Hyperglycemia

Revision as of 05:15, 31 August 2012 by Uma (talk | contribs) (→‎Causes)
Jump to navigation Jump to search

Template:DiseaseDisorder infobox

WikiDoc Resources for Hyperglycemia

Articles

Most recent articles on Hyperglycemia

Most cited articles on Hyperglycemia

Review articles on Hyperglycemia

Articles on Hyperglycemia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Hyperglycemia

Images of Hyperglycemia

Photos of Hyperglycemia

Podcasts & MP3s on Hyperglycemia

Videos on Hyperglycemia

Evidence Based Medicine

Cochrane Collaboration on Hyperglycemia

Bandolier on Hyperglycemia

TRIP on Hyperglycemia

Clinical Trials

Ongoing Trials on Hyperglycemia at Clinical Trials.gov

Trial results on Hyperglycemia

Clinical Trials on Hyperglycemia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Hyperglycemia

NICE Guidance on Hyperglycemia

NHS PRODIGY Guidance

FDA on Hyperglycemia

CDC on Hyperglycemia

Books

Books on Hyperglycemia

News

Hyperglycemia in the news

Be alerted to news on Hyperglycemia

News trends on Hyperglycemia

Commentary

Blogs on Hyperglycemia

Definitions

Definitions of Hyperglycemia

Patient Resources / Community

Patient resources on Hyperglycemia

Discussion groups on Hyperglycemia

Patient Handouts on Hyperglycemia

Directions to Hospitals Treating Hyperglycemia

Risk calculators and risk factors for Hyperglycemia

Healthcare Provider Resources

Symptoms of Hyperglycemia

Causes & Risk Factors for Hyperglycemia

Diagnostic studies for Hyperglycemia

Treatment of Hyperglycemia

Continuing Medical Education (CME)

CME Programs on Hyperglycemia

International

Hyperglycemia en Espanol

Hyperglycemia en Francais

Business

Hyperglycemia in the Marketplace

Patents on Hyperglycemia

Experimental / Informatics

List of terms related to Hyperglycemia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma.

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

Causes

Diabetes mellitus

Chronic hyperglycemia that persists even in fasting states is most commonly caused by diabetes mellitus, and in fact chronic hyperglycemia is the defining characteristic of the disease. Acute episodes of hyperglycemia without an obvious cause may indicate developing diabetes or a predisposition to the disorder. This form of hyperglycemia is caused by low insulin levels. These low insulin levels inhibit the transport of glucose across cell membranes therefore causing high blood glucose levels.

Eating disorders

Certain eating disorders can produce acute non-diabetic hyperglycemia, as in the binge phase of bulimia nervosa, when the subject consumes a large amount of calories at once, frequently from foods that are high in simple and complex carbohydrates. Certain medications increase the risk of hyperglycemia, including beta blockers, thiazide diuretics, corticosteroids, niacin, pentamidine, protease inhibitors, L-asparaginase,[1] and some antipsychotic agents.[2]

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. 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.[3]


Causes by Organ System

Cardiovascular

Myocardial Infarction

Chemical / poisoning

Arizona bark scorpion poisoning

1,3-Dichloropropene

Dermatologic

Leschke syndrome

Ichthyosis and male hypogonadism

Acanthosis Nigricans

Drug Side Effect

Prednisolone

Amprenavir

Ritonavir

Hydrochlorothiazide

Daclizumab

Bendrofluazide

Isoniazid

Oral contraceptives

Diazoxide

Ziprasidone

Indomethacin

Saquinavir

Thiabendazole

Olanzapine

Gemtuzumab ozogamicin

Skipping insulin / hypoglycemic drugs

Cyclopenthiazide

Frusemide

Arsenic trioxide

Somatostatinoma

Lanreotide

Ritodrine

Growth hormone

Nicotinic acid

Somatostatin

Chlortalidone

Pentamidine

Asparaginase

Bumetanide

Glucocorticoids

Niacin

Ear Nose Throat No underlying causes
Endocrine

Diabetic Ketoacidosis

Acromegaly

Impaired Glucose Tolerance (IGT)

Type 1 Diabetes - juvenile diabetes or insulin dependent diabetes

Type 2 Diabetes - adult or non-insulin dependent diabetes

Bard-Pic syndrome

Cushing's syndrome

Rabson-Mendenhall syndrome

Glucagonoma syndrome

Phaeochromocytoma

Hyperglycemic Hyperosmolar Nonketotic Syndrome

VIPoma

Retinohepatoendocrinologic syndrome

Transient neonatal diabetes mellitus

Insulin-resistance syndrome, type A

Maturity onset diabetes of the young

DIDMOAD syndrome

Permanent neonatal diabetes mellitus

Leprechaunism

Hyperaldosternonism

Hyperthyroidism

Pituitary tumour

Environmental No underlying causes
Gastroenterologic

Acute pancreatitis

Cystic fibrosis

Cirrhosis

Chronic pancreatitis

Hemochromatosis

Hepatic disorder

Hepatic insufficiency

Fibrocalculous pancreatopathy

Bard-Pic syndrome

Genetic

Familial partial lipodystrophy type 3 (FPLD3)

