute hyperglycemia varies by study, with mmol/l levels from 8 to 15.<ref>{{cite journal |author=Giugliano D, Marfella R, Coppola L, ''et al.'' |title=Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia |journal=Circulation |volume=95 |issue=7 |pages=1783–90 |year=1997 |pmid=9107164}}</ref>
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.
 
   
  +
==Signs and symptoms==
==History==
 
  +
Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal for significant periods without producing any permanent effects or symptoms. However, chronic hyperglycemia at levels more than slightly above normal can produce a very wide variety of serious complications over a period of years, including kidney damage, neurological damage, cardiovascular damage, [[diabetic retinopathy|damage to the retina]] or damage to feet and legs. [[Diabetic neuropathy]] may be a result of long-term hyperglycemia.
''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.
 
   
  +
In diabetes mellitus (by far the most common cause of chronic hyperglycemia), treatment aims at maintaining blood glucose at a level as close to normal as possible, in order to avoid these serious long-term complications. This is done by a combination of proper diet, regular exercise, and insulin or other medication such as metformin, etc.
==Measurement==
 
Glucose levels are measured in either:
 
   
  +
Acute hyperglycemia involving glucose levels that are extremely high is a medical emergency and can rapidly produce serious complications (such as fluid loss through [[osmotic diuresis]]). It is most often seen in persons who have uncontrolled insulin-dependent diabetes.
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,
 
   
  +
The following symptoms may be associated with acute or chronic hyperglycemia, with the first three composing the classic hyperglycemic triad:
2. Millimoles per liter (mmol/L) in the rest of the "[[metrification|metrified]] world."
 
   
 
* [[Polyphagia]] - frequent hunger, especially pronounced hunger
Comparatively:
 
 
* [[Polydipsia]] - frequent thirst, especially excessive thirst
 
* [[Polyuria]] - frequent urination
 
* [[Blurred vision]]
 
* [[Fatigue (physical)|Fatigue]] (sleepiness)
 
* [[Weight loss]]
 
* Poor wound healing (cuts, scrapes, etc.)
 
* Dry mouth
 
* Dry or itchy [[skin]]
  +
* Tingling in feet or heels
  +
* [[Erectile dysfunction]]
 
* Recurrent [[infection]]s, external ear infections (swimmer's ear)
  +
* [[Cardiac arrhythmia]]
  +
* [[Stupor]]
  +
* [[Coma]]
  +
* Seizures
   
 
Frequent hunger without other symptoms can also indicate that blood sugar levels are too low. This may occur when people who have diabetes take too much oral hypoglycemic medication or insulin 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 I diabetes, especially the juvenile onset form, but it makes the prescription of oral hypoglycemic medication difficult to manage.
*72 mg/dL = 4 mmol/L
 
*90 mg/dL = 5 mmol/L
 
*108 mg/dL = 6 mmol/L
 
*126 mg/dL = 7 mmol/L
 
   
  +
Polydipsia and polyuria occur when blood glucose levels rise high enough to result in excretion of excess glucose via the kidneys ([[glycosuria]]), producing [[osmotic diuresis]].
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.
 
   
  +
Symptoms of [[Diabetic Ketoacidosis]] may include:
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]].
 
  +
* [[Ketoacidosis]]
  +
* [[Kussmaul hyperventilation]]: deep, rapid breathing
  +
* Confusion or a decreased level of consciousness
  +
* Dehydration due to [[glycosuria]] and osmotic diuresis
  +
* Acute hunger and/or thirst
  +
* 'Fruity' smelling breath odor
  +
* Impairment of cognitive function, along with increased sadness and anxiety<ref>{{cite journal |author=Pais I, Hallschmid M, Jauch-Chara K, ''et al.'' |title=Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients |journal=Exp. Clin. Endocrinol. Diabetes |volume=115 |issue=1 |pages=42–6 |year=2007 |pmid=17286234 |doi=10.1055/s-2007-957348}}</ref><ref>{{cite journal |author=Sommerfield AJ, Deary IJ, Frier BM |title=Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes |journal=Diabetes Care |volume=27 |issue=10 |pages=2335–40 |year=2004 |pmid=15451897| doi = 10.2337/diacare.27.10.2335}}</ref>
   
 
==Causes==
In [[Fasting#Fasting for Medical Reasons|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.
 
