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Knsulin develops when your body doesn't Nutritional health supplements enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy.
When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine.
Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves.
Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency.
Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early—before it gets worse. Breadcrumb Home Life with Diabetes Get the Right Care for You Hyperglycemia High Blood Glucose.
What causes hyperglycemia? A number of things can cause hyperglycemia: If you have type 1, you may not have given yourself enough insulin. If you have type 2, your body may have enough insulin, but it is not as effective as it should be.
You ate more than planned or exercised less than planned. You have stress from an illness, such as a cold or flu. You have other stress, such as family conflicts or school or dating problems. You may have experienced the dawn phenomenon a surge of hormones that the body produces daily around a.
to a. What are the symptoms of hyperglycemia? The signs and symptoms include the following: High blood glucose High levels of glucose in the urine Frequent urination Increased thirst Part of managing your diabetes is checking your blood glucose often.
How do I treat hyperglycemia? What if it goes untreated? Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: Shortness of breath Breath that smells fruity Nausea and vomiting Very dry mouth Talk to your doctor about how to handle this condition. Medical IDs Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
How can I prevent hyperglycemia?
: Hyperglycemia and insulin| Diabetes Canada | Clinical Practice Guidelines | Options for initial therapy Foods to avoid bloating other therapeutic issues in diabetes management, Hyperglycemia and insulin as the frequency Hyperglyce,ia monitoring and evaluation Energy-boosting detox diets microvascular and macrovascular complications, insulkn discussed Foods to avoid bloating. Norris Nisulin, Zhang X, Avenell A, et al. GLP-1 receptor agonists may insullin be used safely in chronic kidney disease stage 4, but patient education for signs and symptoms of dehydration due to nausea or satiety is warranted to reduce the risk of acute kidney injury. Estimating the effect of sulfonylurea on HbA1c in diabetes: a systematic review and meta-analysis. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. Similarly, patients without severely increased albuminuria derive some benefit, but the absolute benefits are greater among those with severely increased albuminuria. |
| Key Messages | See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'. In the setting of declining eGFR, the main reason to prescribe an SGLT2 inhibitor is to reduce progression of DKD. However, cardiac and kidney benefits have been shown in patients with eGFR below this threshold. See "Treatment of diabetic kidney disease", section on 'Type 2 diabetes: Treat with additional kidney-protective therapy'. In the absence of randomized trials directly comparing cardiovascular outcomes of the GLP-1 receptor agonists and SGLT2 inhibitors, the following findings and those from network meta-analyses [ 38,39 ] largely support our approach outlined above:. See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects'. Patients at high CVD risk but without a prior event might benefit, but the data are less definitive [ 45 ]. Similarly, patients without severely increased albuminuria derive some benefit, but the absolute benefits are greater among those with severely increased albuminuria. For the other primary outcome a composite of hospitalization for myocardial infarction or stroke , there was a small benefit with SGLT2 inhibitors in patients with a history of CVD rate difference There was no difference in CVD outcomes between the two classes in those without a history of CVD. GLP-1 receptor agonists are an alternative since glycemic benefit is independent of kidney function. In addition, GLP-1 receptor agonists have been shown to slow the rate of decline in eGFR and prevent worsening of albuminuria, albeit to a lesser degree than SGLT2 inhibitors. GLP-1 receptor agonists should be titrated slowly, with monitoring for GI side effects, which could precipitate dehydration and acute kidney injury AKI. See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus" and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Microvascular outcomes'. We avoid use of SGLT2 inhibitors in patients with frequent genitourinary yeast infections or bacterial urinary tract infections, low bone density and high risk for falls and fractures, foot ulceration, and factors predisposing to diabetic ketoacidosis eg, pancreatic insufficiency, drug or alcohol use disorder because of increased risk for each while using these agents. SGLT2 inhibitors should be held for procedures, colonoscopy preparation, and with poor oral intake to prevent diabetic ketoacidosis. See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Contraindications and precautions'. In general, we tolerate higher glycemic targets, and, if medication is required, we prefer a short-acting, low-dose sulfonylurea eg, glipizide , repaglinide , linagliptin , or cautious use of a GLP-1 receptor agonist or insulin. See "Management of hyperglycemia in patients with type 2 diabetes and advanced chronic kidney disease or end-stage kidney disease", section on 'Treatment' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Use in chronic kidney disease' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Clinical use of meglitinides'. Without established cardiovascular or kidney disease — For most patients without established ASCVD