MODY syndrome

Fanconi-Bickel syndrome

Haemochromatosis

MELAS

Congenital partial lipodystrophy

Diabetes-deafness syndrome

Leprechaunism

Friedreich ataxia Down's Syndrome

Huntington's Chorea

Klinefelter's Syndrome

Laurence-Moon-Biedel Syndrome Prader-Willi Syndrome

Turner's Syndrome

Hematologic

Thiamine-responsive megaloblastic anemia syndrome Porphyria

Iatrogenic

Surgery

Subtotal pancreatectomy

Pancreatectomy

Infectious Disease

Cytomegalovirus

Congenital German Measles

Septicaemia

Musculoskeletal / Ortho

Myotonic dystrophy

Anophthalmia - short stature - obesity - hyperglycemia

Radio digito -- facial dysplasia

Christian-Demyer-Franken syndrome

Brunzell syndrome

Wolcott-Rallison syndrome

Acromegaly

Increased stress

Decreased activity or exercising less than usual

Strenuous physical activity

Muscle diseases

Lack of exercise

Neurologic

MELAS

Friedreich ataxia

DEND syndrome

Stroke

Subarachnoid hemorrhage

Status Epilepticus

Nutritional / Metabolic

Lipotrophic Diabetes Familial partial lipodystrophy type 3 (FPLD3)

Fanconi-Bickel syndrome

Haemochromatosis

Cephalothoracic progressive lipodystrophy

Abdominal obesity metabolic syndrome

Acquired total lipodystrophy

Chromium deficiency

Delta-1-pyrroline-5-carboxylate dehydrogenase deficiency

Metabolic Syndrome

Hyperprolinemia type 2

Wernicke Encephalopathy

Obesity

Rabson-Mendenhall syndrome

Obstetric/Gynecologic

Gestational Diabetes Pregnancy

Oncologic

Glucagonoma

Phaeochromocytoma

VIPoma

Pancreatic cancer

Functioning pancreatic endocrine tumor

Conn's Syndrome

Opthalmologic

Anophthalmia - short stature - obesity - hyperglycemia

Retinohepatoendocrinologic syndrome

Overdose / Toxicity

Niacin overdose

Felodipine toxicity

Phenytoin toxicity

Nimodipine toxicity

Isoniazid toxicity

Amlodipine toxicity

Isradipine toxicity

Psychiatric No underlying causes
Pulmonary

Cystic fibrosis

Renal / Electrolyte

Renal insufficiency

Hypokalemia

Rheum / Immune / Allergy

Amyloidosis

Insulin receptor antibodies

Sexual

Ichthyosis and male hypogonadism

Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous

Wolfram's disease

Illness

Trauma

Stress

Causes in Alphabetical Order

  • A...
  • Z...

Make sure that each diagnosis is linked to a page.

Complete List of Differential Diagnoses[4][5]

Sydromes Associated with Diabetes

Measurement and definition

Glucose levels are measured in either:

  1. Milligrams per deciliter (mg/dL), in the United States and other countries (e.g., Japan, France, Egypt, Colombia); or
  2. Millimoles per liter (mmol/L), which can be acquired by dividing (mg/dL) by factor of 18.

Scientific journals are moving towards using mmol/L; some journals now use mmol/L as the primary unit but quote mg/dl in parentheses.[6]

Comparatively:[7]

  • 72 mg/dL = 4 mmol/L
  • 90 mg/dL = 5 mmol/L
  • 108 mg/dL = 6 mmol/L
  • 126 mg/dL = 7 mmol/L
  • 144 mg/dL = 8 mmol/L
  • 180 mg/dL = 10 mmol/L
  • 270 mg/dL = 15 mmol/L
  • 288 mg/dL = 16 mmol/L
  • 360 mg/dL = 20 mmol/L
  • 396 mg/dL = 22 mmol/L
  • 594 mg/dL = 33 mmol/L

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 120 mg/dL or 4 to 7 mmol/L. 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 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.

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.[8][9]

Symptoms

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

  • Polyphagia - frequent hunger, especially pronounced hunger
  • Polydipsia - frequent thirst, especially excessive thirst
  • Polyuria - frequent urination, especially excessive urination
  • 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 (swimmer's ear)

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 acute hyperglycemia may include:

  • Ketoacidosis
  • A decreased level of consciousness or confusion
  • Dehydration due to glycosuria and osmotic diuresis
  • Acute hunger and/or thirst
  • Impairment of cognitive function, along with increased sadness and anxiety[10][11]

Laboratory Findings

  • Complete lab workup
  • Glucose
  • C-peptide

Electrolyte and Biomarker Studies

  • Electrolytes

Treatment

Treatment of hyperglycemia requires elimination of the underlying cause, e.g., treatment of diabetes when diabetes is the cause. Acute and severe hyperglycemia can be treated by direct administration of insulin in most cases, under medical supervision.

  • IV fluids
  • Discontinue use of harmful/offending medications
  • Closely monitor glucose and electrolytes
  • Correct electrolyte disturbances
  • Regular glucose testing, blood pressure, lipid profile, renal function
  • Regular ophthalmology and podiatric examinations
  • Treat underlying etiologies

Pharmacotherapy

Acute Pharmacotherapies

  • Insulin administration (IV or subcutaneous)
  • Oral hypoglycemic medications

See also

References

  1. 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. PMID 7996065.
  2. Luna B, Feinglos MN (2001). "Drug-induced hyperglycemia". JAMA. 286 (16): 1945–8. PMID 11667913.
  3. 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. doi:10.1161/hs1001.096194. PMID 11588337.
  4. isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:79
  5. isbn=1591032016 Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:189-191
  6. What are mg/dl and mmol/l? How to convert?
  7. Mg/dL to mmol/L Conversions
  8. Acute Stress Hyperglycemia
  9. 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. PMID 9107164.
  10. 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. doi:10.1055/s-2007-957348. PMID 17286234.
  11. 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. PMID 15451897.

External links

Template:Abnormal clinical and laboratory findings

af:Hiperglukemie de:Hyperglykämie eo:Hiperglukozemio he:היפרגליקמיה nl:Hyperglykemie no:Hyperglykemi sq:Hiperglikemia fi:Hyperglykemia Template:WH Template:WikiDoc Sources Template:Jb1