Pathogenesis (development of disease) The cause of hyperglycemia is either impaired insulin secretion and/or impaired insulin action (insulin resistance). Hyperglycemia is the result of a disturbance in the coordination or regulation between glucose delivery by the liver, ie, from the glycogen reservoir or by gluconeogenesis, and glucose uptake by the consuming organs. Regulation is by … Hyperglycemia: Causes
If diabetes mellitus disease is present, see regarding “Further Therapy” under corresponding disease. General Measures Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day) – Wines with high sugar content (Spätlese, Auslese, dessert wines), liqueurs and spirits are to be avoided. Aim for normal weight! Determination of … Hyperglycemia: Therapy
To prevent hyperglycemia (high blood sugar), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Consumption of very large amounts of carbohydrates with a high glycemic index (mono- and disaccharides) can lead to hyperglycemia (postprandial hyperglycemia). Micronutrient deficiency (vital substances) – see prevention with micronutrients. Medication Alpha interferon Antipsychotics (neuroleptics) – … Hyperglycemia: Prevention
The following symptoms and complaints may indicate hyperglycemia (high blood sugar): Leading symptoms Polydipsia (excessive thirst). Urinary urgency with polyuria (increased urination). Fatigue Concentration problems Nausea (nausea)/vomiting Pruritus (itching) Visual disturbances Muscle cramps Impaired consciousness Weight loss Glucosuria – excretion of sugar in the urine. Ketonuria – ketone (acetone) excretion in the urine.
Medical history (history of illness) represents an important component in the diagnosis of hyperglycemia (hyperglycemia). Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Have you noticed increased thirst? Do you need to urinate more frequently? Do you feel tired? Do you suffer from concentration problems? Do you feel nauseous/do you vomit? Have … Hyperglycemia: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Acromegaly – endocrinologic disorder caused by overproduction of growth hormone (somatotropic hormone (STH), somatotropin); with marked enlargement of body end limbs or protruding parts of the body (acras) such as hands, feet, mandible, chin, and eyebrow ridges. Diabetes mellitus (diabetes) Hyperadrenalism – increased hormonal activity of the adrenal gland. … Hyperglycemia: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by hyperglycemia (high blood glucose): Endocrine, nutritional, and metabolic diseases (E00-E90). Diabetes mellitus (diabetes). Diabetic ketoacidosis – form of coma diabeticum in which there are blood glucose levels > 250 mg/dl (> 13.9 mmol/l) with ketonuria/ketonemia, acidosis (blood hyperacidity) with pH … Hyperglycemia (High Blood Sugar): Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: Assessment of consciousness for disorders of consciousness using the Glasgow Coma Scale (GCS). General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Auscultation (listening) of the heart Auscultation of the lungs Palpation (palpation) of … Hyperglycemia: Examination
1st-order laboratory parameters-obligatory laboratory tests. Glucose (blood sugar) Laboratory parameters 2nd order – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. HbA1c (long-term blood glucose value) if necessary fructosamine (in case of interference with the determination of HbA1c). Oral glucose tolerance test (oGTT). Insulin (fasting … Hyperglycemia: Test and Diagnosis
Therapeutic target Blood glucose normalization Therapy recommendations Slow blood glucose normalization using insulin therapy. Fluid replacement and compensation of electrolyte losses (blood salts). See also under “Further therapy“. Fluid replacement The most important measure of treatment of hyperglycemia is the compensation of the usually considerable fluid deficit. It should be used initially 0.9% sodium chloride … Hyperglycemia: Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. Computed tomography of the skull (cranial CT, cranial CT or cCT) – for unclear disturbance of consciousness. Abdominal sonography (ultrasound examination of the abdominal organs) – for basic diagnostics.