or kidney disease who have persistent hyperglycemia while taking metformin mg per day or a lower maximally tolerated dose , we suggest a GLP-1 receptor agonist or basal insulin based on the results of the GRADE trial, a comparative effectiveness study of commonly used classes of glucose lowering medications algorithm 2 [ 10,54 ]. In the GRADE trial, choice of a second glucose-lowering medication was evaluated in patients with type 2 diabetes A1C 6. Participants with hyperglycemia despite taking maximum tolerated doses of metformin were randomly assigned to treatment with U glargine, liraglutide , glimepiride , or sitagliptin. Over a mean follow-up of five years, all four medications lowered A1C levels. The proportion of individuals with severe hypoglycemia was highest in the glimepiride group 2. Liraglutide had the highest frequency of gastrointestinal side effects. The treatment groups did not differ in the rate of the prespecified secondary micro- or macrovascular outcomes, including moderately or severely increased albuminuria, reduced kidney function, peripheral neuropathy, major adverse cardiovascular events MACE , hospitalization for HF, cardiovascular mortality, or overall mortality [ 54,55 ]. However, there was a small reduction in the incidence of any CVD defined as first incidence of MACE, hospitalization for unstable angina or HF, or revascularization in any arterial bed with liraglutide 6. The GRADE trial was designed and implemented prior to the availability of SGLT2 inhibitors. SGLT2 inhibitors have lower glycemic efficacy compared with basal insulin and GLP-1 receptor agonists [ 20 ]. The cardiovascular benefit of SGLT2 inhibitors has not been demonstrated in those at low cardiovascular risk. Shorter-term trial data also support selection of the dual-acting GLP-1 and GIP receptor agonist tirzepatide as a second glucose-lowering agent, particularly in individuals for whom substantial body weight loss is a treatment goal. Trial data for tirzepatide are reviewed separately. The choice of an alternative glucose-lowering medication is guided by efficacy, patient comorbidities, preferences, side effects, and cost algorithm 2. These benefits are offset by risks of hypoglycemia and modest weight gain. Sulfonylureas can be used safely and effectively with dose adjustment, even in people at risk of hypoglycemia, but this requires a bit more attention. We prefer a shorter-duration sulfonylurea or one with relatively lower risk for hypoglycemia eg, glipizide , glimepiride , since longer-acting glyburide is associated with a higher risk of hypoglycemia, especially in older or frail patients. In addition, there are good data providing reassurance of the cardiovascular safety of these sulfonylureas. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'. The glycemic efficacy of sulfonylureas in combination with other oral agents is illustrated by the findings of a meta-analysis of trials in which sulfonylureas were added to oral agents predominantly metformin or thiazolidinediones [ 56 ]. Compared with placebo, the addition of sulfonylureas to oral diabetes treatment lowered A1C by 1. The clinical use, side effects, and concerns about the cardiovascular safety of sulfonylureas are reviewed separately. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus". SGLT2 inhibitors are associated with modest weight loss. With both medication classes, weight loss effects are stronger when the medication is combined with sustained efforts at dietary modification. In patients with diabetes mellitus and biopsy-proven NASH, pioglitazone has been shown to improve fibrosis as well as inflammation and steatosis. GLPbased therapies also appear to improve liver biopsy evidence of NASH. These studies are reviewed in detail separately. See "Management of nonalcoholic fatty liver disease in adults", section on 'Patients with NASH and diabetes'. The potential benefits of these drugs must be balanced with their associated adverse effects. In particular, pioglitazone is not typically a first-choice agent due to adverse effects, including increased risk of weight gain, fluid retention, HF, fractures, and the potential increased risk of bladder cancer. It may play a role in the treatment of selected patients with severe insulin resistance, NASH or nonalcoholic fatty liver disease , at low risk of fracture. Adverse effects of pioglitazone may be minimized by using 15 to 30 mg rather than the 45 mg highest dose. See "Management of nonalcoholic fatty liver disease in adults", section on 'Patients with NASH and diabetes' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Safety' and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Adverse effects'. Trials comparing other combinations are reviewed separately in the individual topics. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Glycemic efficacy' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Glycemic efficacy' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Glycemic efficacy'. Dual agent failure — For patients who have deterioration of glycemic management on dual therapy, the options include:. Although guidelines suggest combining SGLT2 inhibitors and GLP-1 receptor agonists [ 1 ], we do not usually add an SGLT2 inhibitor to GLP-1 receptor agonist therapy for hyperglycemia alone given the absence of data showing additive cardiovascular and kidney benefit and increased patient burden cost, polypharmacy, adverse effects. The choice of additional therapy should be individualized, as discussed above for patients with monotherapy failure, based on efficacy, glycemic target, risk of hypoglycemia, the patient's underlying comorbidities, impact on weight, side effects, and cost. See 'Monotherapy failure' above. In patients on sulfonylureas and metformin who are starting insulin therapy, sulfonylureas are generally discontinued, while metformin is continued. In patients on a DPP-4 inhibitor who are starting a GLP-1 receptor agonist or dual-acting GLP-1 and GIP receptor agonist, the DPP-4 inhibitor should be discontinued. Insulin dose requirements can decrease precipitously with the addition of these medications, requiring patient education and close follow-up with insulin dose adjustment in the short term to reduce the risk of hypoglycemia. