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What Drug Is Used To Treat Emergency Hyperglycemia?

Diabetic Ketoacidosis Medication

Diabetic Ketoacidosis Medication

Medication Summary Regular and analog human insulins [2] are used for correction of hyperglycemia, unless bovine or pork insulin is the only available insulin. Clinical considerations in treating diabetic ketoacidosis (DKA) include the following: The blood glucose level should not be allowed to fall lower than 200 mg/dL during the first 4-5 hours of treatment. Avoid induction of hypoglycemia because it may develop rapidly during correction of ketoacidosis and may not provide sufficient warning time. Treatment of ketoacidosis should aim to correct dehydration, reverse the acidosis and ketosis, reduce plasma glucose concentration to normal, replenish electrolyte and volume losses, and identify the underlying cause. According to the 2011 JBDS DKA guideline, patients who are already taking long-acting insulin analogues such as glargine or detemir should be maintained at their usual doses. [19, 20] Continue reading >>

Hyperglycemia

Hyperglycemia

Not to be confused with the opposite disorder, hypoglycemia. Hyperglycemia, or high blood sugar (also spelled hyperglycaemia or hyperglycæmia) is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l (~250–300 mg/dl). A subject with a consistent range between ~5.6 and ~7 mmol/l (100–126 mg/dl) (American Diabetes Association guidelines) is considered slightly hyperglycemic, while above 7 mmol/l (126 mg/dl) is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time. Signs and symptoms[edit] The degree of hyperglycemia can change over time depending on the metabolic cause, for example, impaired glucose tolerance or fasting glucose, and it can depend on treatment.[1] Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal and cause pathological and functional changes for significant periods without producing any permanent effects or symptoms. [1] During this asymptomatic period, an abnormality in carbohydrate metabolism can occur which can be tested by measuring plasma glucose. [1] However, chronic hyperglycemia at above normal levels 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 n Continue reading >>

Hyperglycemia In Diabetes

Hyperglycemia In Diabetes

Print Diagnosis Your doctor sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends target blood sugar levels that are: Between 80 and 120 mg/dL (4 and 7 mmol/L) for people age 59 and younger who have no other underlying medical conditions Between 100 and 140 mg/dL (6 and 8 mmol/L) for people age 60 and older, those who have other medical conditions, such as heart, lung or kidney disease, or those who have a history of low blood sugar (hypoglycemia) or who have difficulty recognizing the symptoms of hypoglycemia Your target blood sugar range may differ, especially if you're pregnant or you develop diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes, reaching your target blood sugar range is a challenge. Home blood sugar monitoring Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your goal range. Check your blood sugar as often as your doctor recommends. If you have any signs or symptoms of severe hyperglycemia — even if they're subtle — check your blood sugar level. If your blood sugar level is 240 mg/dL (13 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. You'll need your doctor's help to lower your blood sugar level safely. Glycated hemoglobin (A1C) test During an appointment, your doctor may conduct an A1C test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. An A1C level of 7 perc Continue reading >>

Predictors And Treatment Outcome Of Hyperglycemic Emergencies At Jimma University Specialized Hospital, Southwest Ethiopia

Predictors And Treatment Outcome Of Hyperglycemic Emergencies At Jimma University Specialized Hospital, Southwest Ethiopia

Abstract Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) commonly known as hyperglycemic emergencies are the two most common life-threatening acute metabolic complications of diabetes. The objective of this study is to assess predictors and treatment outcome of hyperglycemic emergencies (HEs) among diabetic patients admitted to Jimma University Specialized Hospital (JUSH). It is a three year retrospective review of medical records of patients admitted with HEs at JUSH. Patient demographics, admission clinical characteristics, precipitants, insulin used and treatment outcomes were extracted. Statistical analysis was done using student’s t test, Chi square test, and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p < 0.05. Complete data was available for 163 out of 421 patients admitted with HEs. The majority (62.6 %) were males. Mean age of patients was 36.6 ± 15.9 years. About 64 % of patients had type 1 diabetes. About 93 % of the participants developed DKA. The most common precipitants of HEs were infections 95 (59 %), non-compliance to medications 52 (32.3 %), and newly diagnosed diabetes 38 (23.6 %). Recurrent hyperglycemia, hypoglycemia and ketonuria occurred in 88 (54 %), 34 (20.9 %) and 31 (20.5 %) patients respectively. Mean amount of insulin used and duration of treatment till resolution of DKA were 136.85 ± 152.41 units and 64.38 ± 76.34 h respectively. The median length of hospital stay was 6 days. Mortality from HEs was 16 (9.8 %). Admission serum creatinine >1.2 mg/dL (P = 0.018), co-morbidity (P < 0.001) and sepsis (P = 0.014) were independent predictors of HEs mortality. Infections, non-compliance and new onset diabetes were the most common precipitants of HEs. Continue reading >>

