Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose Glucose , a simple sugar (monosaccharide), is an important carbohydrate in biology. Cells use it as a source of energy and a metabolic intermediate. Glucose is one of the main products of photosynthesis and starts cellular respiration. Starch and cellulose are polymers derived from the dehydration of glucose. The name "glucose" comes circulates in the blood plasma Blood plasma is the yellow liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid(all body fluid outside of cells). It is mostly water (90% by volume) and contains dissolved proteins, glucose, clotting. This is generally a glucose level higher than 10 mmol/l Reference ranges for blood test are sets of values used by a health professional to interpret a set of medical test results from blood samples (180 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l Reference ranges for blood test are sets of values used by a health professional to interpret a set of medical test results from blood samples (270-360 mg/dl). However, chronic levels exceeding 7 mmol/l Reference ranges for blood test are sets of values used by a health professional to interpret a set of medical test results from blood samples (125 mg/dl) can produce organ damage.

The origin of the term is Greek Greek , an independent branch of the Indo-European family of languages, is the language of the Greeks. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. In its ancient form, it is the language of classical ancient Greek literature and the New Testament of: hyper-, meaning excessive; -glyc-, meaning sweet; and -emia, meaning "of the blood".

Definition

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]

Comparatively:^[3]

• 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 110 mg/dl or 4 to 6 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 Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. A fast may be total or partial concerning that from which one fasts, and may be prolonged or intermittent as to the period of fasting. Fasting practices may preclude sexual activity as well as food, in addition to refraining from adults, blood plasma glucose should not exceed 126 mg/dl or 7 mmol/l. Sustained higher levels of blood sugar The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally, in mammals the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM (mmol/L, ie, millimoles/liter). It is tightly regulated as a part of metabolic homeostasis 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.^[4]

Signs and symptoms

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 Diabetic retinopathy is retinopathy caused by complications of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new etc.

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.

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 Osmotic diuresis is increased urination caused by the presence of certain substances in the small tubes of the kidneys. The excretion occurs when substances of high molecular weight, such as glucose, enter the kidney tubules. The substances cause an increase in the osmotic pressure within the tubule, causing retention of water within the lumen,). 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 comprising the classic hyperglycemic triad:

• Polyphagia In medicine, polyphagia is a medical sign meaning excessive hunger and abnormally large intake of solids by mouth - frequent hunger, especially pronounced hunger
• Polydipsia Polydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα (dipsa, "thirst"). An etymologically related term is dipsomaniac, meaning an alcoholic - frequent thirst, especially excessive thirst
• Polyuria In medicine, polyuria is a condition usually defined as excessive or abnormally large production and/or passage of urine . Frequent urination is sometimes included by definition, but is in any case a usual complication. Increased production and passage of urine may also be termed diuresis - frequent urination, especially excessive urination
• Blurred vision
• Fatigue Fatigue is a state of awareness. It can describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. It can be both physical and mental. Physical fatigue is the inability to continue functioning at the level of one's normal abilities. It is ubiquitous in everyday life, (sleepiness).
• Weight loss Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. It can occur unintentionally due to an underlying disease or can arise from a conscious
• Poor wound In medicine, a wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin healing (cuts, scrapes, etc.)
• Dry mouth The mouth is the first portion of the alimentary canal that receives food and saliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth
• Dry or itchy skin The skin is a soft outer covering of an animal, in particular a vertebrate. Other animal coverings such the arthropod exoskeleton or the seashell have different developmental origin, structure and chemical composition. The adjective cutaneous literally means "of the skin" . In mammals, the skin is the largest organ of the integumentary
• Tingling in feet or heels
• Impotence (male)
• Recurrent infections An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss such as vaginal yeast infections, groin rash, or external ear infections (swimmer's ear)
• Kussmaul hyperventilation: deep, rapid breathing
• Cardiac arrhythmia Cardiac dysrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular
• Stupor Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. The word derives from the Latin stupure, meaning insensible. Being characterised by impairments of reactions to external stimuli, it usually appears in infectious diseases,
• Coma In medicine, a coma is a profound state of unconsciousness. A person in a coma cannot be awakened, fails to respond normally to pain, light or sound, does not have sleep-wake cycles, and does not take voluntary actions. A person in a state of coma can be described as comatose

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 Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus. Rarely, glycosuria is due to), producing osmotic diuresis.

Symptoms of Diabetic Ketoacidosis Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. DKA results from an absolute shortage of insulin; in response the body switches to burning fatty acids and may include:

• Ketoacidosis Ketoacidosis is a type of metabolic acidosis associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate
• Confusion or a decreased level of consciousness
• Dehydration due to glycosuria Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus. Rarely, glycosuria is due to 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

Diabetes mellitus

Chronic hyperglycemia that persists even in fasting states is most commonly caused by diabetes mellitus Diabetes mellitus —often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn't produce enough insulin, or because body cells don't properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb, and 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 Insulin is a hormone that is central to regulating energy and glucose metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle levels (Diabetes mellitus type 1 Diabetes mellitus type 1 is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms of polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and) and/or by resistance to insulin at the cellular level (Diabetes mellitus type 2 Diabetes mellitus type 2 or type 2 diabetes (formerly called non -insulin-dependent diabetes mellitus , or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and dietary modification. As the), depending on the type and state of the disease. Low insulin levels and/or insulin resistance prevent the body from converting glucose into glycogen Glycogen is the molecule that functions as the secondary long-term energy storage in animal and fungi cells. It is made primarily by the liver and the muscles, but can also be made by glycogenesis within the brain and stomach. Glycogen is the analogue of starch, a less branched glucose polymer in plants, and is commonly referred to as animal (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