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects'. In a meta-analysis of randomized trials evaluating the addition of a third agent in patients inadequately managed with two agents predominantly metformin and a sulfonylurea or metformin and a thiazolidinedione , triple-agent combinations reduced A1C to a greater extent than two agents [ 58 ]. In trials lasting 52 to 54 weeks, the addition of thiazolidinediones, GLP-1 receptor agonists, or SGLT2 inhibitors to metformin and sulfonylurea reduced A1C to a similar extent, and tirzepatide imparted even greater A1C reduction. However, these trials did not directly compare the third-line agents with each other. Moreover, only the GRADE study was of sufficient duration to determine long-term glycemic effects. For patients who are not well managed on two oral agents, switching to insulin may be less expensive than adding a third oral or injectable agent, depending on which insulin and which third oral or injectable agent is selected. Insulin initiation and intensification — If a decision has been made to add insulin to oral hypoglycemic therapy in patients with type 2 diabetes, a single daily dose of either insulin NPH or detemir given at bedtime or insulin glargine or degludec given in the morning or at bedtime is a reasonable initial regimen [ 1 ]. Metformin , GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors can be continued when insulin is added, whereas sulfonylureas and pioglitazone are usually discontinued due to reduced efficacy in comparison with other combinations and to adverse effects [ 59 ]. Patients should measure blood glucose at appropriate times, and usually once to twice per day, depending on the insulin used and timing of administration. For example, if bedtime NPH is used, it should be adjusted based on fasting glucose levels. More frequent self-monitoring should be implemented during insulin dose adjustment and when changes in daily activities traveling, changes in diet or exercise pattern or acute illness makes insulin adjustments necessary. The dose of basal or long-acting insulin may be adjusted every three to four days until fasting glucose targets are achieved. Once an insulin regimen is stable, less frequent glucose monitoring may suffice. See "Insulin therapy in type 2 diabetes mellitus", section on 'Titrating dose'. Related Pathway s : Diabetes: Initiation and titration of insulin therapy in non-pregnant adults with type 2 DM. For patients who continue to have poor glycemic management on basal insulin after titration, diet and exercise patterns should be reviewed. Potential next steps include adding rapid-acting insulin before the largest meal and then two or three meals if needed , adding a GLP-1 receptor agonist, or changing to premixed insulin twice daily figure 5. Several premixed combinations of basal and prandial insulin or basal insulin and a GLP-1 receptor agonist are available. See "Insulin therapy in type 2 diabetes mellitus", section on 'Designing an insulin regimen' and "General principles of insulin therapy in diabetes mellitus" and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus". Use of an intensive insulin regimen with multiple daily injections MDI; similar to that used in type 1 diabetes may be necessary in insulin-deficient type 2 diabetes. Patients with type 2 diabetes on MDI or with insulin deficiency may benefit from devices used more commonly in type 1 diabetes such as insulin pumps or continuous glucose monitors. See "Continuous subcutaneous insulin infusion insulin pump " and "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'CGM systems'. MDI results in higher serum insulin concentrations and better glycemic management than that achieved with either an oral drug or basal insulin therapy alone [ 7 ]. MDI in type 2 diabetes may require large doses of insulin to overcome insulin resistance and can be associated with substantial weight gain averaging 8. Patients with type 2 diabetes with generalized obesity or with central overweight, often with nonalcoholic fatty liver disease, frequently require insulin doses in the range of 65 to units per day or much higher. Although the total daily dose of insulin may be high, the insulin dose per kilogram is less remarkable. High daily insulin requirements may prompt consideration of use of concentrated insulins, such as U glargine or U regular insulin. Concentrated insulin formulations deliver more potent insulins in smaller volumes, which is less cumbersome for patients and facilitates improved insulin absorption. See "General principles of insulin therapy in diabetes mellitus", section on 'U regular insulin' and "General principles of insulin therapy in diabetes mellitus", section on 'Basal insulin analogs'. While use of concentrated insulins is often effective for glycemic management, the worsening obesity associated with high-dose insulin can result in progressively increasing insulin requirements. This phenomenon may then lead to reconsideration of addition of an insulin-sparing agent eg, GLP-1 receptor agonist or thiazolidinedione or bariatric surgery. See 'Bariatric metabolic surgery' below and "Medical nutrition therapy for type 2 diabetes mellitus". The vast