Common Drugs

Common Drugs

ANORO is only approved for use in COPD. ANORO is NOT approved for use in asthma. People with asthma who take long-acting beta2-adrenergic agonist (LABA) medicines, such as vilanterol (one of the medicines in ANORO), have an increased risk of death from asthma problems. It is not known if LABA medicines increase the risk of death in people with COPD. Call your healthcare provider if breathing problems worsen over time while using ANORO. Get emergency medical care if your breathing worsens quickly or if use of your rescue inhaler does not relieve your breathing problems. Do not use ANORO to treat sudden breathing problems. Always have a rescue inhaler with you to treat sudden symptoms. It is not known if ANORO is safe and effective in people with asthma. Do not use ANORO if you have a severe allergy to milk proteins or any of the ingredients in ANORO. Ask your healthcare provider if you are not sure. Do not use ANORO more often than prescribed. Do not take ANORO with other medicines that contain a LABA or an anticholinergic for any reason. Tell your healthcare provider about all the medicines you take and about all of your health conditions. ANORO can cause serious side effects, including: sudden breathing problems immediately after inhaling your medicine. If you experience this, stop using ANORO and call your healthcare provider right away. serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms: rash hives swelling of your face, mouth, and tongue breathing problems effects on heart increased blood pressure a fast or irregular heartbeat, awareness of heartbeat chest pain effects on nervous system tremor nervousness new or worsened eye problems, including acute narrow-angle glaucoma that can cause pe Continue reading >>

Hyperglycemia And What To Do About It

Hyperglycemia And What To Do About It

This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail [email protected] Both hypoglycemia and hyperglycemia are true medical emergencies. As we discussed last month, hypoglycemia often has a rapid onset and can impact any patient whose body is not provided an adequate glucose supply. While anyone can experience hypoglycemia, it is most common in patients who have been diagnosed with diabetes and whose natural insulin does not function normally. Patients with diabetes also risk developing hyperglycemia, a complex and dangerous metabolic derangement that can be fatal without proper care. The American Diabetes Association says that in 2011 there were a staggering 25 million patients with diabetes and 79 million with pre-diabetes across the United States. This month’s CE article explores the consequences of hyperglycemia on the body and the life-threatening emergencies it can cause. Diabetic Disease Progression Recall that insulin secretion is stimulated by eating. Insulin secretion is not stimulated between meals, and a decline in the body’s blood glucose levels inhibits the pancreatic islets’ insulin secretion and stimulates the secretion of glucagon, which allows glucose levels to remain in a normal range. Figure 1 demonstrates the relationship between blood glucose levels and the pancreas. With the exception of very few organs, such as the brain and the kidneys, the body’s tissues require insulin for glucose to pass through the cell walls. For patients with diabetes mellitus (DM), either thei Continue reading >>

Hyperglycemia And Type 2 Diabetes

Hyperglycemia And Type 2 Diabetes

Part 1 of 6 Highlights High blood glucose, or hyperglycemia, primarily affects those with diabetes. If left untreated it can lead to chronic complications, such as kidney disease or nerve damage. Good diabetes management and careful blood glucose monitoring are both effective ways of preventing hyperglycemia. High blood glucose, or hyperglycemia, can cause major health complications in people with diabetes over time. Several factors can contribute to hyperglycemia, including eating more carbohydrates than normal and being less physically active than normal. Regular blood sugar testing is crucial for people with diabetes, because many people do not feel the symptoms of high blood sugar. Part 2 of 6 Short-term symptoms of high blood sugar include: excessive thirst excessive urination increased urination at night blurry vision sores that won’t heal fatigue If you experience symptoms of hyperglycemia, it’s important that you check your blood glucose levels. Untreated high blood sugar can lead to chronic complications, such as eye, kidney, or heart disease or nerve damage. The symptoms listed above can develop over several days or weeks. The longer the condition is left untreated, the more severe the problem may become. Generally, blood glucose levels greater than 180 mg/dL after meals — or over 130 mg/dL before eating — are considered high. Be sure to check with your doctor to learn your blood sugar targets. Part 3 of 6 A number of conditions or factors can contribute to hyperglycemia, including: eating more carbohydrates than usual being less physically active than usual being ill or having an infection experiencing high levels of stress not getting the right dosage of glucose-lowering medication Part 4 of 6 There are several treatment methods available for hypergl Continue reading >>