   
 
===Diabetes mellitus===
==Common Symptoms of Diabetic Hyperglycemia==
 
  +
Chronic hyperglycemia that persists even in fasting states is most commonly caused by [[diabetes mellitus]]. In fact, chronic hyperglycemia is the defining characteristic of the disease. Intermittent hyperglycemia may be present in prediabetic states. Acute episodes of hyperglycemia without an obvious cause may indicate developing diabetes or a predisposition to the disorder.
If you have diabetes mellitus, the presence of these symptoms can indicate that blood sugar levels are too high:
 
   
  +
In diabetes mellitus, hyperglycemia is usually caused by low [[insulin]] levels ([[Diabetes mellitus type 1]]) and/or by resistance to insulin at the cellular level ([[Diabetes mellitus type 2]]), depending on the type and state of the disease. Low insulin levels and/or insulin resistance prevent the body from converting glucose into [[glycogen]] (a starch-like source of energy stored mostly in the liver), which in turn makes it difficult or impossible to remove excess glucose from the blood. With normal glucose levels, the total amount of glucose in the blood at any given moment is only enough to provide energy to the body for 20-30 minutes, and so glucose levels must be precisely maintained by the body's internal control mechanisms. When the mechanisms fail in a way that allows glucose to rise to abnormal levels, hyperglycemia is the result.
* [[Polyphagia]] (frequent hunger, especially pronounced hunger)
 
* [[Polydipsia]] (frequent thirst, especially excessive thirst)
 
* [[Polyuria]] (frequent urination, especially excessive urination)
 
   
  +
===Drugs===
'''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).
 
   
  +
Certain medications increase the risk of hyperglycemia, including [[corticosteroids]], [[octreotide]], [[beta blocker]]s, [[epinephrine]], [[thiazide]] [[diuretic]]s, [[niacin]], [[pentamidine]], [[protease inhibitors]], [[L-asparaginase]],<ref>{{cite journal |author=Cetin M, Yetgin S, Kara A, ''et al.'' |title=Hyperglycemia, ketoacidosis and other complications of L-asparaginase in children with acute lymphoblastic leukemia |journal=J Med |volume=25 |issue=3–4 |pages=219–29 |year=1994 |pmid=7996065}}</ref> and some [[antipsychotic]] agents.<ref>{{cite journal |author=Luna B, Feinglos MN |title=Drug-induced hyperglycemia |journal=JAMA |volume=286 |issue=16 |pages=1945–8 |year=2001 |pmid=11667913 | doi = 10.1001/jama.286.16.1945}}</ref> The acute administration of [[stimulants]] such as [[amphetamine]] typically produces hyperglycemia; chronic use, however, produces [[hypoglycemia]]. Some of the newer psychotropic medications such as [[Zyprexa]] (Olanzapine), and [[Cymbalta]] (Duloxetine), can also cause significant hyperglycemia.
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.
 
   
  +
===Critical illness===
Other symptoms of diabetic hyperglycemia may include:
 
* Blurred vision
 
* [[Fatigue (physical)|Fatigue]]
 
* [[Weight loss]]
 
* Poor [[wound]] healing (cuts, scrapes, etc.)
 
* Dry [[mouth]]
 
* Dry or itchy [[skin]]
 
* [[Impotence]] (male)
 
* Recurrent [[infection]]s such as vaginal yeast infections, groin rash, or external ear infections (swimmers ear)
 
   
  +
A high proportion of patients suffering an acute stress such as [[stroke]] or [[myocardial infarction]] may develop hyperglycemia, even in the absence of a diagnosis of diabetes. (Or perhaps stroke or myocardial infarction was caused by hyperglycemia and undiagnosed diabetes.) Human and animal studies suggest that this is not benign, and that stress-induced hyperglycemia is associated with a high risk of mortality after both stroke and myocardial infarction.<ref>{{cite journal |author=Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC |title=Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview |journal=Stroke |volume=32 |issue=10 |pages=2426–32 |year=2001 |pmid=11588337 |doi=10.1161/hs1001.096194}}</ref>
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==
 
  +
The following conditions can also cause hyperglycemia in the absence of diabetes. 1) Dysfunction of the thyroid, adrenal, and pituitary glands 2) Numerous diseases of the pancreas 3) Severe increases in blood glucose may be seen in sepsis and certain infections 4) Intracranial diseases (frequently overlooked) can also cause hyperglycemia. Encephalitis, brain tumors (especially those located near the pituitary gland), brain bleeds, and meningitis are prime examples. 5) Mid to high blood sugar levels are often seen in convulsions and terminal stages of many diseases. Prolonged, major surgeries can temporarily increase glucose levels. Certain forms of severe stress and Physical trauma can increase levels for a brief time as well yet rarely exceeds 120 mg/dl.
Hyperglycemia
 