majority of these CVD safety studies were placebo-controlled and enrolled all or a majority of patients with pre-existing CVD or at high cardiovascular risk, representing a minority of the type 2 diabetes population. The long-term benefits and risks of using one agent over another in the absence of diagnosed CVD or high atherosclerotic CVD ASCVD risk are less clear. Thus, the results of these trials are most applicable to patients similar to the trial population and not to all patients with type 2 diabetes [ 2,60 ]. Cardiovascular benefit has been demonstrated for some of these medications when taken in combination with metformin , but benefit has not been definitively established in drug-naïve patients at low to moderate cardiovascular risk. See 'Without established cardiovascular or kidney disease' above. The cardiovascular effects of each diabetes drug when data are available is reviewed in the individual topics. See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Insulin therapy in type 2 diabetes mellitus". They can reduce A1C values slightly 0. They act predominantly by lowering glucose concentrations after meals but may be poorly tolerated because of flatulence and other gastrointestinal GI side effects. However, if they are started at a low dose 25 mg before meals and slowly increased, they can be effective in people who follow high-carbohydrate diets. See "Alpha-glucosidase inhibitors for treatment of diabetes mellitus". Pramlintide is only approved for use in patients also taking prandial insulin, and therefore, it is not generally used in patients with type 2 diabetes. It also has frequent GI side effects. See "Amylin analogs for the treatment of diabetes mellitus". In , another inhaled insulin preparation was approved by the US Food and Drug Administration FDA. Inhaled insulin causes a very rapid rise in serum insulin concentration similar to that after subcutaneous rapid-acting insulins and faster than that after subcutaneous regular insulin. It is designed to be used to manage postprandial glucose levels. Inhaled insulin may cause a transient cough with each inhalation, and it requires pulmonary monitoring. It is used infrequently in patients with type 2 diabetes. See "Inhaled insulin therapy in diabetes mellitus". Colesevelam's mechanism of action to improve glycemia is uncertain [ 64 ]. One possibility is that bile acid sequestrants act in the GI tract to reduce glucose absorption. In a meta-analysis of five short-term trials 16 to 26 weeks in patients with type 2 diabetes inadequately treated with oral agents or insulin, the addition of colesevelam compared with placebo modestly reduced A1C levels mean difference 0. The meta-analysis was limited by the high or unclear risk of bias in the individual trials. Side effects can include constipation, nausea, and dyspepsia. In contrast to its effects on LDL cholesterol, colesevelam increases triglyceride concentrations by approximately 20 percent [ 66,67 ]. The clinical implications of this increase are unknown. See "Lipoprotein classification, metabolism, and role in atherosclerosis", section on 'Apolipoprotein C-III'. Given the modest glucose-lowering effectiveness, expense, and limited clinical experience, we typically do not recommend colesevelam to improve glycemic management in patients with type 2 diabetes. See "Management of hyperprolactinemia", section on 'Overview of dopamine agonists'. A quick-release formulation of bromocriptine has been approved by the FDA for the treatment of type 2 diabetes mellitus [ 68 ]. In short-term clinical trials in patients with type 2 diabetes mellitus, bromocriptine up to 4. Common side effects include nausea, vomiting, dizziness, and headache [ 70 ]. The mechanism of action in reducing blood sugar is unknown. Given its modest glucose-lowering effect, very frequent GI side effects, and the availability of more effective drugs, we do not recommend bromocriptine for the treatment of type 2 diabetes. BARIATRIC METABOLIC SURGERY — In patients with type 2 diabetes and obesity, bariatric and metabolic surgical procedures that result in sustained, major weight loss have been shown to lead to at least temporary remission of diabetes in a substantial fraction of patients. Bariatric surgical procedures are targeted at weight loss in the setting of obesity; the term "metabolic surgery" is used when a major goal of surgery is to improve diabetes or other metabolic diseases eg, nonalcoholic fatty liver disease. Patient selection — Surgical treatment of obesity is an option to treat type 2 diabetes in appropriate surgical candidates with [ 71 ]:. Surgical treatment has also been endorsed in patients with type 2 diabetes with BMI 30 to Given the increasing availability of potent GLPbased therapies and lack of comparative effectiveness data for bariatric surgery and these potent agents, we review these options with our patients and engage in shared decision-making. See "Initial management of hyperglycemia in adults with type 2 diabetes mellitus", section on 'Diabetes education' and "Bariatric surgery for management of obesity: Indications and preoperative preparation", section on 'Indications'. Outcomes — Unblinded trials have compared bariatric surgery with medical therapy for the treatment of type 2 diabetes see "Outcomes of bariatric surgery", section on 'Diabetes mellitus'. However, relapse of diabetes usually occurs over time, with 35 to 50 percent of patients who initially achieved diabetes remission after surgery experiencing a recurrence [ 72,75 ]. Nevertheless, bariatric surgery improves glycemia substantially and significantly more than medication therapy, and most patients have marked improvement in glycemic management for at least 5 to 15 years