Elevated Glucose In The Er

Elevated Glucose In The Er

Over the past few years advancements have been made in the approach to, and management of, elevated blood glucose. In the emergency room, elevated blood glucose (hyperglycemia) is commonly encountered. Often times, patients who present with unrelated problems are coincidentally found to have elevated blood glucose. Many emergency physicians dismiss this finding as a chronic finding and therefore, do not investigate further. But this is a mistake that often results in an adverse patient outcome, and later a medical-legal inquiry and possibly a medical malpractice lawsuit. Elevated blood glucose can be a tip-off that there are serious metabolic abnormalites present. A detailed investigation is warranted in the ER because many of these patients are asymptomatic and will not seek follow-up medical care until they become symptomatic, by which time their condition may be far advanced. The following review article on the approach to hyperglycemia in the ER is current and represents the standard of care approach to these patients. Background: Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes. Despite advances in the prevention and management of diabetes, its prevalence and associated health care costs continue to increase worldwide. Hyperglycemic crisis typically requires critical care management and hospitalization and contributes to global health expenditures. Objective: Diagnostic and resolution criteria and management strategies for diabetic ketoacidosis and hyperosmolar hyperglycemic crisis are provided. A discussion of prevalence, mortality, pathoph Continue reading >>

Hyperglycemia - Symptoms, Causes And Treatments

Hyperglycemia - Symptoms, Causes And Treatments

Hyperglycemia is a term referring to high blood glucose levels - the condition that often leads to a diagnosis of diabetes. High blood glucose levels are the defining feature of diabetes, but once the disease is diagnosed, hyperglycemia is a signal of poor control over the condition. Hyperglycemia is defined by certain high levels of blood glucose:1 Fasting levels greater than 7.0 mmol/L (126 mg/dL) Two-hours postprandial (after a meal) levels greater than 11.0 mmol/L (200 mg/dL). Chronic hyperglycemia usually leads to the development of diabetic complications.2 Symptoms of hyperglycemia The most common symptoms of diabetes itself are related to hyperglycemia - the classic symptoms of frequent urination and thirst.2,3 Typical signs and symptoms of hyperglycemia that has been confirmed by blood glucose measurement include:1,3,4 Thirst and hunger Dry mouth Frequent urination, particularly at night Tiredness Recurrent infections, such as thrush Weight loss Vision blurring. Causes of hyperglycemia Hyperglycemia often leads to the diagnosis of diabetes. For people already diagnosed and treated for diabetes, however, poor control over blood sugar levels leads to the condition. Causes of this include:1,3,4 Eating more or exercising less than usual Insufficient amount of insulin treatment (more commonly in cases of type 1 diabetes) Insulin resistance in type 2 diabetes Illness such as the flu Psychological and emotional stress The "dawn phenomenon" or "dawn effect" - an early morning hormone surge. The video below from Diabetes UK explains the dawn phenomenon and offers practical tips. Treatment and prevention of hyperglycemia Prevention of hyperglycemia for people with a diabetes diagnosis is a matter of good self-monitoring and management of blood glucose levels, including ad Continue reading >>

Hyperglycemic Emergencies

Hyperglycemic Emergencies

Diabetic ketoacidosis and hyperosmolar hyperglycemic state have the same cause: insufficient insulin. There are two types of hyperglycemic emergencies: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). These situations require emergency medical intervention, since they can lead to serious conditions such as coma, even death, if left untreated. Diabetic ketoacidosis and hyperosmolar hyperglycemic state have the same cause: insufficient insulin. These complications can arise in specific situations, during sick days, for example. Diabetic ketoacidosis Diabetic ketoacidosis mainly occurs in people with type 1 diabetes. It is characterized by hyperglycemia often greater than 20 mmol/L, with the presence of ketones in the blood or urine. Ketones are produced from the breakdown of fats. Their accumulation in the blood is toxic for the body. This situation arises when the body lacks insulin and must use its fat reserves for the energy it normally gets from glucose. Diabetic ketoacidosis can arise due to a forgotten or skipped insulin dose, an improper adjustment to the insulin dose, an insulin pump that stops working, or a serious medical problem (e.g., heart attack, pneumonia). The following symptoms are associated with diabetic ketoacidosis: deep, rapid breathing nausea, vomiting abdominal pain decreased consciousness, confusion, agitation, unusual behaviour Hyperosmolar hyperglycemic state Hyperosmolar hyperglycemic state occurs primarily in people with type 2 diabetes. This state is characterized by hyperglycemia often greater than 30 mmol/L, and severe dehydration. During a hyperglycemic episode, the accumulation of glucose in the blood increases the frequency and volume of urination. This can cause excessive water loss and significant dehydration. Th Continue reading >>