Certain medications increase the risk of hyperglycemia, including beta blockers Beta blockers is a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction (heart attack), and hypertension. As beta adrenergic receptor antagonists, they diminish the effects of epinephrine (adrenaline) and other stress hormones. Invented by Sir James W, epinephrine Epinephrine is a hormone and neurotransmitter.. It increases heart rate, contracts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. Chemically, epinephrine is a catecholamine, a monoamine produced only by the adrenal glands from the amino acids phenylalanine and tyrosine, thiazide Thiazide is a term used to describe a type of molecule and a class of diuretics often used to treat hypertension and edema (such as that caused by heart, liver, or kidney disease) diuretics A diuretic is any drug that elevates the rate of urination and thus provides a means of forced diuresis. There are several categories of diuretics. All diuretics increase the excretion of water from bodies, although each class does so in a distinct way, corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior, niacin Niacin is an organic compound with the formula C5H4NCO2H and, depending on the definition used, one of the between forty to eighty essential human nutrients. This colourless, water-soluble solid is a derivative of pyridine, with a carboxyl group (COOH) at the 3-position. Other forms of vitamin B3 include the corresponding amide, nicotinamide (&, pentamidine Pentamidine is an antimicrobial medication given for prevention and treatment of Pneumocystis pneumonia (PCP) caused by Pneumocystis jirovecii (formerly known as Pneumocystis carinii), a severe interstitial type of pneumonia often seen in patients with HIV infection. The drug is also the mainstay of treatment for stage I infection with Trypanosoma, protease inhibitors Protease inhibitors are a class of drugs used to treat or prevent infection by viruses, including HIV and Hepatitis C. PIs prevent viral replication by inhibiting the activity of HIV-1 protease, an enzyme used by the viruses to cleave nascent proteins for final assembly of new virons, L-asparaginase Asparaginase is an enzyme that catalyzes the hydrolysis of asparagine to aspartic acid. It is marketed under the brand name Elspar, to treat acute lymphoblastic leukemia (ALL) and is also used in some mast cell tumor protocols. Unlike other chemotherapy agents, it can be given as an intramuscular, subcutaneous, or intravenous injection without,^[7] and some antipsychotic An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis (including delusions or hallucinations, as well as disordered thought), particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s. Most of the drugs in the second agents.^[8] The acute administration of stimulants Stimulants produce a variety of different kinds of effects by enhancing the activity of the central and peripheral nervous systems. Common effects, which vary depending on the substance in question, may include enhanced alertness, awareness, wakefulness, endurance, productivity, and motivation, increased arousal, locomotion, heart rate, and blood such as amphetamine Amphetamine or amfetamine (INN) is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is chemically related to methamphetamine and lisdexamfetamine, a class of potent drugs that act by increasing levels of dopamine and norepinephrine in the brain, inducing typically produces hyperglycemia; chronic use, however, produces hypoglycemia Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood" . It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function (. Some of the newer, double action anti-depressants like Zyprexa Olanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder. The olanzapine formulations are manufactured and marketed by the pharmaceutical company Eli Lilly and Company, whose patent for olanzapine proper expires in 2011 (in October 2009 a Canadian judge ruled that the 1991 patent was, and Cymbalta, can also cause significant hyperglycemia.

Critical illness

A high proportion of patients suffering an acute stress such as stroke A stroke, known medically as a cerebrovascular accident , is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is or myocardial infarction Myocardial infarction or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of 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.^[9]

Plasma glucose >120 mg/dl in the absence of diabetes is a clinical sign of sepsis Sepsis is a serious medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, more aptly applied to.

Physical trauma Physical trauma refers to a physical injury, generally of a considerable degree. A trauma patient is someone who has suffered serious and life-threatening physical injury, with the potential for secondary complications such as shock, respiratory failure and death, surgery Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply and many forms of severe stress can temporarily increase glucose levels.

Physiological stress

Hyperglycemia occurs naturally during times of infection and inflammation. When the body is stressed, endogenous catecholamines are released that - amongst other things - serve to raise the blood glucose levels. The amount of increase varies from person to person and from inflammatory response to response. As such, no patient with first-time hyperglycemia should be diagnosed immediately with diabetes if that patient is concomitantly ill with something else. Further testing, such as a fasting plasma glucose, random plasma glucose, or two-hour postprandial plasma glucose level, must be performed.

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.

See also

• Hypoglycemia
• Diabetes
• Prediabetes

References

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. ^ Mg/dL to mmol/l Conversions
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. PMID 9107164.
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. doi:10.1055/s-2007-957348. PMID 17286234.
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. doi:10.2337/diacare.27.10.2335. PMID 15451897.
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. PMID 7996065.
8. ^ Luna B, Feinglos MN (2001). "Drug-induced hyperglycemia". JAMA 286 (16): 1945–8. doi:10.1001/jama.286.16.1945. PMID 11667913.
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. doi:10.1161/hs1001.096194. PMID 11588337.

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