Introduction[edit | edit source]
Hyperglycemia means high blood sugar level (specifically of the sugar glucose in the blood). This can develop over many hours or days. Many people do not experience the symptoms of hyperglycaemia until their blood sugar levels are extremely high.
Hyperglycemia is blood glucose greater than 125 mg/dL while fasting and greater than 180 mg/dL or 10/mmol/L 2 hours postprandial. A patient has impaired glucose tolerance, or pre-diabetes, with a fasting plasma glucose of 100 mg/dL to 125 mg/dL or 5.6-6.9 mmol/L. A patient is termed diabetic with a fasting blood glucose of greater than 125 mg/dL 6.9 mmol/L.
When hyperglycemia is left untreated, it can lead to many serious life-threatening complications that include damage to the eye, kidneys, nerves, heart, and peripheral vascular system. Thus, it is vital to manage hyperglycemia effectively and efficiently to prevent complications of the disease and improve patient outcomes.
The signs of hyperglycemia are polydipsia (a great thirst), polyuria (a need to urinate often), and a dry mouth.
Etiology[edit | edit source]
Factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
- Glucose homeostasis is a balance between hepatic glucose production and peripheral glucose uptake and utilization.
- Insulin is the most important regulator of glucose homeostasis.
Secondary Cause of Hyperglycemia
- Destruction of the pancreas from chronic pancreatitis, hemochromatosis, pancreatic cancer, and cystic fibrosis
- Endocrine disorders that cause peripheral insulin resistance like Cushing syndrome, acromegaly, and pheochromocytoma
- Use of medications like glucocorticoids, phenytoin, and estrogens
- Gestational diabetes is known to occur in 4% of all pregnancies and is primarily due to decreased insulin sensitivity
- Total parental nutrition and dextrose infusion
- Reactive as seen postoperatively or in critically ill patients
Major Risk Factors for Hyperglycemia
- Weight more than 120% of the desired body weight
- Family history of type 2 diabetes
- Native Americans, Hispanics, Asian Americans, Pacific Islanders, or African Americans
- Presence of hyperlipidemia or hypertension
- History of gestational diabetes
- Presence of polycystic ovarian syndrome
Epidemiology[edit | edit source]
The incidence of hyperglycemia has increased dramatically over the last two decades due to increased obesity, decreased activity level, and an aging population. The prevalence is equal between men and women. The countries with the greatest number of patients with diabetes included China, India, United States, Brazil, and Russia. Hyperglycemia is more prominent in low to medium-income households.
Management[edit | edit source]
The treatment goals of hyperglycemia involve eliminating the symptoms related to hyperglycemia and reducing long-term complications. Glycemic control in patients with type 1 diabetes is achieved by a variable insulin regimen along with proper nutrition. Patients with type 2 diabetes are managed with diet and lifestyle changes as well as medications. Type 2 diabetes also may be managed on oral glucose-lowering agents. Patients with hyperglycemia need to be screened for complications including retinopathy, nephropathy, and cardiovascular disease. For full elaboration see links to Diabetes as shown above.
Physiotherapy[edit | edit source]
Prognosis[edit | edit source]
The prognosis of individuals with hyperglycemia depends on how well the levels of blood glucose are controlled.
- Chronic hyperglycemia can cause severe life- and limb-threatening complications.
- Changes in lifestyle, regular physical exercise, and changes in diet are the keys to a better prognosis.
- Once the complications of hyperglycemia have developed, they are basically irreversible. Countless studies have shown that untreated hyperglycemia shortens lifespan and worsens the quality of life.
An aggressive lowering of hyperglycemia must be initiated, and patients must be closely followed. However, controlling blood sugars too tightly can result in hypoglycemia which is not well tolerated by elderly individuals who already may have a pre-existing cardiovascular disease.
Why to Aviod.[edit | edit source]
- The significant hyperglycemia that occurs in the acute inflammatory state of COVID-19 patients has been recognized and found to be pronounced among those with diabetes, prediabetes, and/or obesity.
- Increased blood sugar levels may decrease benefits of aerobic exercise
- High blood sugar following surgery common, increases risk of complications
- Maternal hyperglycemia ups offspring cardiometabolic risk.
- Famine alters metabolism for successive generations. The increased risk of hyperglycemia associated with prenatal exposure to famine is also passed down to the next generation.
- Hyperglycemia is common among patients presenting with myocardial infarction and is associated with a higher risk of death
References[edit | edit source]
- Mouri M, Badireddy M. Hyperglycemia. StatPearls [Internet]. 2020 Sep 10.Available from:https://www.statpearls.com/ArticleLibrary/viewarticle/23176 (accessed 16.5.2021)
- Medicinenet Hyperglycemia Available from:https://www.medicinenet.com/hyperglycemia/definition.htm (accessed 16.5.2021)
- Medexpress Hyperglycemia, hypoglycemia linked to poor outcomes in COVID-19 Available from: https://medicalxpress.com/news/2020-12-hyperglycemia-hypoglycemia-linked-poor-outcomes.html (accessed 16.5.2021)
- Gianchandani R, Esfandiari NH, Ang L, Iyengar J, Knotts S, Choksi P, Pop-Busui R. Managing hyperglycemia in the COVID-19 inflammatory storm. Diabetes. 2020 Oct 1;69(10):2048-53.Available from: https://diabetes.diabetesjournals.org/content/69/10/2048(accessed 16.5.2021)
- MedicalXpress Available from:https://medicalxpress.com/tags/hyperglycemia/ (accessed 16.5.2021)
- medicalXpress Hyperglycemia and MI Available from:https://medicalxpress.com/news/2013-11-hyperglycemia-myocardial-infarction-mortality.html (accessed 16.5.2021)