Hyperglycemia causes and management
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Causes of Hyperglycemia: Insulin Deficiency, Resistance, and Stress
Hyperglycemia, or high blood glucose, is most commonly caused by problems with insulin—either the body does not make enough insulin, or the cells do not respond to it properly. In type 1 diabetes, the main issue is an absolute deficiency of insulin due to autoimmune destruction of pancreatic cells. In type 2 diabetes, both insulin resistance and inadequate insulin secretion play a role. These problems can exist together and may change over time, leading to persistent high blood sugar and related complications .
Stress-induced hyperglycemia is also common, especially in hospitalized or critically ill patients. During stress (such as surgery, illness, or trauma), the body releases hormones like cortisol, catecholamines, glucagon, and growth hormone. These hormones increase glucose production in the liver and reduce the effectiveness of insulin, leading to higher blood sugar levels. Inflammatory cytokines like TNF-α and interleukins further worsen insulin resistance. This stress response can cause hyperglycemia even in people without diabetes 123.
Certain medications, especially glucocorticoids (steroids), can also cause hyperglycemia by increasing insulin resistance and glucose production, and by reducing insulin secretion. Some anti-cancer drugs, such as L-asparaginase and mTOR inhibitors, are also known to cause hyperglycemia 47.
Consequences of Hyperglycemia: Short- and Long-Term Risks
Hyperglycemia is linked to both short-term and long-term health risks. In the hospital, high blood sugar increases the risk of infections, poor wound healing, longer hospital stays, and higher mortality rates. It can also worsen outcomes in acute illnesses like heart attacks and strokes 1236.
Long-term, chronic hyperglycemia can damage organs and tissues, leading to complications such as vision loss (retinopathy), kidney failure (nephropathy), nerve damage (neuropathy), and increased risk of heart disease and stroke .
Management of Hyperglycemia: Individualized and Context-Specific Approaches
General Principles and Outpatient Management
For people with type 2 diabetes, management focuses on lifestyle changes (diet, exercise, weight loss) and medications. The choice of medication depends on individual risk factors, such as heart or kidney disease. Newer drugs like GLP-1 receptor agonists and SGLT2 inhibitors are recommended for people at high risk of cardiovascular or kidney problems, regardless of their baseline blood sugar levels 58.
Treatment targets and strategies should be individualized, taking into account the patient’s age, comorbidities, and preferences. Blood pressure and cholesterol control, along with smoking cessation, are also important parts of comprehensive care .
Hospital and Perioperative Management
In hospitalized patients, especially those who are not critically ill, regular blood glucose monitoring is essential. Insulin is the main treatment for high blood sugar in the hospital, as it can be adjusted quickly and is effective in most situations. Oral medications may be used in selected cases, but insulin is preferred for rapid control 1610.
For patients receiving steroids or certain chemotherapy drugs, blood sugar should be monitored closely, and insulin or other medications may be needed to keep glucose in a safe range. DPP-4 inhibitors, metformin, and certain types of insulin have been found to be safe and effective for steroid-induced hyperglycemia 47.
Recent guidelines recommend moderate, individualized blood sugar targets in the hospital to avoid both high and low blood sugar. Overly aggressive glucose lowering can increase the risk of hypoglycemia, which is also dangerous 110.
Discharge and Long-Term Follow-Up
Patients who develop stress-induced hyperglycemia during hospitalization are at increased risk of developing type 2 diabetes in the future. It is important to have a follow-up plan after discharge, including regular blood sugar checks and lifestyle counseling .
Conclusion
Hyperglycemia can result from insulin deficiency, insulin resistance, stress, or certain medications. It is associated with serious short- and long-term health risks. Management should be individualized, with insulin as the mainstay in hospital settings and a combination of lifestyle and medication strategies for outpatients. Careful monitoring and follow-up are essential to reduce complications and improve outcomes 12345678+2 MORE.
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