User:Zinger94/sandbox

Hyperglycemia (also spelled hyperglycaemia or hyperglycæmia), is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l (~250–300 mg/dl). A subject with a consistent range between ~5.6 and ~7 mmol/l (100–126 mg/dl) (American Diabetes Association guidelines) is considered slightly hyperglycemic, while above 7 mmol/l (126 mg/dl) is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average however, chronic levels above 10–12 mmol/L (180–216 mg/dl) can produce noticeable organ damage over time. Hyperglycemia is caused by diabetes, they are unable to utilize glucose due to the body not producing insulin from Type 1 diabetes. People with Type 2 diabetes are resistant to insulin and are not able to respond to it being secreted. When insulin is ineffective, the body stays in a prolonged state with elevated blood glucose levels which can lead to other complications.

Diagnosis
Chronic hyperglycemia can be measured by Clinical urine tests which can detect sugar in the urine or Microalbuminuria which could be a symptom of diabetes.

Treatments
Treatment of hyperglycemia requires elimination of the underlying cause, such as diabetes. Acute hyperglycemia can be treated by direct administration of insulin in most cases. Severe hyperglycemia can be treated with oral hypoglycemic therapy and lifestyle modification.

In diabetes mellitus (by far the most common cause of chronic hyperglycemia), treatment aims at maintaining blood glucose at a level as close to normal as possible, in order to avoid serious long-term complications. This is done by a combination of proper diet, regular exercise, and insulin or other medication such as metformin, etc.

Those with hyperglycaemia can be treated using sulphonylureas or metformin or both. These drugs help by improving glycaemic control. Dipeptidyl peptidase 4 inhibitor alone or in combination with basal insulin can be used as a treatment for hyperglycemia with patients still in hospital.

Hyperglycemia can be managed with medicine or with diet changes and exercise. Lifestyle changes to diet such as intermittent fasting and ketogenic diet could significantly reduce hyperglycemia.

Calorie restriction would be one of the main lifestyle changes because it reduces over eating which contributes to hyperglycemia.

Increasing Aerobic exercise will make better use of glucose accumulated in the body since glucose is being used for energy by the muscle.

Carbohydrates are the main cause for hyperglycemia, whole wheat items should be substituted for non whole wheat items. Fruits are apart of a complete nutritious diet, but should be limited due to its high sugar content.

Diabetes mellitus
Chronic hyperglycemia that persists even in fasting states is most commonly caused by diabetes mellitus. In fact, chronic hyperglycemia is the defining characteristic of the disease. Intermittent hyperglycemia may be present in prediabetic states. Acute episodes of hyperglycemia without an obvious cause may indicate developing diabetes or a predisposition to the disorder.

In diabetes mellitus, hyperglycemia is usually caused by low insulin levels (Diabetes mellitus type 1) and/or by resistance to insulin at the cellular level (Diabetes mellitus type 2), depending on the type and state of the disease. Low insulin levels and/or insulin resistance prevent the body from converting glucose into glycogen (a starch-like source of energy stored mostly in the liver), which in turn makes it difficult or impossible to remove excess glucose from the blood. With normal glucose levels, the total amount of glucose in the blood at any given moment is only enough to provide energy to the body for 20–30 minutes, and so glucose levels must be precisely maintained by the body's internal control mechanisms. When the mechanisms fail in a way that allows glucose to rise to abnormal levels, hyperglycemia is the result.

Ketoacidosis may be the first symptom of immune-mediated diabetes, particularly in children and adolescents. Also, patients with immune-mediated diabetes, can change from modest fasting hyperglycemia to severe hyperglycemia and even ketoacidosis as a result of stress or an infection.

Drugs
Certain medications increase the risk of hyperglycemia, including corticosteroids, octreotide, beta blockers, epinephrine, thiazide diuretics, statins, niacin, pentamidine, protease inhibitors, L-asparaginase, and antipsychotics. The acute administration of stimulants such as amphetamines typically produces hyperglycemia; chronic use, however, produces hypoglycemia. Some of the newer psychiatric medications, such as Zyprexa (Olanzapine) and Cymbalta (Duloxetine), can also cause significant hyperglycemia.

Thiazides are used to treat type 2 diabetes but it also causes severe hyperglycemia.

Critical illness
The following conditions can also cause hyperglycemia in the absence of diabetes. 1) Dysfunction of the thyroid, adrenal, and pituitary glands 2) Numerous diseases of the pancreas 3) Severe increases in blood glucose may be seen in sepsis and certain infections 4) Intracranial diseases (frequently overlooked) can also cause hyperglycemia. Encephalitis, brain tumors (especially those located near the pituitary gland), brain bleeds, and meningitis are prime examples. 5) Mild to high blood sugar levels are often seen in convulsions and terminal stages of many diseases. Prolonged, major surgeries can temporarily increase glucose levels.[citation needed] Certain forms of severe stress and physical trauma can increase levels for a brief time as well yet rarely exceeds 6.6 mmol/l (120 mg/dl).

Stress
A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a diagnosis of diabetes. (Or perhaps stroke or myocardial infarction was caused by hyperglycemia and undiagnosed diabetes.) Human and animal studies suggest that this is not benign, and that stress-induced hyperglycemia is associated with a high risk of mortality after both stroke and myocardial infarction.

Somatostatinomas and aldosteronoma-induced hypokalemia can cause hyperglycemia but usually disappears after the removal of the tumour.

Mechanism
Hormones such as the growth hormone, glucagon, cortisol and catecholamines, can cause hyperglycemia when they are present in the body in excess amounts. Also, increased proinflammatory cytokines that interrupt carbohydrate metabolism, leading to excessive glucose production and reduced uptake in tissues, can cause hyperglycemia.

Environmental Factors
Hyperglycemia is caused by type 1 diabetes and non-whites have a higher susceptibility for it. Hyperglycemia is lower in higher income groups since there is access to better education and resources. Low-middle income groups are more likely to develop hyperglycemia due education and access to food options. Living in warmer climates can reduce hyperglycemia due to increased physical activity while people are less active in colder climates.

Population
Hyperglycemia one of the main symptoms of diabetes and it has substantially affected the population making it an epidemic. Healthcare providers are working more closely with people allowing them to choose the best intervention that suits their lifestyle. Insulin resistance continues to increase due to hyperglycemia As physical inactivity and calorie consumption increases it makes individuals more susceptible to developing hyperglycemia.