  +
*Seek urgent medical advice
 
  +
==Complications==
*Give fluids without sugar
 
  +
Hyperglycemia can be a serious problem if not treated in time. In untreated hyperglycemia, a condition called [[ketoacidosis]] (contrast [[ketosis]]) could occur. Ketoacidosis develops when the body does not have enough [[insulin]]. Without insulin, the body isn't able to utilize the glucose for fuel, so the body starts to break down fats for energy.
*Continue insulin
 
  +
*Continue tests
 
  +
Ketoacidosis is a life-threatening condition which needs immediate treatment. Symptoms include: shortness of breath, breath that smells fruity (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 with no coronary heart disease or history of heart failure.<ref>{{cite web|title=Chronic hyperglycemia may lead to cardiac damage|url=http://www.news-medical.net/news/20120203/Chronic-hyperglycemia-may-lead-to-cardiac-damage.aspx|work=Journal of the American College of Cardiology|accessdate=3 February 2012}}</ref>
  +
  +
==Treatment==
  +
  +
Treatment of hyperglycemia requires elimination of the underlying cause, ''e.g.,'' treatment of diabetes when diabetes is the cause. Acute hyperglycemia can be treated by direct administration of insulin in most cases. Severe hyperglycemia can be treated with [[Anti-diabetic medication|oral hypoglycemic therapy]] and lifestyle modification.<ref name="rosen">{{cite book |author=Ron Walls MD; John J. Ratey MD; Robert I. Simon MD |authorlink= |editor= |others= |title=Rosen's Emergency Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print (Rosen's Emergency Medicine: Concepts & Clinical Practice (2v.))|publisher=Mosby |location=St. Louis |year=2009|isbn=0-323-05472-2 }}</ref>
   
 
==See also==
 
==See also==
 
* [[Hypoglycemia]]
 
* [[Hypoglycemia]]
 
* [[Diabetes]]
 
* [[Diabetes]]
* [[diabetic coma]]
+
* [[Prediabetes]]
  +
  +
==References==
  +
{{reflist|2}}
   
 
==External links==
 
==External links==
*[http://www.diabetescaregroup.info/high-blood-sugar-hyperglycemia/ High blood sugar “Hyperglycemia”] Article from the Diabetes Care Group.
+
*[http://www.diabetes.org/type-1-diabetes/hyperglycemia.jsp Hyperglycemia information] - from the [[American Diabetes Association]]
  +
*[http://www.nlm.nih.gov/medlineplus/ency/article/007228.htm Hyperglycemia in infants] - from [[MedlinePlus]]
  +
*[http://rad.usuhs.edu/medpix/kiosk_image.html?quiz=no&pt_id=13826&imageid=54993&imid=&this_week=561#pic Hyperglycemia affects brain] Hemichorea/Hemiballismus
  +
   
  +
{{Abnormal clinical and laboratory findings}}
[[Category:Metabolism disorders]]
 
[[Category:Nutrition]]
+
[[Category:Disorders of endocrine pancreas]]
  +
[[Category:Abnormal clinical and laboratory findings for blood]]
   
  +
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[[af:Hiperglukemie]]
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[[ar:فرط سكر الدم]]
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[[az:Hiperqlikemiya]]
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[[ca:Hiperglucèmia]]
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[[cs:Hyperglykemie]]
 
[[de:Hyperglykämie]]
 
[[de:Hyperglykämie]]
 
[[es:Hiperglucemia]]
 
[[es:Hiperglucemia]]
 
[[eo:Hiperglukozemio]]
 
[[eo:Hiperglukozemio]]
 
[[fr:Hyperglycémie]]
 
[[fr:Hyperglycémie]]
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[[hi:हायपर ग्लाईसीमिया]]
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[[id:Hiperglisemia]]
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[[it:Iperglicemia]]
 
[[he:היפרגליקמיה]]
 
[[he:היפרגליקמיה]]
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[[pam:Matas Mayumu]]
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[[nl:Hyperglykemie]]
 
[[nl:Hyperglykemie]]
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[[ja:高血糖症]]
 
