Hyperglycemia is a pathological condition that accompanies type 1 and type 2 diabetes mellitus, which is characterized by a significant increase in serum glucose levels. In addition to diabetes mellitus, this condition can meet and in the presence of other diseases of the endocrine system.
Conditionally, hyperglycemia is usually divided into degrees of severity: mild, moderate severity and severe hyperglycemia. With mild hyperglycemia, the glucose level does not exceed ten millimoles per liter, with medium sugar fluctuating within ten to sixteen, and the heavy sugar is characterized by a rise in the indicator of more than sixteen. In the event that sugar has risen to a level of 16, 5 and above, there is a serious threat of development of the precoma or even coma.
A person with diabetes mellitus suffers from two types of hyperglycemia: fasting hyperglycemia (occurs when food has not been taken in for more than eight hours, the sugar level rises to seven millimoles per liter) and postprandial (blood glucose rises after eating to ten millimole per liter and more). There are cases when people who do not have diabetes mellitus, note the increase in sugar levels to ten millimoles and above after they eat a large amount of food. This phenomenon indicates a high risk of developing non-insulin-dependent diabetes.
The level of glucose in the blood regulates a special hormone - insulin, which produces beta cells. In diabetes mellitus type 1, its production in the pancreas decreases significantly due to necrosis or apoptosis of hormone-producing cells due to productive inflammation. The period of pronounced manifestations of hyperglycemia begins when more than 80% of the beta cells are destroyed. With type 2 diabetes, tolerance (susceptibility) of body tissues to insulin is impaired. The tissues "do not recognize" insulin, therefore, despite its sufficient level, the hormone can not perform its function, insulin resistance develops and, as a consequence, hyperglycemia.
The reasons for the development of hyperglycemia are many. It can be caused by eating too much food, eating foods that are rich in simple or complex carbohydrates, or simply high-calorie foods. In addition, the non-diabetic cause of hyperglycemia may be psychoemotional overstrain. That is why it is so important to follow your lifestyle, as increased mental and physical loads or, conversely, a passive adynamic life, can serve as a reason for the emergence of this state. Syndrome of hyperglycemia can develop and against the background of viral and bacterial diseases, as well as a long-running chronic process.
People with diabetes may suffer from hyperglycemia if they missed the intake of a hypoglycemic drug or an injection of insulin. The reason can be hidden in the violation of diet and eating foods prohibited by the treating doctor.
Timely detection of the first symptoms of hyperglycemia will help prevent serious consequences. The main sign that should attract attention is a constant thirst. A man with a high level of sugar constantly wants to drink. The amount of absorbed liquid can reach 5-6 liters per day and even more. As a consequence, the number of urination per day increases several times. If the glucose level has risen to ten, it begins to be excreted along with urine and will be detected by a laboratory technician during the tests.
Together with a large amount of urine from the body displays a huge amount of useful ions of salts, and this causes a lot of unpleasant symptoms. The phenomena associated with the removal of salt from the body include: permanent unmotivated weakness, prolonged headache, a feeling of dryness in the mouth, a decrease in body weight of several kilograms, intense skin itching , worsening visual acuity, fainting. Symptoms of hyperglycemia also include problems with the gastrointestinal tract: constipation , diarrhea or alternation, a decrease in sensitivity and chilliness of the hands and feet.
Hyperglycemia can have such serious consequences as ketoacidosis (accumulation of a large number of ketone bodies in the body) and ketonuria (their excretion in the urine). These conditions can cause the development of ketoacidotic coma. When such a coma occurs, a large number of positively charged hydrogen ions accumulate in the patient's body, the buffer systems of the body do not cope with such volumes and fail. After that, the content of potassium ions with charge "+" increases, and this element promotes the expansion of blood vessels and, as a result, to collapse, hypotension. Such a condition can be fatal. It is possible to suspect the development of ketoacidotic coma by characteristic signs: dehydration of the body (skin, tongue is dry and pale), frequent irregular breathing, depression of the functioning of the central nervous system, refusal to eat, pain in the abdominal cavity, strong thirst, frequent urge to urinate and a significant increase in the amount of urine output.
The process of transition of hyperglycemia from mild to severe form, in a person suffering from diabetes, can last for many years. But this process can be protracted only if the body is still able to independently produce hormone insulin, that is, in the case of non-insulin-dependent diabetes mellitus.
It is important to remember that hyperglycemia is not a necessary sign of diabetes. It can indicate a violation in other departments of the human endocrine system, so it is extremely important to undergo signs of hyperglycemia undergoing a full medical examination.
Hyperglycemia in children
Doctors distinguish a large number of varieties of hyperglycemia in children, but mostly they are divided according to the type of diabetes.