Managing Hyperglycemia

Managing Hyperglycemia

When you were diagnosed with diabetes, your doctor probably told you that your blood glucose levels were too high. Indeed, high blood glucose, or hyperglycemia, is the hallmark of diabetes. Regardless of your knowledge of diabetes at that time, you may have wondered what the significance of high blood glucose levels was for you. The answer is that hyperglycemia is linked to the development of long-term diabetes complications, which include nephropathy (kidney disease), retinopathy (eye disease), neuropathy (nerve damage), foot and skin problems, heart and blood vessel disease, and tooth and gum disease. That’s why individual treatment plans for people with diabetes focus on preventing hyperglycemia and keeping blood glucose levels as close to the normal range as possible. Keeping blood glucose levels close to normal requires learning how to balance food intake, physical activity, and the effects of any diabetes medicines your doctor may prescribe to lower your blood glucose level. For some people, the balancing act also involves learning to avoid hypoglycemia, or low blood glucose. Blood glucose goals In healthy people who don’t have diabetes, blood glucose levels typically run in the range of 65–110 mg/dl and may rise to 120–140 mg/dl one to two hours after eating. A diagnosis of diabetes is made when a person’s HbA1c (a measure of glucose control over the previous 2–3 months) is 6.5% or higher, his fasting blood glucose level is above 126 mg/dl on two separate occasions, or when he has symptoms of diabetes (such as excessive thirst and urination) and his nonfasting blood glucose level is greater than 200 mg/dl on two separate occasions. Until several years ago, a diagnosis of prediabetes, a condition in which blood glucose levels are high but not high enou Continue reading >>

> Hyperglycemia And Diabetic Ketoacidosis

> Hyperglycemia And Diabetic Ketoacidosis

When blood glucose levels (also called blood sugar levels) are too high, it's called hyperglycemia. Glucose is a sugar that comes from foods, and is formed and stored inside the body. It's the main source of energy for the body's cells and is carried to each through the bloodstream. But even though we need glucose for energy, too much glucose in the blood can be unhealthy. Hyperglycemia is the hallmark of diabetes — it happens when the body either can't make insulin (type 1 diabetes) or can't respond to insulin properly (type 2 diabetes). The body needs insulin so glucose in the blood can enter the cells to be used for energy. In people who have developed diabetes, glucose builds up in the blood, resulting in hyperglycemia. If it's not treated, hyperglycemia can cause serious health problems. Too much sugar in the bloodstream for long periods of time can damage the vessels that supply blood to vital organs. And, too much sugar in the bloodstream can cause other types of damage to body tissues, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes. These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, they can happen in adulthood in some people, particularly if they haven't managed or controlled their diabetes properly. Blood sugar levels are considered high when they're above someone's target range. The diabetes health care team will let you know what your child's target blood sugar levels are, which will vary based on factors like your child's age. A major goal in controlling diabetes is to keep blood sugar levels as close to the desired range as possible. It's a three-way balancing act of: diabetes medicines (such as in Continue reading >>

Management Of Hyperglycemia In The Er: A Randomized Clinical Trial Of A Subcutaneous Insulin Aspart Protocol Coupled With Rapid Initiation Of Basal Bolus Insulin Prior To Hospital Admission Versus Usual Care (novo Er)

Management Of Hyperglycemia In The Er: A Randomized Clinical Trial Of A Subcutaneous Insulin Aspart Protocol Coupled With Rapid Initiation Of Basal Bolus Insulin Prior To Hospital Admission Versus Usual Care (novo Er)