[[no:Hyperglykemi]]
 
[[no:Hyperglykemi]]
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[[pl:Hiperglikemia]]
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[[pt:Hiperglicemia]]
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[[ro:Hiperglicemie]]
 
[[ru:Гипергликемия]]
 
[[ru:Гипергликемия]]
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[[sq:Hiperglikemia]]
 
[[simple:Hyperglycemia]]
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[[fi:Hyperglykemia]]
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[[sv:Hyperglykemi]]
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[[ta:இரத்தச் சர்க்கரை அதிகரிப்பு]]
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[[te:హైపర్‌గ్లైసీమియా]]
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-->
 
{{enWP|Hyperglycemia}}
 
{{enWP|Hyperglycemia}}

Latest revision as of 08:19, 20 July 2012

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Hyperglycemia
ICD-10 R73.9
ICD-9 790.29
OMIM [1]
DiseasesDB 6234
MedlinePlus [2]
eMedicine /
MeSH {{{MeshNumber}}}

Hyperglycemia or Hyperglycæmia, or high blood sugar, is a metabolic disorder in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than (200 mg/dl). Reference ranges for blood tests are 11.1 mmol/l, but symptoms may not start to become noticeable until even higher values such as 250–300 mg/dl or 15–20  mmol/l. A subject with a consistent range between 100 and 126 (American Diabetes Association guidelines) is considered hyperglycemic, while above 126 mg/dl or 7 mmol/l is generally held to have Diabetes. Chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage.

The origin of the term is Greek: hyper-, meaning excessive; -glyc-, meaning sweet; and -emia, meaning of the blood.

Definition[edit | edit source]

It is critical for patients who monitor glucose levels at home to be aware of which units of measurement their testing kit uses. Glucose levels are measured in either:

  1. Milligrams per decilitre (mg/dl), in the United States and other countries (e.g., Japan, France, Egypt, Colombia); or
  2. Millimoles per litre (mmol/l), which can be acquired by dividing (mg/dl) by factor of 18.[1]

Scientific journals are moving towards using mmol/l; some journals now use mmol/l as the primary unit but quote mg/dl in parentheses.[2]

Glucose levels vary before and after meals, and at various times of day; the definition of "normal" varies among medical professionals. In general, the normal range for most people (fasting adults) is about 80 to 110 mg/dl or 4 to 6 mmol/l. (where 80 mg/dl is "optimal".) A subject with a consistent range above 126 mg/dl or 7 mmol/l is generally held to have hyperglycemia, whereas a consistent range below 70 mg/dl or 4 mmol/l is considered hypoglycemic. In fasting adults, blood plasma glucose should not exceed 126 mg/dL. Sustained higher levels of blood sugar cause damage to the blood vessels and to the organs they supply, leading to the complications of diabetes.[3]

Chronic hyperglycemia can be measured via the HbA1c test. The definition of acute hyperglycemia varies by study, with mmol/l levels from 8 to 15.[4]

Signs and symptoms[edit | edit source]

Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal for significant periods without producing any permanent effects or symptoms. However, chronic hyperglycemia at levels more than slightly above normal can produce a very wide variety of serious complications over a period of years, including kidney damage, neurological damage, cardiovascular damage, damage to the retina or damage to feet and legs. Diabetic neuropathy may be a result of long-term hyperglycemia.

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

Acute hyperglycemia involving glucose levels that are extremely high is a medical emergency and can rapidly produce serious complications (such as fluid loss through osmotic diuresis). It is most often seen in persons who have uncontrolled insulin-dependent diabetes.

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

Frequent hunger without other symptoms can also indicate that blood sugar levels are too low. This may occur when people who have diabetes take too much oral hypoglycemic medication or insulin 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 I diabetes, especially the juvenile onset form, but it makes the prescription of oral hypoglycemic medication difficult to manage.

Polydipsia and polyuria occur when blood glucose levels rise high enough to result in excretion of excess glucose via the kidneys (glycosuria), producing osmotic diuresis.

Symptoms of Diabetic Ketoacidosis may include:

  • Ketoacidosis
  • Kussmaul hyperventilation: deep, rapid breathing
  • Confusion or a decreased level of consciousness
  • Dehydration due to glycosuria and osmotic diuresis
  • Acute hunger and/or thirst
  • 'Fruity' smelling breath odor
  • Impairment of cognitive function, along with increased sadness and anxiety[5][6]

Causes[edit | edit source]

Diabetes mellitus[edit | edit source]

Chronic hyperglycemia that persists even in fasting states is most commonly caused by diabetes mellitus. In fact, chronic hyperglycemia is the defining characteristic of the disease. Intermittent hyperglycemia may be present in prediabetic states. Acute episodes of hyperglycemia without an obvious cause may indicate developing diabetes or a predisposition to the disorder.