In the overwhelming majority of cases, endocrinologists diagnose insulin-dependent diabetes in children (that is, type two). Over the past two decades, the problem of diabetes in children is becoming more and more urgent, as the number of newly reported cases of this disease in the industrialized countries with a high level of development increases exponentially. There is a noticeable trend in the increase in the incidence of children and adolescents in medical institutions with severe consequences of hyperglycemia. These complications develop due to the fact that hyperglycemia was not diagnosed on time. In most cases, these conditions appear suddenly and very rapidly develop, worsening the condition of the child.
Hyperglycemia is more likely to develop in children whose parents have not been trained in all the necessary skills for a healthy lifestyle. In such families, little attention is paid to the physical development and upbringing of the child, correct and adequate nutrition, the regime of work and rest are not provided. These three factors are the leading factors in the development of hyperglycemia in childhood and adolescence.
Doctors together with scientists conducted a large number of studies and found that hyperglycemia often occurs and progresses in children living in cities. This is due to the fact that the inhabitants of the urban area lead an inert way of life. Hyperglycemia in children of lower grades and preschool children can develop due to excessive mental, mental and physical exertion. A certain role in the emergence of glycemia is assigned to reducing the digestive processes of the pancreas of the baby.
The prerequisites and reasons for the development of hyperglycemia in children are many. The main place is the organic metabolic disorder. As the progression of diabetes, manifestations of hyperglycemia become more vivid and characteristic. At first, hyperglycemia can be stopped on its own, without the help of medications and physical effects on the body, but in the following months and years this will happen less and less.
Hyperglycemia can be caused by a decreased intake of insulin into the bloodstream, inhibition of its activity, or the production of an initially defective hormone by the body. These phenomena can be a consequence of strong mental shocks of the baby, an infectious or fungal disease, especially with a protracted course, as well as the activation of autoimmune processes that begin with the development of insulin-dependent diabetes.
Most children and adolescents do not suffer from any manifestations of diabetes, because the disease does not go as aggressively as type 1 diabetes, and they do not get injections of insulin.
But with the progression of the disease and its long course, there are symptoms that become an excuse for contacting the pediatrician. The first signs of hyperglycemia in children - frequent urge to urinate and expressed thirst. Later the child can begin to complain of dryness in the oral cavity, a feeling of heat in the face, frequent headaches , morning sickness and vomiting, a veil before the eyes, a strong palpitation, shortness of breath. Parents should be alerted by the smell of acetone in the air exhaled by the child, dry flaky skin on the elbows, knees, back of hands, face.
The child should be taken to see a doctor at the appearance of the first signs. If he starts drinking a lot of water and often urinating, you should consult a doctor. Disease in a child can manifest and with constant drowsiness, uncertainty and stiffness of movements, as well as with increased heart rate and difficulty in the act of breathing. If the baby receives injections of the hormone insulin, parents should always remember the time of the last injection to report it to the doctor. For such purposes, it is better to keep a small notebook and enter the time of each injected drug into it - this will greatly help the doctor in identifying the causes of the child's hyperglycemia.
Increase in the concentration of sugar in the systemic circulation is a consequence of the development of diabetes mellitus. That is why the tactics of treatment in this condition should be directed to the therapy of the underlying cause, which caused the development of hyperglycemia.
In the treatment of hyperglycemia, a very important condition is the constant and timely measurement of glucose. This is done using a special device called a glucometer. Most of these devices are light and portable, so they can be taken with you everywhere and monitor your glucose.
To assign the right therapy for this condition, it is necessary to conduct a series of tests and studies. In a hospital setting the level of glycemia. Normally, in a physically healthy person, this figure ranges between 3.3-5.5 millimoles per liter per hungry stomach, during the day this figure can increase to 4-9 millimoles per liter.
A person with hyperglycemia must necessarily take an analysis of morning urine for glucosuria. In healthy people, glucosuria is absent. Also in the hospital, an analysis of glycosylated hemoglobin is carried out. This is a fundamentally new and very informative test. If the index of glycosylated hemoglobin is 7 units or more, diabetes mellitus is put. A very indicative test is a test for glucose tolerance. To perform this test, the person being examined receives a test breakfast consisting of 75 g of glucose. A prerequisite is not to eat from the evening of the previous day. If the test score is 11.1 and higher, this indicates the development of diabetes.
Treatment of hyperglycemia should begin with non-pharmacological methods. The most important point is the constant strict adherence to the medical diet. With an easy degree of hyperglycemia, proper nutrition is the most important method of treatment. With moderate to severe diabetes, dietary nutrition should be combined with medications that lower the sugar content in the bloodstream or with hormone injections - this depends on the type of diabetes. In hyperglycemia, which is a symptom of insulin-dependent diabetes, the main place in treatment belongs to substitution therapy, and the diet pursues an auxiliary goal.
