HYPERGLYCEMIA AND ITS EFFECT

Hyperglycemia
High blood glucose level

A condition in which an excessive amount

of glucose circulates in the blood plasma glucose level higher than 11.1 mmol/l (200 mg/dl)
1mmol = 18 mg/dL

 Fasting hyperglycemia

A blood sugar >130 mg/dL after fasting for at least 8 hours.

Postprandial or after-meal hyperglycemia is

defined as a blood sugar after 2 hours of meal. usually >180 mg/dL

Causes
Lack of insulin ( type 1)

Enough insulin with less effective action (type 2)

Ate more than planned or exercised less than

planned. Stress from an illness, such as a cold or flu. The dawn phenomenon (a surge of hormones that the body produces daily around 4:00 a.m. to 5:00 a.m.).

Symptoms
Polyuria

Polyphagia
Polydypsia

Effects
Type 1 diabetes : ketoacidosis Type 2 diabetes : hyperglycemic hyperosmolar non-

ketotic syndrome (HHNS)

Damage to vessels and organs

I) Diabetic ketoacidosis
Causes profound osmotic diuresis

Dehydration and electrolyte loss

Contraction of the size of ECF occurs, with hemoconcentration Decreased blood volume

Fall in blood pressure

Unrestrained lipolysis

Increase free fatty acid in plasma

Increase Acetyl CoA

Acidosis

Ketonemia

Increase ketone body

Kussmaul breathing

Coma

Clinical feature
Polyuria, polydypsia and polyphagia Tachycardia with deep breathing (Kusmaul

breathing) Hypotension Loss of weight Abdominal pain

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Severe hyperglycaemic

>50mmol/L (600mg/dL)
With severe dehydration and pre-renal uremia Causes profound osmotic diuresis

Decreased peripheral utilization of glucose - hyperglycemia

Osmotic diuresis
Osmotic shift of fluid to the intravascular space Diuresis lead to loss of electrolytes

Dehydration

Dehydration

Hypovolemia

Hypotension

Coma

Impaired tissue perfusion

Management
Soluble insulin

Fluid replacement
0.9% saline (NaCl) 5% dextrose

Potassium replacement Antibiotics- in case of infection

References
DM Vasudevan, Textbook Of Medical Biochemistry

6th Edition DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 21st EDITION

http://www.webmd.com/diabetes/diabetes-

hyperglycemia http://emedicine.medscape.com/article/1914705overview#a0104