Hyperosmolar Hyperglycemic State Treatment & Management
Approach Considerations Diagnosis and management guidelines for hyperglycemic crises are available from the American Diabetes Association. [6, 10, 24] The main goals in the treatment of hyperosmolar hyperglycemic state (HHS) are as follows: In an emergency situation, whenever possible, contact the receiving facility while en route to ensure preparation for a comatose, dehydrated, or hyperglycemic patient. When appropriate, notify the facility of a possible cerebrovascular accident or myocardial infarction (MI). Initiation of insulin therapy in the emergency department (ED) through a subcutaneous insulin pump may be an alternative to intravenous (IV) insulin infusion.  Airway management is the top priority. In comatose patients in whom airway protection is of concern, endotracheal intubation may be indicated. Rapid and aggressive intravascular volume replacement is always indicated as the first line of therapy for patients with HHS. Isotonic sodium chloride solution is the fluid of choice for initial treatment because sodium and water must be replaced in these severely dehydrated patients. Although many patients with HHS respond to fluids alone, IV insulin in dosages similar to those used in diabetic ketoacidosis (DKA) can facilitate correction of hyperglycemia.  Insulin used without concomitant vigorous fluid replacement increases the risk of shock. Adjust insulin or oral hypoglycemic therapy on the basis of the patient’s insulin requirement once serum glucose level has been relatively stabilized. All patients diagnosed with HHS require hospitalization; virtually all need admission to a monitored unit managed by medicine, pediatrics, or the intensive care unit (ICU) for close monitoring. When available, an endocrinologist should direct the care of these patien Continue reading >>
What Is The Difference Between Hypoglycemia And Hyperglycemia?
Difference between Hypoglycemia and Hyperglycemia Body metabolizes food stuff that we eat daily and produces energy for daily activities. Food is taken by mouth, broken down into small pieces by GIT and energy is derived from food in the form of glucose and this glucose is transferred to A constant blood glucose level is necessary for physical work otherwise a person can have complications like getting faint, cramps or convulsions. Blood glucose level has got two phases in the body. One is called ‘fasting blood glucose level’ which is the level of blood sugar without having meals. Second is called ‘random glucose level’ and is described as blood glucose level after having meals. Hypoglycemia Normal blood glucose in fasting condition is up to 126 mg per deciliter. Level of glucose in blood less than 70 mg per dl is labeled as hypoglycemia. It has got different reasons like prolonged fasting, high insulin, mal-absorption due to GIT diseases. It can be diagnosed clinically through symptoms like confusion, sweating and nervousness. But only diagnostic approach is to check blood sugar level so that if present, it can be treated immediately as it can be fatal leading to death. People who are prone to develop hypoglycemia are diabetics mainly but anyone can suffer from this metabolic complication. Majority of people are unaware of hypoglycemia, its symptoms and treatment so public awareness should be encouraged in this regard. Hyperglycemia Hyperglycemia is characterized by a fasting blood sugar level of more than 126 mg per dL and random blood glucose level of more than 200 mg per dL. Pathological reason of low blood glucose level is either deficiency of or total absence of insulin in the blood. As with hypoglycemia, diabetic patients are more liable to develop hyperg Continue reading >>
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 (high Blood Sugar)
Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes. Other conditions that can cause hyperglycemia are pancreatitis, Cushing's syndrome, unusual hormone-secreting tumors, pancreatic cancer, certain medications, and severe illnesses. The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate. Severely elevated glucose levels can result in a medical emergency like diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemic hyperosmolar state). Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Hyperglycemia due to medical conditions other than diabetes is generally treated by treating the underlying condition responsible for the elevated glucose. Blood Sugar Swings: Tips for Managing Diabetes & Glucose Levels A number of medical conditions can cause hyperglycemia, but the most common by far is diabetes mellitus. Diabetes affects over 8% of the total U.S. population. In diabetes, blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel. This keeps blood glucose levels in the normal range. Type 1 diabetes is responsible for about 5% of all cases of diabetes and results from damage to the insulin-secreting cells of the pancreas. Type 2 diabetes is far more common and is related to the body's inability to effectively use insulin. In addition to type 1 and type 2, gestational diabe Continue reading >>
Hyperglycemia And How To Treat It