after surgery. The effects of bariatric surgery on diabetes-related complications are reviewed in detail elsewhere. See "Outcomes of bariatric surgery", section on 'Diabetic complications'. Risks and concerns — Despite these impressive metabolic results, concerns remain about acute postoperative complications including the need for reoperations and rehospitalizations and rare, but potentially severe, adverse events; the long-term success rates in maintaining weight loss [ 71,80,81 ]; and the reproducibility of the results in patients with an extensive history of diabetes or with different surgical teams [ 82 ]. Some weight regain is typical within two to three years of bariatric procedures, and different procedures result in different levels of weight loss and corresponding reductions in glycemia. Bariatric surgical procedures are reviewed in detail elsewhere. See "Bariatric procedures for the management of severe obesity: Descriptions" and "Bariatric surgery for management of obesity: Indications and preoperative preparation" and "Bariatric operations: Early fewer than 30 days morbidity and mortality". SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetes mellitus in children" and "Society guideline links: Diabetic kidney disease". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. This decision is based on glycated hemoglobin A1C assay results calculator 1 typically performed every three to six months after initial therapy. After a successful initial response to lifestyle intervention and oral therapy, the majority of patients do not maintain target A1C levels during the subsequent three to five years. See 'Indications for a second agent' above. Diabetes Care ;—8. Carpenter DL, Gregg SR, Xu K, et al. Prevalence and impact of unknown diabetes in the ICU. Crit Care Med ;e— Kompoti M, Michalia M, Salma V, et al. Glycated hemoglobin at admission in the intensive care unit: Clinical implications and prognostic relevance. J Crit Care ;—5. Can HbA1c detect undiagnosed diabetes in acute medical hospital admissions? Diabetes Res Clin Pract ;— Malcolm JC, Kocourek J, Keely E, et al. Implementation of a screening program to detect previously undiagnosed dysglycemia in hospitalized patients. Can J Diabetes ;— Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline. Lewandrowski K, Cheek R, Nathan DM, et al. Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing. Am J Med ;— Rumley AG. Improving the quality of near-patient blood glucose measurement. Ann Clin Biochem ;34 Pt 3 —6. Boyd JC, Bruns DE. Quality specifications for glucose meters: Assessment by simulation modeling of errors in insulin dose. Clin Chem ;— Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA ;— Desachy A, Vuagnat AC, Ghazali AD, et al. Accuracy of bedside glucometry in critically ill patients: Influence of clinical characteristics and perfusion index. Mayo Clin Proc ;—5. Critchell CD, Savarese V, Callahan A, et al. Accuracy of bedside capillary blood glucose measurements in critically ill patients. Intensive Care Med ;— Petersen JR, Graves DF, Tacker DH, et al. Comparison of POCT and central laboratory blood glucose results using arterial, capillary, and venous samples from MICU patients on a tight glycemic protocol. Clin Chim Acta ;— Nirantharakumar K, Chen YF, Marshall T, et al. Clinical decision support systems in the care of inpatients with diabetes in non-critical care setting: Systematic review. Diabet Med ;— Maynard G, Schnipper JL, Messler J, et al. Design and implementation of a webbased reporting and benchmarking center for inpatient glucometrics. J Diabetes Sci Technol ;— Baker EH, Janaway CH, Philips BJ, et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax ;—9. McAlister FA, Majumdar SR, Blitz S, et al. The relation between hyperglycemia and outcomes in 2, patients admitted to the hospital with communityacquired pneumonia. Diabetes Care ;— American Diabetes Association. Diabetes care in the hospital. Diabetes Care ;S99— Lewis KS, Kane-Gill SL, Bobek MB, et al. Intensive insulin therapy for critically ill patients. Ann Pharmacother ;— van den Berghe G,Wouters P,Weekers F, et al. Intensive insulin therapy in critically ill patients. Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: A meta-analysis including NICE-SUGAR study data. CMAJ ;—7. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract ;— Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care ;—7. Rea RS, Donihi AC, BobeckM, et al. Implementing an intravenous insulin infusion protocol in the intensive care unit. Am J Health Syst Pharm ;— Nazer LH, Chow SL, Moghissi ES. Insulin infusion protocols for critically ill patients: A highlight of differences and similarities. Ntaios G, Papavasileiou V, Bargiota A, et al. Intravenous insulin treatment in acute stroke: A systematic review and meta-analysis of randomized controlled trials. Int J Stroke ;— Schmeltz LR, DeSantis AJ, Schmidt K, et al. Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patientswith hyperglycemia. Bode BW, Braithwaite SS, Steed RD, et al. Intravenous insulin infusion therapy: Indications, methods, and transition to subcutaneous insulin therapy. Endocr Pract ;10 Suppl. Kwoun MO, Ling PR, Lydon E, et al. Immunologic effects of acute hyperglycemia in nondiabetic rats. JPEN J Parenter Enteral Nutr ;—5. Verhofstad MH, Hendriks T. Complete prevention of impaired anastomotic healing in diabetic rats requires preoperative blood glucose control. Br J Surg ;— Golden SH, Peart-Vigilance C, Kao WH, et al. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. McAlister FA, Man J, Bistritz L, et al. Diabetes and coronary artery bypass surgery: An examination of perioperative glycemic control and outcomes. Thomas MC, Mathew TH, Russ GR, et al. Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: A pilot study. Transplantation ;—4. Estrada CA, Young JA, Nifong LW, et al. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg ;—9. Brandt M, Harder K, Walluscheck KP, et al. Coronary artery bypass surgery in diabetic patients. J Card Surg ;— Bucerius J, Gummert JF,Walther T, et al. Diabetes in patients undergoing coronary artery bypass grafting. Impact on perioperative outcome. Z Kardiol ;— Impact of diabetes mellitus on cardiac surgery outcome. Thorac Cardiovasc Surg ;— Doenst T,Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg ; Gandhi GY, Nuttall GA, Abel MD, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc ;—6. Ouattara A, Lecomte P, Le Manach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology ;— Boreland L, Scott-Hudson M, Hetherington K, et al. The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: A systematic review. Heart Lung ;— Raucoules-Aime M, Lugrin D, Boussofara M, et al. Intraoperative glycaemic control in non-insulin-dependent and insulin-dependent diabetes. Br J Anaesth ;—9. Hemmerling TM, Schmid MC, Schmidt J, et al. Comparison of a continuous glucose-insulin-potassium infusion versus intermittent bolus application of insulin on perioperative glucose control and hormone status in insulintreated type 2 diabetics. J Clin Anesth ;— Christiansen CL, Schurizek BA, Malling B, et al. Insulin treatment of the insulindependent diabetic patient undergoing minor surgery. Continuous intravenous infusion compared with subcutaneous administration. Anaesthesia ;—7. de Vries FE, Gans SL, Solomkin JS, et al. Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection. Br J Surg ;e95— Suto C, Hori S, Kato S, et al. Effect of perioperative glycemic control in progression of diabetic retinopathy and maculopathy. Arch Ophthalmol ;— Kamio S, Kawasaki R, Yamashita H. Influence of systemic conditions and glycemic control on complications of vitrectomy for diabetic retinopathy. Folia Ophthalmologica Japonica ;—9, Japanese. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery RABBIT 2 Surgery. Huang QX, Lou FC, Wang P, et al. Basal insulin therapy strategy is superior to premixed insulin therapy in the perioperative period blood glucose management. Chin Med J ;—6. Coan KE, Schlinkert AB, Beck BR, et al. Clinical inertia during postoperative management of diabetes mellitus: Relationship between hyperglycemia and insulin therapy intensification. J Diabetes Sci Technol ;—7. Yogi-Morren D, Lansang MC. Management of patients with type 1 diabetes in the hospital topical collection on hospital management of diabetes. Curr Diab Rep ; Meyer C, Boron A, Plummer E, et al. Glulisine versus human regular insulin in combination with glargine in noncritically ill hospitalized patients with type 2 diabetes: A randomized double-blind study. Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes RABBIT 2 Trial. Lee YY, Lin YM, Leu WJ, et al. Sliding-scale insulin used for blood glucose control:A meta-analysis of randomized controlled trials. Metabolism ;— Thomann R, Schütz P, Muller B, et al. Evaluation of an algorithm for intensive subcutaneous insulin therapy in noncritically ill hospitalised patients with hyperglycaemia in a randomised controlled trial. Swiss Med Wkly ; Umpierrez GE, Smiley D, Hermayer K, et al. Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: Basal plus trial. Mader JK, Neubauer KM, Schaupp L, et al. Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients. Diabetes Obes Metab ;— Efficacy and safety of weight-based insulin glargine dose titration regimen compared with glucose level- and current dose-based regimens in hospitalized patients with type 2 diabetes: A randomized, controlled study. Clin Ther ;— Inagaki N, Goda M, Yokota S, et al. Effects of baseline blood pressure and lowdensity lipoprotein cholesterol on safety and efficacy of canagliflozin in Japanese patients with type 2 diabetes mellitus. Adv Ther ;— Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes. Zhang T, Lin M, Li W, et al. Comparison of the efficacy and safety of insulin detemir and insulin glargine in hospitalized patients with type 2 diabetes: A randomized crossover trial. Management of diabetes and hyperglycemia in the hospital: A practical guide to subcutaneous insulin use in the non-critically ill, adult patient. J Hosp Med ;— Mendez CE, Umpierrez GE. Pharmacotherapy for hyperglycemia in noncritically ill hospitalized patients. Diabetes Spectr ;—8. Pasquel FJ, Gianchandani R, Rubin DJ, et al. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes Sita-Hospital : A multicentre, prospective, open-label, non-inferiority randomised trial. Lancet Diabetes Endocrinol ;— Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in hospitals. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: Myth or insanity? Am J Med ;—7. Curll M, Dinardo M, Noschese M, et al. Menu selection, glycaemic control and satisfaction with standard and patient-controlled consistent carbohydrate meal plans in hospitalised patients with diabetes. Qual Saf Health Care ;—9. Jakoby MG, Nannapaneni N. An insulin protocol for management of hyperglycemia in patients receiving parenteral nutrition is superior to ad hoc management. JPEN J Parenter Enteral Nutr ;—8. People with diabetes may need to take extra medication to keep their blood sugar levels stable during times of illness or stress. Dawn phenomenon, or a surge of hormones occurring roughly between 4 and 5 a. This is a cause of high blood sugars in the morning. Hyperglycemia can be dangerous, as it often does not cause symptoms until glucose levels are very high. People who have had type 2 diabetes for several years may not have any symptoms despite having high blood