People suffering from hyperglycemia should closely monitor the amount of absorbed carbohydrates. Unfortunately, you can not measure their quantity with the usual kitchen technique (measuring cup, table spoon). It is also extremely difficult to determine the required number of products without special knowledge. Just to make life easier for diabetics, there is a grain unit. This indicator is the so-called measuring spoon for measuring carbohydrates. Bread unit contains up to 15 grams of carbohydrates. It increases the glucose value by 2.8 millimoles per liter and requires two units of insulin action. This conditional unit was invented for diabetics, since if the diet is not adhered to and the exact dosage of carbohydrates, they can develop hyperglycemia. For example, 1XE corresponds to a piece of bread weighing thirty grams, one small apple, two prunes, one hundred grams of oatmeal. For twenty-four hours in the body of a person suffering from hyperglycemia should not be more than twenty-five HEU. It is most rational to distribute them for five or six receptions. Foods that contain a lot of carbohydrates should be eaten for breakfast and lunch.
Suffering hyperglycemia people need to follow the rules of therapeutic nutrition: the amount of energy in food should be exactly as much as the body requires, you need to keep a balance in the ratio of proteins, fats, carbohydrates, food should be divided into six receptions. If a person suffering from hyperglycemia is overweight, to satiate his body and not feel hunger, you need in large quantities to eat vegetables: cabbage, tomatoes, cucumbers, spinach, peas. It is important to know that with diabetes, liver function is seriously impaired, so it is necessary to introduce into the habitual diet products of soy, oatmeal, home-made cottage cheese. These products are lipotropic, help the liver to stabilize the work.
In the medical diet recommend to include up to three hundred grams of black bread, vegetable, meat and fish soups, the second dishes of poultry and meat, cooked by extinguishing or cooking, boiled lean fish. It is recommended to eat no more than two chicken eggs, preferably in the form of an omelet or soft-boiled. Fruits and berries, mostly sour (lemons, apples, currants and cranberries, oranges) will benefit. You can add to the meal mild tomato and milk sauces, eat small amounts of milk and cottage cheese. The permissible amount of creamy and lean oil is forty grams. People suffering from hyperglycemia, it is important to saturate the body with enough vitamins, so you need to drink brewer's yeast, broths of dogrose, fruit drinks.
Patients with hyperglycemia are strictly forbidden to eat sweets: ice cream, any sorts of chocolate, pastries, honey. Can damage sharp, spicy, fatty dishes, mustard, ground pepper. Alcohol in this disease should be excluded. You can not eat raisins, grapes, bananas. In occasion of sugar it is necessary to consult with the doctor: often its use is admissible, but in very small quantities. Reduce the amount of glucose in the systemic circulation and alleviate the syndrome of hyperglycemia will help intake of large amounts of water and exercise.
Medical treatment of hyperglycemia in non-insulin-dependent diabetes includes derivatives of sulfonylureas (SM) and biguanides. Preparations of the first group help the pancreas to produce a hormone necessary for the assimilation of glucose. Biguanides stimulate the capture of the already existing amount of insulin by the tissues. They are prescribed a patient with hyperglycemia with a large body weight.
Maninil (CM) is prescribed in a dose of 10-20 mg per day. People after 60 years are not recommended to take more than 10 mg, because at this age is very high risk of developing hypoglycemia. The daily dose is divided into two: one part is drunk before breakfast, the second - before dinner. Traditional Maninil drink 40-50 minutes before meals, and micronized - for 10. The tablet can not be chewed. This medicine needs to be combined with a diet - then the therapy will be effective. It is undesirable to stay in direct sunlight for a long time and control the mechanisms. The reception begins with a half tablet (1.75 mg in the morning hours). If the result is not, after a week, bring the dose to one tablet, divided by two. In case the effect is absent and at this stage, one tablet is prescribed in the morning and half in the evening. In the fourth week, the dose increases to two tablets (one morning and before dinner). Then every week the dose is increased by 1.75 mg (half a tablet). At the end of two months, you can switch to a tablet form of 3.5 mg, and from the tenth week of therapy - to a standard five-milligram tablet. Treatment takes place under strict control of sugar in the bloodstream and morning urine. If after a few months of treatment with hyperglycemia the maximum dose does not satisfy the result, they switch to a combination of Maninil and Metformin.
Metformin in hyperglycemia is taken by half a gram every eight hours for the first three days of treatment (one gram per every twelve), starting with the fourth and the fourteenth - one gram every eight hours. From the fifteenth day, the dosage is regulated by the attending physician on the basis of these analyzes. The maintenance dosage of the drug is 200 mg per day. It should be noted that this medication is strictly forbidden for pregnant women, as well as during breastfeeding.
Hyperglycemia caused by insulin-dependent diabetes mellitus is treated by the introduction of an insulin hormone into the body. It can only be injected, as when taken per os it is destroyed by digestive juice. Insulin, introduced into the body, completely corresponds to the hormone, which normally should be produced by the pancreas.