What is hyperglycemia? Hyperglycemia, or high blood sugar, occurs when glucose is trapped in the bloodstream due to lack of insulin. Individual blood glucose ranges vary, so talk with your diabetes team about your threshold for high blood glucose levels. A reading above 160 mg/dL (8.9 mmol/L) indicates hyperglycemia according to the Joslin Diabetes Center, although symptoms may not be present until blood sugar levels reach 200 mg/dL or 11 mmol/L (Mayo Clinic). If left untreated, hyperglycemia may lead to severe dehydration, diabetic ketoacidosis, and coma. The effects of tong-term hyperglycemia include damage to the eyes, kidneys, nervous system and heart. Why does it occur? Taking too little insulin, under-counting carbohydrates at mealtimes, stress, not exercising as much as planned, fluctuating hormones and illness can all contribute to hyperglycemia. Hyperglycemia can occur when when your body is under physical stress, like when you’re fighting an infection or other illness, if you’re recovering from an injury, or recently had surgery. Emotional stress also contributes to hyperglycemia as hormones produced in response to stress cause blood glucose levels to rise. Make a plan with your endocrinologist for sick days as your insulin needs may change (your pump may even have a “sick day” category in the basal settings). Keep a close eye on your blood sugar and check for ketones when you’re under the weather to prevent yourself from feeling the negative effects of hyperglycemia, too. Communicate with your diabetes team about how you’re feeling and ask questions about adjusting your insulin schedule. Sometimes hyperglycemia can occur when insulin has expired or if it “goes bad,” from being exposed to extreme heat or cold. Store your insulin within appropri Continue reading >>
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 >>
Hyperglycemia: When Your Blood Glucose Level Goes Too High
Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when the blood glucose level is too high because the body isn't properly using or doesn't make the hormone insulin. You get glucose from the foods you eat. Carbohydrates, such as fruit, milk, potatoes, bread, and rice, are the biggest source of glucose in a typical diet. Your body breaks down carbohydrates into glucose, and then transports the glucose to the cells via the bloodstream. Body Needs Insulin However, in order to use the glucose, your body needs insulin. This is a hormone produced by the pancreas. Insulin helps transport glucose into the cells, particularly the muscle cells. People with type 1 diabetes no longer make insulin to help their bodies use glucose, so they have to take insulin, which is injected under the skin. People with type 2 diabetes may have enough insulin, but their body doesn't use it well; they're insulin resistant. Some people with type 2 diabetes may not produce enough insulin. People with diabetes may become hyperglycemic if they don't keep their blood glucose level under control (by using insulin, medications, and appropriate meal planning). For example, if someone with type 1 diabetes doesn't take enough insulin before eating, the glucose their body makes from that food can build up in their blood and lead to hyperglycemia. Your endocrinologist will tell you what your target blood glucose levels are. Your levels may be different from what is usually considered as normal because of age, pregnancy, and/or other factors. Fasting hyperglycemia is defined as when you don't eat for at least eight hours. Recommended range without diabet Continue reading >>
What Is The Difference Between Hyperglycemia And Diabetes?
The two are related, but not the same. Hyperglycemia is a term that describes a blood sugar level that is higher than normal. Hyperglycemia is not itself a disease. Diabetes, on the other hand, is. Diabetes occurs when the body is no longer able to effectively control the amount of sugar in your blood, which leads to hyperglycemia. While diabetes is one of the most common causes of hyperglycemia, it can come from other sources, too, including pancreatitis, pancreatic cancer, Cushing’s syndrome, certain types of tumors, and some medications. Both hyperglycemia and diabetes can be serious if left untreated, so you should talk to a doctor if you suspect you have one (or both). This website can get you access to 24/7 online doctor consultations as well as information about both traditional and holistic treatments for these and other symptoms/diseases. Here’s to your continued health and happiness! Continue reading >>
Can Saline Drips Lower Blood Sugar In An Emergency?
When type one diabetics are insulin deficient / dehydrated, a process spirals out of control in which the sugar rises, which leads to loss of water in the kidneys because the glucose carries it out, which creates more stress and dehydration, making the patient more insulin resistant and driving the sugar ever higher. There’s also the production of ketoacids because the body can’t use the sugar in the blood even though it’s high. These patients often arrive at the ER with blood sugar in the high triple digits or even over a thousand (normal is ~70–100) and dehydrated by 4–8 liters or so. The whole thing is called diabetic ketoacidosis or DKA. When you give saline to a diabetic with a high sugar and acidosis, it immediately dilutes the glucose in the blood. Next, it reduces the stress hormones of dehydration, which makes insulin work better and indirectly lowers the blood sugar. Is this the only treatment that’s needed for DKA? No, of course not, but it’s the FIRST thing to do. If you give insulin alone, it will never work—without correcting the dehydration you will never correct the problem. In fact, if the insulin works and the glucose shifts back into cells, it can carry liquid with it leaving the blood volume reduced to the point of shock. Insulin also causes potassium to shift into cells, and so if potassium isn’t replaced as needed, its value will drop causing the danger of lethal heart rhythms. In short, saline is a crucial part of severe hyperglycemia treatment, but rarely by itself. Continue reading >>
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 >>
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 >>
Why Is Hyperglycemia More Common Than Hypoglycemia?