sugar. Many people have undiagnosed type 2 diabetes. Prolonged hyperglycemia increases the risk of diabetes-related complications, such as kidney disease, eye disease, and neuropathy. One complication of uncontrolled diabetes is diabetic ketoacidosis DKA. Ketoacidosis develops in response to an inability to use existing glucose in the bloodstream. Without insulin, or if the body is highly resistant to insulin, the body is unable to use sugar as energy. This causes the breakdown of fats for energy, creating ketones as a waste product. Both resistance to insulin and a lack of insulin in the body can cause DKA. However, the people most at risk are those with type 1 diabetes. Ketoacidosis is rare for people with type 2 diabetes, but it can occur. Another complication of uncontrolled diabetes is hyperglycemic hyperosmolar syndrome. This occurs when the blood sugar levels become very high. Without treatment, diabetic hyperglycemic hyperosmolar syndrome can be life-threatening and lead to severe dehydration and possibly coma. This syndrome is quite rare and usually occurs in older adults with type 2 diabetes. It is most likely to occur when people are sick and have difficulty hydrating themselves regularly. Typically, a co-occurring illness such as infection or stroke causes hyperglycemic hyperosmolar syndrome in diabetes. Developing hyperglycemia as a result of uncontrolled diabetes can cause serious long-term complications. They may include:. A person can monitor their blood sugar at home with the help of a fingerstick or a continuous glucose monitoring system. An A1C test is a blood test that indicates average blood sugar control during the previous 3 months. The A1C test works by measuring the percentage of glucose in the bloodstream that has bound to hemoglobin, which is the oxygen-carrying protein in red blood cells. A score of higher than 6. The American Diabetes Association suggest the following blood sugar targets for most adults with diabetes who are not pregnant:. Ranges can vary depending on age and any underlying medical conditions, such as a heart, lung, or kidney disease. Ranges also vary for people who are pregnant or experiencing complications from diabetes. All people with diabetes should use a glucose meter to monitor blood sugar at home and make sure they stay within their goal range. Home monitoring allows people to quickly notice any potentially harmful changes and immediately report problems to a physician. Over-the-counter urinary ketone level test kits are also available to determine the presence of DKA. If a person is experiencing any of the symptoms above, getting a positive test means that their body may be in the early stages of DKA, and they should consider seeking treatment immediately. A doctor can adjust the drug regimen accordingly for a person with diabetes who is also experiencing symptoms of hyperglycemia. |
| Insulin, Blood Sugar, and Type 2 Diabetes | DKA and HHS are medical emergencies. They are treated with intravenous fluids, electrolytes, and insulin. In general, hyperglycemia that is transient does not cause long-term problems. But if hyperglycemia persists, it can lead to serious complications, including eye problems, kidney damage, nerve damage, and cardiovascular disease. But with appropriate treatment and regular monitoring of blood glucose levels, people can reduce the risk of hyperglycemia, lower their chances of having serious complications, and live healthy lives. Our multidisciplinary approach ensures people with blood glucose problems get self-management skills and knowledge to achieve and maintain long-term optimal blood glucose control. We focus on lifestyle interventions, including healthy diet and exercise. Our patients have access to the most advanced medical care, including the latest medications and technologies to prevent hyperglycemic complications and maintain better health throughout their lives. Visit the Yale Medicine Diabetes Content Center for more diabetes-related articles and videos. Skip to Main Content. Hyperglycemia: Symptoms, Causes, and Treatments. Print Share. What is hyperglycemia? What causes hyperglycemia? What are the risk factors for hyperglycemia? Certain factors or conditions increase the risk for hyperglycemia, including: Obesity or being overweight Family history of type 2 diabetes Personal history of gestational diabetes Prediabetes when blood glucose levels are high, but not high enough to be diagnosed as diabetes. What are the symptoms of hyperglycemia? Symptoms of hyperglycemia include: Urinating large amounts Excessive thirst Feeling tired Frequent hunger Dry mouth Weight loss Blurred vision Recurrent infections e. How is hyperglycemia diagnosed? How is hyperglycemia treated? The treatment depends on the cause of hyperglycemia, and may include the following: Insulin. For people with type 1 diabetes, insulin is the main treatment for hyperglycemia. In some cases, it may also be used to treat people with type 2 diabetes. Glucose-lowering medications. Various drugs such as metformin may be used to lower blood glucose levels. Glucose monitoring. People with diabetes should monitor their blood glucose levels as instructed by their doctor. Lifestyle changes. People with diabetes can reduce the risk of developing hyperglycemia or treat existing hyperglycemia by getting regular exercise, following a nutritious diet, and maintaining a healthy weight. What is the outlook for people who have hyperglycemia? People with prediabetes, in which blood sugar levels are higher than normal but not as high as they would be in diabetes, are at risk of developing diabetes. People with prediabetes would score — on an oral glucose tolerance test. Those with diabetes would score and