In the Emergency Department (ED), diabetes is commonly encountered as a secondary diagnosis and many patients with uncontrolled diabetes are admitted to the hospital after initial evaluation in the ED. Currently there are no guidelines in the US for the management of hyperglycemia in patients with diabetes during the duration of evaluation and treatment in the ED. It is known that high blood glucose levels in hospitalized patients with diabetes are associated with increased risk of medical complications. In this study, we hypothesize that a defined two-step approach to the management of high blood sugars with insulin injections initiated in the ED may decrease length of stay in the ED or hospital, improve clinical outcome and prevent some hospital complications. In the first phase, patients with diabetes admitted to the ED that have a high blood sugar (BG 200mg/dL) will be randomized to receive scheduled aspart or the usual care as dictated by the ED physicians. In the second phase, patients enrolled in the first phase that are subsequently admitted to the hospital will receive a combination of detemir and aspart insulin or usual care as dictated by the Admitting Medicine Team. Detemir is a long-acting insulin which is given subcutaneously (under the skin) once daily. Aspart is a rapid-acting insulin which is given subcutaneously several times a day and frequently before meals. Detemir and aspart insulins are approved for use in the treatment of patients with diabetes by the FDA. Usual care can be oral anti-diabetic agents, subcutaneous insulin therapy or a combination of both. Subcutaneous insulin used for usual care could include NPH, 70/30 insulin, aspart insulin, regular insulin or insulin glargine. This investigator-initiated research will be conducted at Grady Mem Continue reading >>

Hyperglycemia: Treat It Early

Hyperglycemia: Treat It Early

Hyperglycemia is when your blood glucose level goes too high; it is high blood sugar. Part of managing diabetes (either type 1 diabetes or type 2 diabetes) on a daily basis is learning how to avoid hyperglycemia. Being able to recognize the signs and symptoms of hyperglycemia early is helpful. If your blood sugar shoots up too high, it can be dangerous—and it can possibly land you in the hospital, especially if it leads to diabetic ketoacidosis. Also, if your blood sugar is continually in the high range, your likelihood of developing long-term diabetes complications such as nerve damage, kidney failure, and heart disease rises dramatically. So it is important to detect when your blood glucose reaches unacceptable levels. Early Signs and Symptoms of Hyperglycemia The best defensive tactic for identifying elevated blood glucose is testing with a glucose meter. Your doctor will advise you how frequently you should test and what levels you should be aiming for. However, your body can also let you know when there is too much glucose circulating in your blood. It may prompt you with: thirst dry mouth blurry vision fatigue If you experience these symptoms, check your blood glucose right away. Hyperglycemia Treatments If your blood glucose is high (based on the target levels your doctor said you should be aiming for), it is time to act. Your physician and diabetes educator have likely taught you how to treat high blood glucose levels—how to bring them back to a target range. Some possible ideas for treating hyperglycemia: Exercise: Exercise can help your body use the extra glucose, whether you have type 1 diabetes or type 2 diabetes. But please note, if your blood glucose level is above 250 mg/dL and you have type 1 diabetes, you’ll need to check for ketones before exerci Continue reading >>

Diabetes In The Emergency Department And Hospital: Acute Care Of Diabetes Patients

Diabetes In The Emergency Department And Hospital: Acute Care Of Diabetes Patients

Go to: Hyperglycemic Crisis: DKA and HHS Diabetic ketoacidosis (DKA) accounts for more than 110,000 hospitalizations annually in the United States, with mortality ranging from 2 to 10%4–6. Hyperglycemic hyperosmolar state (HHS) is much less common but confers a much greater mortality7. Patients with DKA classically present with uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration. On the other hand, HHS is defined by altered mental status caused by hyperosmolality, profound dehydration, and severe hyperglycemia without significant ketoacidosis6,8. Initial evaluation In the Emergency Department, the primary goals are rapid evaluation and stabilization. All patients with severe hyperglycemia should immediately undergo assessment and stabilization of their airway and hemodynamic status, with consideration of administration of naloxone for all patients with altered mentation to reverse potential opiate overdose, and thiamine for all patients at risk for Wernicke’s encephalopathy. In cases requiring intubation, the paralytic succinylcholine should not be used if hyperkalemia is suspected as it may acutely further elevate potassium. Immediate assessment should also include placing patients on oxygen, measure O2 saturation and cardiac monitoring as well as obtaining vital signs, a fingerstick glucose, intravenous (IV) access, and a 12-lead electrocardiogram to evaluate for arrhythmias and signs of hyper-and hypokalemia. Emergency Department evaluation should include a thorough clinical history and physical examination, as well as a venous blood gas,9,10 complete blood count, basic metabolic panel, and urinalysis; a urine pregnancy test must be sent for all women with childbearing potential. An important goal of this evaluation is id Continue reading >>

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