What is Hyperglycemia?
“Hyperglycemia” is a term from Greek that translates to “high sugar blood”. This refers to when your blood sugar levels are higher than normal – over 125 mg/dL after fasting, or over 180 mg/dL two hours after eating. If you have a fasting blood sugar level from 100 to 125 mg/dL, this is known as pre-diabetes, and having fasting blood sugar levels over 125 mg/dL is referred to as diabetes.
Ignoring hyperglycemia can cause many dangerous health problems, such as damage to the eyes, kidneys, nerves, heart, and the blood vessels in the limbs. That’s why it’s so important to control high blood sugar levels effectively and quickly – to avoid complications and help patients live healthier lives.
What Causes Hyperglycemia?
Hyperglycemia is a condition that occurs when there’s too much glucose or sugar in your blood. This can happen if your body doesn’t produce enough insulin (a hormone that helps your body use sugar), can’t use glucose the way it should, or makes too much glucose. Making sure your body has the right amount of glucose it needs comes down to a balance between how much glucose your liver makes and how much glucose the rest of your body takes in and uses. Insulin plays a big role in keeping this balance.
Hyperglycemia can also be caused by other things, for example:
* Damage to the pancreas from long-term inflammation, a condition where your body has too much iron, pancreatic cancer, and a genetic disease that mainly affects the lungs.
* Hormone-related disorders that cause the body to resist insulin such as Cushing syndrome, acromegaly, and pheochromocytoma.
* Using certain medications like steroids, phenytoin, and estrogens.
* Diabetes that only happens during pregnancy. This impacts about 4% of all pregnancies and mostly happens because the body doesn’t use insulin the way it should.
* Nutrient-rich fluid administration to the body and glucose infusion.
* In response to surgery or in seriously ill patients.
Here are some major risk factors that can increase the chances of developing hyperglycemia:
* Being significantly over your ideal body weight.
* Having a family history of type 2 diabetes.
* Being Native American, Hispanic, Asian-American, Pacific Islander, or African American.
* Having high levels of fat in the blood or high blood pressure.
* A history of diabetes during pregnancy.
* Having polycystic ovarian syndrome, a hormonal disorder in women.
Risk Factors and Frequency for Hyperglycemia
Over the past twenty years, there has been a significant increase in the number of people with high blood sugar levels, also known as hyperglycemia. This increase is attributed to factors such as obesity, decreased physical activity, and an aging population. Both men and women are equally affected by hyperglycemia. Countries that report the highest number of people living with diabetes, a condition characterized by hyperglycemia, are China, India, United States, Brazil, and Russia. Interestingly, hyperglycemia is more common in households with low to medium income levels.
- Hyperglycemia, or high blood sugar levels, has become more common in the last 20 years.
- This increase is due to more obesity, less physical activity, and an aging population.
- High blood sugar levels affect men and women equally.
- China, India, the United States, Brazil, and Russia have the most people with diabetes.
- Hyperglycemia is more often found in households earning a low to medium income.
- According to the Centers for Disease Control and Prevention, about 30.5 million Americans have diabetes, and nearly 84 million have prediabetes.
- These numbers are expected to significantly increase over the next decade.
Signs and Symptoms of Hyperglycemia
Severe high blood sugar, or hyperglycemia, can cause various symptoms. These can include frequently needing to urinate (polyuria), excessive thirst (polydipsia), and weight loss. If blood sugar levels continue to rise, it can affect the brain, leading to tiredness, specific neurological problems, or changes in mental state. In extreme cases, the person may even become unconscious. People with a condition called diabetic ketoacidosis might experience added symptoms such as nausea, vomiting, and stomach pain. They may also have a sweet, fruity smell to their breath and breathe rapidly and shallowly. This is the body’s way of trying to compensate for the acid buildup in the blood.
Dry mouth and physical signs of low body fluid levels, like low blood pressure (hypotension), rapid heartbeat (tachycardia), and dry mouth, may also be noted during a physical examination.
Testing for Hyperglycemia
If your doctor suspects that you may have high blood sugar, or hyperglycemia, several things will be checked. They’ll look at your breathing and heart function, your mental state, and your body fluid (volume) status. They can quickly test your blood sugar levels at your bedside. Other tests include checking your blood for key substances, including: electrolytes (salts in your blood), blood urea nitrogen and creatinine (waste products that can show how well your kidneys are functioning), and your complete blood count (the number of different types of cells in your blood). A urine test can tell if there is sugar or ketones (a by-product of fat breakdown) in your urine. If your bicarbonate level (a substance that helps regulate your body’s pH) is significantly low, a blood gas test from an artery or vein may be required.
To figure out if you might have developed type 2 diabetes (a long-term condition where your body doesn’t properly use the insulin it produces, leading to high blood sugar levels), you would need to meet certain criteria based on these tests:
- If your fasting plasma glucose level (which is your blood sugar level when you have not eaten for at least eight hours) is 126 mg/dL or higher
- If your 2-hour plasma glucose level (which is your blood sugar level two hours after you’ve had a sugary drink as part of an oral glucose tolerance test) is 200 mg/dL or higher
- If your random plasma glucose (which is your blood sugar level checked at random times of the day) is 200 mg/dL or higher, and you’re also experiencing symptoms of high blood sugar
- If your hemoglobin A1c level (a measure of your average blood sugar levels over the past 2 to 3 months) is 6.5% or higher
Treatment Options for Hyperglycemia
The objective of treating high blood sugar, or hyperglycemia, is to get rid of associated symptoms and prevent long-term health issues. To achieve this, people with type 1 diabetes often follow an individualized plan involving insulin and a balanced diet. Those with type 2 diabetes, on the other hand, are usually guided to make dietary and lifestyle changes, and they may take medications to lower their blood sugar. They might also take pills meant to decrease glucose. Regular check-ups are also needed to catch possible complications like eye disease, kidney disease, and heart disease.
