When we speak of hyperglycemia or hyperglycemia we refer to the temporary or permanent increase in blood glucose concentrations above normal values.
To regulate blood glucose levels, the pancreas secretes a hormone called insulin, so the higher the blood glucose levels are, the more insulin will have to be secreted by the pancreas. Over time, these pancreatic insulin stores can be depleted, developing the disease called Diabetes Mellitus.
The 2018 American Diabetes Association Guide defines fasting hyperglycemia as the elevation of blood glucose levels above 100mg / dl. When the fasting glycemia exceeds 125mg / dl, the patient meets a diagnostic criterion compatible with Diabetes Mellitus.
The state of hyperglycemia can occur in people with or without the diagnosis of Diabetes Mellitus, due to a state of incorrect or low use of circulating insulin.
Why does hyperglycemia occur?
In healthy people, hyperglycemia occurs when circulating insulin is not enough to regulate all the glucose in the blood. It should be remembered that insulin allows the passage of glucose into all the cells of the body, especially neurons, liver cells and muscle cells.
In some situations such as chronic use of steroids, stress, obesity and sedentary lifestyle, glucose cannot enter all cells, remaining circulating in the blood above the allowed values.
In patients with Diabetes Mellitus, hyperglycemia occurs when treatment with insulin or oral hypoglycemic agents is not enough to reach therapeutic levels and there is a decompensation that raises blood glucose levels. While there are situations such as stress or bacterial infections, which can alter the functioning of circulating insulin levels and cause hyperglycemia.
The hyperglycemia in healthy patients is a risk factor for the development of Diabetes Mellitus because of the constant effort made by the pancreas to regulate glucose.
Symptoms of hyperglycemia
When blood glucose rises, chemical signals are sent to the central nervous system to activate compensatory mechanisms that regulate glucose levels. Some of the symptoms that occur are:
- Polydipsia (feeling of constantly wanting to drink water).
- Polyphagia (feeling of anxiety caused by wanting to eat constantly).
- Polyuria (increased frequency of urination).
- Dry mouth.
- Blurry vision.
In patients with diabetes, if glycemic values rise disproportionately, depleting all insulin reserves, a state known as diabetic ketoacidosis can occur, associated with more severe symptoms such as abdominal pain, nausea, vomiting, even neurological alterations that can lead the patient to coma. .
Risk factors for hyperglycemia
Risk factors for the development of hyperglycemia are obesity, sedentary lifestyle, an unhealthy diet with high consumption of fats and carbohydrates and low in fruits, vegetables, greens and vegetables, family members with diabetes, alcohol consumption, in addition to cholesterol levels and elevated triglycerides.
How is hyperglycemia treated?
The initial treatment of hyperglycemia is based on the modification of lifestyles. The European and American guidelines on obesity and diabetes recommend diet and exercise for at least 6 continuous months for proper glycemic control. If hyperglycemia persists despite lifestyle modifications, the use of oral hypoglycemic agents such as Metformin is recommended.
Metformin is a drug, used in patients with a diagnosis of peripheral insulin resistance and Type 2 Diabetes Mellitus, which decreases the production of glucose in the liver and facilitates the entry of glucose into muscle cells, thereby regulating the levels of Blood glucose.
There are other oral hypoglycemic agents, in addition to Metformin, which are only used in patients with a confirmed diagnosis of Type 2 Diabetes Mellitus. When the patient with Type 2 Diabetes Mellitus cannot be controlled with Metformin therapy, then it is decided to start a combination therapy with other groups of drugs such as sulfonylureas or glitazones.
On some occasions it is necessary to use a combination of oral hypoglycemic agents associated with subcutaneous insulin. In the case of patients with type 1 Diabetes Mellitus, only insulin should be used and the doses increased according to the weight and daily caloric requirements of the patient.
In patients with type 1 and type 2 diabetes mellitus (refractory to oral treatment or in diabetic ketoacidosis) the first choice of treatment is subcutaneous insulin or intravenous infusion if there is decompensation and there is a risk of serious complications. This should always be indicated by the doctor, with strict monitoring of vital signs and electrolytes, especially potassium.