why does hyperglycemia occur in diabetes mellitus

Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can't use insulin properly. What Causes Hyperglycemia? If you have type 1, you may not have given yourself enough insulin. If you have type 2, your body may have enough insulin, but it is not as effective as it should be. You ate more than planned or exercised less than planned. You have stress from an illness, such as a cold or flu. You have other stress, such as family conflicts or school or dating problems. You may have experienced (a surge of hormones that the body produces daily around 4:00 a. m. to 5:00 a. m. ). What are the Symptoms of Hyperglycemia? Part of managing your diabetes is often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia. How Do I Treat Hyperglycemia? You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise. Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level. Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it. What if it Goes Untreated? Hyperglycemia can be a serious problem if you don't treat it, so it's important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called
(diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy. When your body breaks down fats, waste products called are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine.


Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: Talk to your doctor about how to handle this condition. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times. In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves. Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency. How Can I Prevent Hyperglycemia? Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early before it gets worse. If you're new to type 2 diabetes, to get help and support during your first year. People who are diagnosed with diabetes find themselves in a whole new world where even the most common everyday events, such as eating breakfast, take on exaggerated importance. It's a world where a person needs a sympathetic guide to help him or her decide what to do next. Fully revised and updated, this is the "take-you-by-the-hand" guide that will become a trusted friend and adviser for the millions of people who find themselves in the growing ranks of people with diabetes. Articles from bg-and-a1c-hyperglycemia,tips-and-how-tos, As the incidence of diabetes mellitus continues to rise, common focus areas for diabetes control are blood glucose levels, diet, and exercise. Addressing and controlling these factors as well as other factors associated with diabetes are essential for a better quality of life; however, awareness of an increased risk of infections is also warranted in diabetes patients with chronic hyperglycemia.


The immune system is comprised of two subcategories: innate immunity and adaptive immunity. Innate immunity, the first line of defense, is activated when a pathogen initially presents itself. This portion of immunity is inherited at birth and is not specific in its mechanism of defense. In addition, it serves the overall immune system by alerting specific cells of pathogen invasion to activate the adaptive immune system. The innate immune system has physical and chemical mechanisms of response. These include but are not limited to sneezing, coughing, sweating, maintenance of normal body temperature, and gram-positive normal flora on the skin. Adaptive immunity is a very specific aspect of a properly functioning immune system that provides protection against previous infections experienced by the host. These responses are mediated by lymphocytes, which consist of natural killer (NK) cells, B cells and T cells. Vaccinations and exposure to pathogens benefit the adaptive immune system by establishing immunologic memory. In the event of another attack by the same foreign organism, the adaptive immune system is able to provide a more efficient response. Complications of Chronic Hyperglycemia Patients with uncontrolled diabetes are considered immunosuppressed due to the negative effects of elevated blood sugars on the immune system. Hyperglycemia impairs overall immunity through different mechanisms. Chronic hyperglycemia in diabetes patients can lead to acidosis, which limits the activity of the immune system. The effects of these changes are reversible upon treatment of acidosis and hyperglycemia. Chronic hyperglycemia slows perfusion through blood vessels, causing nerve damage as time progresses. The skin, one of the key barriers in innate immunity, is no longer competent, yielding protection against trauma and inflammation. Because of impaired nerves in the skin, the host may not notice trauma to the skin until an infection is present. As a result, skin and soft tissue infections are prominent in diabetes patients with chronic hyperglycemia. Along with poor management of blood glucose, cellulitis and diabetic foot ulcers could heal slower than desired and transition to more severe conditions such as osteomyelitis.


Such conditions must be treated promptly and correctly with antimicrobial therapy and other appropriate supplements of care (i. e. wound care and debridements). Damaged nerves are not only noted in the skin, but in other areas of the body such as the urinary tract. With damage to the nerves in the urinary tract, urine retention will breed urinary tract infections. Although the most common infections in diabetes patients involve the skin and urinary tract, more severe infections may arise if blood sugars are not controlled. High glucose levels limit and deregulate neutrophil synthesis, which is essential in the immune system to attack a foreign object. Cytosolic calcium in polymorphonuclear leukocytes (PMNs) increases in the presence of hyperglycemia and is inversely proportional to the occurrence of phagocytosis in patients with type II diabetes. High levels of cytosolic calcium inhibit the synthesis of adenosine triphosphate (ATP), which is essential for phagocytosis. The ability of PMN leukocytes to mobilize to the site of infection and stimulate of apoptosis is negatively impacted as well. If the pathogen is able to invade the host without the assistance of the innate immune system, an increased risk of infection is expected. Hyperglycemia causes other undesirable changes in the function of the immune system such as decreased complement response, leukocyte adherence and bactericidal activity. Bacteria s ability to thrive in the presence of elevated blood sugars activates the immune response to combat such infections. In addition, a hyperglycemic state negatively affects the body s ability to respond to antimicrobial therapy. Common bacterial infections include gram negative organisms such as Pseudomonas aeruginosa, Klebsiella pneumonia, and E. coli. Gram-positive organisms, such as Staphylococcus Streptococcus are common, also. Anaerobic organisms may be present as well due to decreased blood and oxygen perfusion throughout the blood vessels for the synthesis of leukocytes. Other infections include fungal infections such as Candida, and viral infections.

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