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

Drugs[edit | edit source]

Certain medications increase the risk of hyperglycemia, including corticosteroids, octreotide, beta blockers, epinephrine, thiazide diuretics, niacin, pentamidine, protease inhibitors, L-asparaginase,[7] and some antipsychotic agents.[8] The acute administration of stimulants such as amphetamine typically produces hyperglycemia; chronic use, however, produces hypoglycemia. Some of the newer psychotropic medications such as Zyprexa (Olanzapine), and Cymbalta (Duloxetine), can also cause significant hyperglycemia.

Critical illness[edit | edit source]

A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a diagnosis of diabetes. (Or perhaps stroke or myocardial infarction was caused by hyperglycemia and undiagnosed diabetes.) Human and animal studies suggest that this is not benign, and that stress-induced hyperglycemia is associated with a high risk of mortality after both stroke and myocardial infarction.[9]


The following conditions can also cause hyperglycemia in the absence of diabetes. 1) Dysfunction of the thyroid, adrenal, and pituitary glands 2) Numerous diseases of the pancreas 3) Severe increases in blood glucose may be seen in sepsis and certain infections 4) Intracranial diseases (frequently overlooked) can also cause hyperglycemia. Encephalitis, brain tumors (especially those located near the pituitary gland), brain bleeds, and meningitis are prime examples. 5) Mid to high blood sugar levels are often seen in convulsions and terminal stages of many diseases. Prolonged, major surgeries can temporarily increase glucose levels. Certain forms of severe stress and Physical trauma can increase levels for a brief time as well yet rarely exceeds 120 mg/dl.

Complications[edit | edit source]

Hyperglycemia can be a serious problem if not treated in time. In untreated hyperglycemia, a condition called ketoacidosis (contrast ketosis) could occur. Ketoacidosis develops when the body does not have enough insulin. Without insulin, the body isn't able to utilize the glucose for fuel, so the body starts to break down fats for energy.

Ketoacidosis is a life-threatening condition which needs immediate treatment. Symptoms include: shortness of breath, breath that smells fruity (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 with no coronary heart disease or history of heart failure.[10]

Treatment[edit | edit source]

Treatment of hyperglycemia requires elimination of the underlying cause, e.g., treatment of diabetes when diabetes is the cause. Acute hyperglycemia can be treated by direct administration of insulin in most cases. Severe hyperglycemia can be treated with oral hypoglycemic therapy and lifestyle modification.[11]

See also[edit | edit source]

References[edit | edit source]

  1. Blood glucose converter-mg/dl to mmol/L and vice-versa-Children With Diabetes
  2. What are mg/dl and mmol/l? How to convert?
  3. Total Health Life (2005). High Blood Sugar. Total Health Institute. URL accessed on May 4, 2011.
  4. Giugliano D, Marfella R, Coppola L, et al. (1997). Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia. Circulation 95 (7): 1783–90.
  5. Pais I, Hallschmid M, Jauch-Chara K, et al. (2007). Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients. Exp. Clin. Endocrinol. Diabetes 115 (1): 42–6.
  6. Sommerfield AJ, Deary IJ, Frier BM (2004). Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes. Diabetes Care 27 (10): 2335–40.
  7. Cetin M, Yetgin S, Kara A, et al. (1994). Hyperglycemia, ketoacidosis and other complications of L-asparaginase in children with acute lymphoblastic leukemia. J Med 25 (3–4): 219–29.
  8. Luna B, Feinglos MN (2001). Drug-induced hyperglycemia. JAMA 286 (16): 1945–8.
  9. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC (2001). Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32 (10): 2426–32.
  10. Chronic hyperglycemia may lead to cardiac damage. Journal of the American College of Cardiology. URL accessed on 3 February 2012.
  11. Ron Walls MD; John J. Ratey MD; Robert I. Simon MD (2009). Rosen's Emergency Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print (Rosen's Emergency Medicine: Concepts & Clinical Practice (2v.)), St. Louis: Mosby.

External links[edit | edit source]


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