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  2. 2. HYPERGLYCEMIA  Hyperglycemia means high blood sugar or glucose.  Insulin is a hormone that moves glucose into cells to give them energy.  Hyperglycemia happens when body doesn't make enough insulin or can't use it the right way.  Blood glucose levels can vary from day to day.
  3. 3. An occasional high level (above 10mmol/L) is not a problem, as long as it returns to normal (below 8mmol/L) within 12-24 hours.  Persistently high blood glucose levels (above 15mmol/L) for more than 12-24 hours can result in the symptoms of hyperglycemia.
  4. 4. Cells remove glucose from the blood in response to insulin. If pancreas doesn't make enough insulin, glucose can't enter the cells and remains in the blood. Blood glucose levels can also get too high if cells are unable to respond to insulin properly (insulin resistance).
  5. 5. Types of hyperglycemia Complicated hyperglycemia is life-threatening .  Two type of hyperglycemia 1. diabetic ketoacidosis (DKA) 2. hyperosmolar hyperglycemic state (HHS) DKA- is a problem that occurs in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. Byproducts of fat breakdown, called ketones, build up in the body. 
  6. 6. HHS- hyperglycemic hyperosmolar syndrome is a condition of: 1. Extremely high blood sugar (glucose) levels 2. Extreme lack of water dehydration  Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream.  This draws the water out of the body's other organs, including the brain. Sometimes it can cause coma. 
  7. 7. CAUSES OF HYPERGLYCAEMIA       Blood glucose levels Diabetes Medications that cause hyperglycaemia Gestational diabetes Critical illness Other factor
  8. 8. Blood glucose levels The amount of glucose in your blood is controlled by a hormone called insulin, which is produced by pancreas.  Insulin takes glucose out of blood and moves it into cells, where it is broken down to produce energy.  Glucagon is a different peptide hormone secreted by the pancreatic cells. 
  9. 9. Its secretion is stimulated by low blood glucose levels, and its general effect is to oppose the action of insulin.  Glycogenesis and glycogenolysis are controlled by these hormones.  The three regulatory enzyems of glycolysis HK , PFK. PK. Are also regulate by these hormones.  These pathways play an important role in blood glucose regulation . 
  10. 10. DIABETES In people with diabetes the body is unable to break glucose down into energy.  This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.  The glucose remains in the blood, causing a high blood glucose level. 
  11. 11. In diabetes type 1 hyperglycemia is usually caused by low insulin levels .  In type 2 hyperglycemia caused by resistance to insulin at the cellular level depending on the type and state of the disease.  Low insulin levels or insulin resistance prevent the body from converting glucose into glycogen which can cause excess glucose level in blood. 
  12. 12. Medications that cause hyperglycaemia  Sometimes, hyperglycaemia and diabetes can occur as a side effect of taking some medicines. Olanzapine and risperidone are medications that are sometimes used to treat mental health conditions, such as schizophrenia (a condition that can cause hallucinations and delusions). 
  13. 13. Certain medications increase the risk of hyperglycemia, including corticosteroids, octreotide, bet blockers, epinephrine, thiazide diuretics, niacin, pentamidine, protease inhibitors, L-asparaginase, and some antipsychotic agents. 
  14. 14. GESTATIONAL DIABETES Gestational diabetes is when a woman develops diabetes during pregnancy.  This may occur if your body is unable to produce enough extra insulin to meet the demands of pregnancy.  This leads to an increased level of glucose in the blood. 
  15. 15. CRITICAL ILLNESS A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia.  stress' hormones such as epinephrine.  several of the steroids, infections, trauma.  Dysfunction of the thyroid, adrenal, and pituitary glands  Numerous diseases of the pancreas 
  16. 16. OTHER REASONS 1. 2. 3. 4. 5. 6. 7. a change of medication a wrong (or missed dose) of insulin changing your diet, or eating too much not exercising regularly an illness, such as a cold Being inactive Family history of diabetes
  17. 17. BLOOD SUGAR REGULATION It is important that the concentration of glucose in the blood is maintained at a constant level.  Insulin and glucagon, are hormone produced by the pancreas that regulates glucose levels in the blood.
  18. 18. Role of insulin in Blood Glucose Control Glucose level Effect on pancreas Effect on liver Effect on glucose level too high insulin secreted into the blood liver converts glucose into glycogen goes down too low insulin not secreted into the blood liver does not convert glucose into glycogen goes up
  21. 21. Symptoms of Hyperglycemia Increased thirst  Headaches  Difficulty concentrating Blurred vision  Frequent urination Fatigue (weak, tired feeling) Weight loss
  22. 22. What are the risks of hyperglycemia  Without treatment, high blood sugar levels can lead to severe dehydration.  May get a blood clot in your leg or arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. Hyperglycemia  may cause pancreatitis. Hyperglycemia can also lead to diabetes.
  23. 23. Hyperglycemia can damage nerves, veins, arteries, and organs over time.  Damage to arteries may increase risk for a heart attack or stroke. Hyperglycemia can be a serious problem if not treated in time. In untreated hyperglycemia, a condition called ketoacidosis (contrast ketosis) could occur. 
  24. 24. Without insulin, the body isn't able to utilize the glucose for fuel, so the body starts to break down fats for energy.  Ketoacidosis is a life-threatening condition which needs immediate treatment. 
  25. 25. References ^" Hyperglycemia". ^ What are mg/dl and mmol/l? How to convert? ^ Total Health Life (2005). "High Blood Sugar". Total Health Institute. Retrieved May 4, 2011. ^ Giugliano D, Marfella R, Coppola L, et al. (1997). "Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia". Circulation 95 (7): 1783– 90.doi:10.1161/01.CIR.95.7.1783. PMID 9107164. ^ Pais I, Hallschmid M, Jauch-Chara K, et al. (2007). "Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients". Exp. Clin. Endocrinol. Diabetes 115 (1): 42–6. doi:10.1055/s-2007957348.PMID 17286234. ^ Sommerfield AJ, Deary IJ, Frier BM (2004). "Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes". Diabetes Care 27(10): 2335–40. doi:10.2337/diacare.27.10.2335. PMID 15451897.
  26. 26. ^ Cetin M, Yetgin S, Kara A, et al. (1994). "Hyperglycemia, ketoacidosis and other complications of Lasparaginase in children with acute lymphoblastic leukemia". J Med25 (3–4): 219–29. PMID 7996065. ^ Luna B, Feinglos MN (2001). "Drug-induced hyperglycemia". JAMA 286 (16): 1945– 8. doi:10.1001/jama.286.16.1945. PMID 11667913. ^ Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC (2001). "Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview". Stroke 32 (10): 2426– 32. doi:10.1161/hs1001.096194.PMID 11588337. ^ "Chronic hyperglycemia may lead to cardiac damage". Journal of the American College of Cardiology. Retrieved 3 February 2012. ^ Ron Walls MD; John J. Ratey MD; Robert I. Simon MD (2009). Rosen's Emergency Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print (Rosen's Emergency Medicine: Concepts & Clinical Practice (2v.)). St. Louis: Mosby.ISBN 0-323-05472-2.