In more detail, the treatment targets are:
* Preventing kidney and eye diseases by keeping blood pressure in check and lowering high blood sugar.
* Avoiding heart disease, stroke, and diseases of the blood vessels by controlling high blood pressure, high levels of fat in the blood, and convincing patients to stop smoking.
* Reducing the risk of developing a group of conditions that increase the risk of heart disease and stroke (known as metabolic syndrome) by controlling weight and lowering high blood sugar.
If patients have high blood sugar and are confirmed to have type 2 diabetes, they need to see a specialist, known as an endocrinologist. Unless there is a specific reason not to, one of the first medicines prescribed to lower their blood sugar is typically metformin. In addition to this, some patients may also require insulin therapy together with other treatments.
To prevent health issues linked to high blood sugar, the following suggestions are recommended:
* Regular eye check-ups with an eye specialist.
* Routine blood tests to monitor hemoglobin A1c levels every 3-6 months. High levels of hemoglobin A1c can indicate poorly controlled diabetes.
* Checking levels of a protein called albumin in urine every 12 months, as this can indicate kidney damage.
* Regular foot examinations during each clinic visit.
* Keeping blood pressure to less than 130/80 mmHg.
* Starting treatment to lower cholesterol levels if the patient has high levels of cholesterol (hyperlipidemia).
Some patients experience wide fluctuations in their blood sugar levels throughout the day and from one day to another, causing frequent episodes of low and high blood sugar. Close monitoring by an endocrinologist along with a specific treatment plan can help reduce these risks.
What else can Hyperglycemia be?
Many health conditions can cause high blood sugar. These conditions that may cause high blood sugar include:
- Type 1 and type 2 diabetes
- High blood sugar caused by stress
- High blood sugar caused by certain medications, like steroids
- Acromegaly, a condition where too much growth hormone is produced
- Cushing disease, a condition where too much cortisol is produced
- Iatrogenic hyperglycemia, which can happen when someone receives certain types of medical care, like intravenous fluids with dextrose or tube feeds
What to expect with Hyperglycemia
The outlook for people with high blood sugar levels greatly depends on how successfully these levels are managed. Prolonged high blood sugar can lead to serious, even life-threatening complications. Making lifestyle changes, staying active and modifying the diet are all crucial for improving this outlook. People who can maintain normal blood sugar levels usually have a much better outlook and a higher quality of life than those who do not manage their blood sugar levels effectively.
Unfortunately, once the complications of high blood sugar develop, they are often irreversible. A number of studies have established that untreated high blood sugar can shorten lives and negatively affect the quality of life. This is why it’s so important to start aggressively lowering high blood sugar levels, and closely monitor the patient’s progress.
Research suggests a target of less than 7% for a measure called A1C, which indicates the average blood sugar levels over the past three months. However, we must prevent blood sugars from going too low, a condition called hypoglycemia, especially in elderly people who may have heart disease. It is vital to strike a balance to keep the blood sugar levels in a safe range.
Possible Complications When Diagnosed with Hyperglycemia
If high blood sugar levels are not managed over a long period, they can lead to some severe health problems. Complications can affect tiny vessels in the body (microvascular) or larger ones (macrovascular).
Small-vessel complications can include:
- Retinopathy – damage to the retina, which is the part of the eye you use to focus on things
- Nephropathy – damage to your kidneys
- Neuropathy – nerve damage, often noticed first in hands and feet
Larger vessel complications can include:
- Coronary artery disease – heart disease caused by buildup of plaque in the arteries that supply blood to the heart
- Cerebrovascular disease – disorders that affect the blood vessels which supply blood to the brain
- Peripheral vascular disease – blocked blood vessels that reduce blood flow to the legs and arms
People with diabetes are also more prone to depression than those without the disease, particularly those recently diagnosed and younger patients. This can be due to the significant lifestyle changes required to manage their diabetes.
Recovery from Hyperglycemia
It’s common for blood sugar levels to be high after surgery. This is known as hyperglycemia. If these high blood sugar levels aren’t managed properly, it can lead to a higher risk of complications during and after surgery. That’s why the doctors aim to keep the blood sugar levels between 140-180 mg/dL following a surgical procedure.
As there can be many different medical teams involved in caring for a patient after surgery, it’s important for them to work together as a unified multidisciplinary team. This team creates and follows specific guidelines to treat high blood sugar levels and reduce the risk of complications during and after surgery.
Preventing Hyperglycemia
Being diagnosed with diabetes can often feel overwhelming and can require a lot of attention, especially in the first few months. It’s really important during this time to focus on understanding and managing the condition. Both patients and their families need to learn about checking blood sugar levels, taking diabetes medications including insulin, attending all medical appointments, and making lifestyle changes.
These lifestyle changes often include adjustments to diet and exercise habits. Patients should also be provided with information about diabetes classes. These classes can provide additional support and education, helping you take control of your health with confidence.