higher. Diabetes causes high blood sugar levels through two possible mechanisms: insufficient insulin production in the pancreas, or resistance to the action of insulin elsewhere in the body. In type 1 diabetes , the immune system destroys the insulin-producing cells of the pancreas. It does not put out enough insulin. People with type 1 diabetes need to take supplementary insulin to keep their blood sugars under control. Some people with type 2 diabetes might need insulin, though they may also take noninsulin oral medications. All people with diabetes, regardless of type, should monitor their blood sugar levels to make sure they stay within a safe range. People with diabetes may need to take extra medication to keep their blood sugar levels stable during times of illness or stress. Dawn phenomenon, or a surge of hormones occurring roughly between 4 and 5 a. This is a cause of high blood sugars in the morning. Hyperglycemia can be dangerous, as it often does not cause symptoms until glucose levels are very high. People who have had type 2 diabetes for several years may not have any symptoms despite having high blood sugar. Many people have undiagnosed type 2 diabetes. Prolonged hyperglycemia increases the risk of diabetes-related complications, such as kidney disease, eye disease, and neuropathy. One complication of uncontrolled diabetes is diabetic ketoacidosis DKA. Ketoacidosis develops in response to an inability to use existing glucose in the bloodstream. Without insulin, or if the body is highly resistant to insulin, the body is unable to use sugar as energy. This causes the breakdown of fats for energy, creating ketones as a waste product. Both resistance to insulin and a lack of insulin in the body can cause DKA. However, the people most at risk are those with type 1 diabetes. Ketoacidosis is rare for people with type 2 diabetes, but it can occur. Another complication of uncontrolled diabetes is hyperglycemic hyperosmolar syndrome. This occurs when the blood sugar levels become very high. Without treatment, diabetic hyperglycemic hyperosmolar syndrome can be life-threatening and lead to severe dehydration and possibly coma. This syndrome is quite rare and usually occurs in older adults with type 2 diabetes. It is most likely to occur when people are sick and have difficulty hydrating themselves regularly. Typically, a co-occurring illness such as infection or stroke causes hyperglycemic hyperosmolar syndrome in diabetes. Developing hyperglycemia as a result of uncontrolled diabetes can cause serious long-term complications. They may include:. A person can monitor their blood sugar at home with the help of a fingerstick or a continuous glucose monitoring system. An A1C test is a blood test that indicates average blood sugar control during the previous 3 months. The A1C test works by measuring the percentage of glucose in the bloodstream that has bound to hemoglobin, which is the oxygen-carrying protein in red blood cells. A score of higher than 6. The American Diabetes Association suggest the following blood sugar targets for most adults with diabetes who are not pregnant:. Ranges can vary depending on age and any underlying medical conditions, such as a heart, lung, or kidney disease. Ranges also vary for people who are pregnant or experiencing complications from diabetes. All people with diabetes should use a glucose meter to monitor blood sugar at home and make sure they stay within their goal range. Home monitoring allows people to quickly notice any potentially harmful changes and immediately report problems to a physician. Over-the-counter urinary ketone level test kits are also available to determine the presence of DKA. If a person is experiencing any of the symptoms above, getting a positive test means that their body may be in the early stages of DKA, and they should consider seeking treatment immediately. A doctor can adjust the drug regimen accordingly for a person with diabetes who is also experiencing symptoms of hyperglycemia. Visiting the emergency room might be necessary if certain symptoms occur or do not resolve, including:. As well as talking to a doctor about managing their blood sugar levels, people can take the following steps to help avoid hyperglycemia:. People with diabetes must keep track of their blood sugar, stay within their target levels, follow a dedicated eating plan, exercise, and always take their medicine. They should report any abnormal symptoms to their doctor. This can help people with diabetes prevent hyperglycemia and receive early treatment with a view to preventing long-term complications. Many types of diet can benefit people with diabetes. Eating carbohydrates, for example, directly impacts blood sugars, so doctors recommend a carb-controlled diet. Ketogenic diets have become popular, as they lead to rapid weight loss. |
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Insulin Receptor and Type 2 Diabetes One of the most important nutrients Hyperglycenia glucose, a type of sugar. Foods to avoid bloating sometimes, as Dry skin hydration solutions Hyperglycemia and insulin people with diabetesthe insuli is unable to effectively control insuulin levels. Foods to avoid bloating occurs when the level of blood glucose gets too high. If left untreated for a long period of time, it can lead to serious complications, such as eye damage, kidney problems, and heart disease, among others. Fortunately, treatments are available that can help prevent hyperglycemia and control blood glucose levels. Hyperglycemia is a condition in which the level of glucose in the blood is higher than normal. Glucose is the primary source of energy for all cells in our bodies.
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