Insulins are of ultrashort, short action, medium duration and long-term action. The type of drug is selected by the doctor depending on the pattern of the disease and the severity of hyperglycemia. If a patient is diagnosed with type 1 diabetes, one-half of a unit of action per kilogram of body weight is prescribed; if the result is unsatisfactory, the dosage is increased to 0.8 units per kilogram. The amount of the drug can be increased to one unit per kilogram without bad consequences, a large dosage can cause hypoglycemia.
It is important to remember the principles of intensive insulin therapy: short-acting insulin injection is done before three main meals, and the medications are administered before breakfast and before bedtime. The second way: short insulin - before the three main meals, and the middle - just before bed. The ratio of insulin is 70% to 30% or 65% to 35%, respectively. If the average insulin is administered twice a day, it should be dosed so that the two parts are in the morning, and the remaining third is for the evening. The amount of short insulin directly depends on the amount of carbohydrates consumed. Short insulin needs to be distributed so that about forty percent of the total dose is for breakfast, and the remaining sixty are evenly introduced before lunch and dinner.
If the recommended dosages of insulin are not met or if the need for the drug is completely ignored, hyperglycemia of coma may develop. It progresses slowly and is characterized by an increase in symptoms such as thirst, increased urination, anorexia , nausea, Kussmaul breathing, abdominal pain. The first aid in this pathological condition is intravenous injection of a hundred-two hundred milliliters of a four-percent solution of soda and Heparin (subcutaneously 5000 ED).
The acute complications of improper treatment of hyperglycemia in diabetes include hyperosmolar non-ketoacidotic, hypoglycemic and lactacidemic coma. With a hyperosmolar non-ketoacidotic coma, the sugar concentration can reach sixty millimoles per liter. Ketotela is absent. With this pathological condition, a thickening of the blood is observed, which contributes to the formation of micro- and macrothromboses. In this condition, the patient must enter a hypotonic NaCl solution at a concentration of 0.45% and a short insulin under the control of glycemia.
Hypoglycemic coma develops in people who suffer from hyperglycemia for a long time, due to the excess of the prescribed dose of insulin. Its development is possible with therapy with sulfonylureas and medium insulins. Short insulin peaks do not give. Hypoglycemic coma is accompanied by a fall in sugar, strong salivation, trembling, dizziness. Treatment with the appearance of the first signs: subcutaneous injection of one cube of Adrenaline or Glucagon. If the coma has developed, the combination of Prednisolone with Adrenaline can help the patient. The dose of Prednisolone is 120 milligrams, the adrenaline is 1 milliliter.
Lactacidemic coma is extremely dangerous for high mortality. High mortality is due to acute brain hypoxia and heart failure. Symptoms: arterial hypotension , Kussmaul's breathing, depression of consciousness. The reason for its occurrence: the use of alcohol and increased physical activity on the background of Metformin treatment. Help: 4% sodium bicarbonate drip intravenously and 0.9% NaCl solution. After - 5% glucose, ascorbic acid and up to a hundred milligrams of cocarboxylase. If the result is insufficient, hemodialysis is necessary.
Hyperglycemia first aid
First of all, a person with symptoms of hyperglycemia should measure sugar in capillary blood. If the level of glucose is fourteen or more, it is necessary to prick insulin of an ultrashort or short action (Humulin, Humalog) in usual doses. After injection, a person should drink water. It is advisable in the first hour to drink 1-1.5 liters. Determine the sugar should be every 1.5 to 2 hours and enter the hormone until the indicators will not return to normal. If glucose values stay on the same numbers, hospitalization is necessary.
To reduce the concentration of acetone in the body, which in hyperglycemia significantly increases, it is necessary to rinse the stomach with a weak solution of baking soda. It will be enough 1-2 teaspoons per liter of boiled water. It is very important in the development of hyperglycemia to reduce acidity, so the patient must drink large amounts of alkaline mineral water. Normalizing acidity will help soda. It is necessary to dissolve a teaspoon in a glass of boiled water and drink the resulting mixture. In the state of pre-skin, the skin becomes dry, so you need to moisten a small towel in the water and wipe your hands, feet, forehead, and neck.
It must be remembered that the body in a state of hyperglycemia needs a lot of fluid, but if a person is sharply depressed consciousness, it is impossible to force water into the mouth, as it can get into the respiratory tract. A patient in this state needs a complete physical and emotional rest, so you should provide him with the appropriate environment and rest.
To prevent hyperglycemia, you need to follow the instructions of the treating doctor about the dosage and time of taking medication. A person suffering from this disease must comply with the diet: forever give up fatty, sweet, carbohydrate-superseded foods, regularly engage in morning physical therapy and more often be in the open air. All these recommendations will significantly improve the quality of life, since hyperglycemia and related unpleasant symptoms will bother the patient very rarely.