Statistically I cannot tell you which is more common. From experience as a Type 1 Diabetic I can say hyperglycemia is definitely more common than hypoglycemia. As to why, I can offer a couple of guesses. Diabetes, by its definition, is a "loss" of usable insulin. Either the body does not make any (or enough) - Type 1 - or the body cannot use the insulin it does make - Type 2. The end result is the same either way: hyperglycemia. Sometimes an unexpected or unanticipated variable will occur with a diabetic, causing a low blood sugar reaction (hypoglycemia). The treatment for that is to consume some type of sugar. But the experience of a hypoglycemic event is stressful and causes a "panicked" need to eat. It is not uncommon for a person experiencing hypoglycemia to overcompensate with the food. Soon enough, the blood sugar level is back to normal. The problem is, there is usually some undigested food still being turned into sugar. After a while the person's blood sugar level is too high - back to hyperglycemia. Mathematically, for nearly every low blood sugar there is going to be a follow-up high blood sugar, making the occurrence of high blood sugar and low blood sugar nearly equal. There is not the same correspondence of high blood sugar leading to low blood sugar. When a diabetic finds his glucose level is too high, he may take insulin to bring it down, but is careful not to overdose. If anything, underdosing is more likely. But underdosing still leaves the person at least a little hyperglycemic. The math equation we might write for this event leaves hyperglycemia occurring a little more often than hypoglycemia. So with one equation showing the two conditions equaling out and a second equation tipping the scales in favor of high blood sugar, the net result is more hyper Continue reading >>
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 >>
What Is The Mechanism Of Action In The Treatment Of Diabetes?
Insulin therapy is necessary for type 1 diabetics because they have an absolute insulin deficiency due to the autoimmune destruction of the pancreatic beta cells. Insulin therapy is also used in treating type 2 diabetes. As the disease advances, many type 2 diabetics will require insulin therapy, because the beta cells are damaged by hyperglycemia, and patients develop significant defects in insulin secretion. These drugs bind to and block the ATP-sensitive K+ channel on pancreatic beta cells, causing depolarization and increased insulin secretion (review Humoral Regulation). These drugs improve glycemic control, but patients taking them tend to gain weight. Sulfonylureas (glyburide, glimepiride) are older drugs and less expensive. A potential problem is that they can induce too much insulin secretion and hypoglycemia can result. The meglitinides (repaglinide, nateglinide) are newer drugs that are designed to avoid this problem. They have a shorter half-life, and are taken at mealtimes to enhance insulin secretion and prevent postprandial hyperglycemia. Incretins are gastrointestinal hormones that increase insulin secretion (review Incretins). GLP-1 agonists are peptide drugs with a longer half-life than the native hormone because they are resistant to digestion by the protease DPP-4. DPP-4 inhibitors (“gliptins”) prolong the action of native incretins. DPP-4 inhibitors are less effective at lowering HbA1c than GLP-1 agonists, but an advantage is that they are oral drugs. GLP-1 agonists have the added benefit of inducing weight loss (several kilograms, depending upon the length of treatment). The mechanism is thought to be that GLP-1 delays stomach emptying into the small intestine, causing patients to eat less because they feel full sooner. These drugs improve insu Continue reading >>
Blood Sugar Control And Stabilization: Can One Roughly Determine Whether He Has Hypoglycemia Or Hyperglycemia, Without Any Special Equipment?
Barbara Carleton's answer assumes that you know what you have recently eaten, which is indeed a pretty good way to know on what side of the blood sugar spectrum you are. For the sake of this answer, I'll suppose you meant with regards to symptoms and as a diabetic. Simply put, it depends on the person. Whilst Wikipedia describes symptoms that fit both hyper and hypoglycemia, I've never found it to be the case. Hypoglycemias, or "feeling low", usually the result of a slight insulin overdose, are much more acute. In my case, I start to feel a rapid heart beat, shaking hands, sweating, a relative faintness, and increased irritability. Naturally, these worsen as your blood sugar continues to drop, but I have never been to the point of confusion and disorientation. It's simply a matter of eating some rapid sugars and riding it out until they kick in. Hyperglycemias, however, are a completely different business. Your body has mechanisms to try and deal with a lack/surplus of sugar, although these take time to act, and probably won't be efficient enough to deal with the rapid onset of a hypoglycemia. On the contrary, when you're hyper, chances are you will stay in hyper unless you are aware of it and take insulin. Consequently, your body has the time to deal with this sugar surplus, and so symptoms will progressively appear. With regards to symptoms, as mentioned in an other answer, your body will try to evacuate extra sugar through your urine. Unless you drink your urine regularly, I doubt you would notice the extra sweetness. I wouldn't consider it an identifiable symptom. However, in the case of long-term hyperglycemia (such as during an undiagnosed diabetes), a few symptoms will appear. In my case, my body responded to the lack of sugar being transformed by cells into ener Continue reading >>