High blood sugar usually refers to an increase in the glucose content in the blood. The normal value of fasting blood sugar is below 6.1mmol/L, and the normal value of blood sugar 2 hours after a meal is below 7.8mmol/L. If it is higher than this range, it is called hyperglycemia. It is divided into physiological and pathological increases. Physiological hyperglycemia can be seen 1 to 2 hours after a meal, or when emotional tension increases adrenal secretion. Pathological hyperglycemia can be seen in diabetes caused by endocrine dysfunction; increased intracranial pressure caused by cranial trauma, intracranial hemorrhage, and meningitis; dehydration, acute and chronic pancreatitis, and liver dysfunction.
symptom
Typical manifestations
Increased blood sugar may be accompanied by symptoms such as thirst, polydipsia, polyuria, fatigue, weight loss, nausea, vomiting, and abdominal discomfort.
reason
Overview
High blood sugar can be divided into physiological and pathological increases. Physiological increases are mostly caused by high-sugar diet, short-term strenuous exercise, emotional excitement, etc., while pathological increases can be caused by genetic factors, certain chronic diseases, tumors, environmental factors, etc.
Cause of symptoms
1. Physiological increase in blood sugar
It usually occurs 1 to 2 hours after a meal. In addition, high-sugar diet, short-term strenuous exercise, emotional excitement, gastric dumping syndrome, etc. can all cause a temporary increase in blood sugar.
2. Pathological increase in blood sugar
(1) Pancreatic islet dysfunction: absolute or relative insulin deficiency and insulin utilization disorder, such as diabetes.
(2) Genetic factors: Genetic factors are an important factor causing high blood sugar. If a direct relative (father, mother, siblings) has elevated blood sugar, the risk of developing high blood sugar is higher. In addition, many genetic diseases are often accompanied by high blood sugar, such as type 1 hepatic glycogenostasis, acute paroxysmal porphyria, lipoatrophy syndrome, progeria syndrome, Down syndrome, congenital ovarian dysgenesis, etc.
(3) Chronic diseases: Hepatitis, cirrhosis, and extensive liver damage can cause dysfunction of the liver’s glycogen synthesis function and decreased liver glycogen storage capacity, making postprandial hyperglycemia more likely to occur. Hyperthyroidism-induced hyperglycemia is caused by hyperthyroidism, which accelerates blood flow in the intestinal wall and increases the absorption of sugar in food. Therefore, postprandial blood sugar increases significantly and glucose in the urine appears. Glucose tolerance tests may also be abnormal.
(4) Tumors: Endocrine tumors can cause high blood sugar. For example, Cushing’s syndrome, glucagonoma, pancreatic α-cell tumor, pancreatic β-cell tumor, pheochromocytoma, etc. can all cause high blood sugar. The main reason for high blood sugar is that various hormones cause abnormal sugar metabolism in the body.
(5) Stress factors: Some serious diseases, such as cerebrovascular accident, acute myocardial infarction, septic shock, severe burns, and major surgery, can increase the secretion of glucose-raising hormones in the body, antagonize insulin, and thus increase blood sugar.
(6) Environmental factors: viral infection, chemical poisons, obesity, etc.
(7) Dehydration: Vomiting, diarrhea, high fever, etc. can cause a slight increase in blood sugar.
(8) Others: such as anesthesia, asphyxia, epilepsy, eclampsia, etc.
3. Drug factors
(1) Among the drugs that cause blood sugar to rise, hormone drugs are the most serious. Glucocorticoids are contraindicated for diabetic patients. There are many other drugs that can cause drug-induced hyperglycemia, such as diuretics, anticancer drugs, antihypertensive drugs, female contraceptives, tricyclic antidepressants, phenytoin sodium, aminophylline, cimetidine, thyroxine, etc. These drugs can increase blood sugar.
(2) Isoniazid can also cause blood sugar to rise. Isoniazid is a first-line drug for treating tuberculosis. The medication period for treating tuberculosis is at least half a year. Long-term use of isoniazid can affect sugar metabolism and reduce glucose tolerance. Therefore, blood sugar should be checked regularly during medication and corresponding measures should be taken.
Common diseases
Type 1 hepatic glycogenostasis, acute paroxysmal porphyria, lipoatrophy syndrome, progeria syndrome, Down syndrome, congenital ovarian dysgenesis, hepatitis, cirrhosis, Cushing’s syndrome, glucagonoma, pancreatic α-cell tumor, pancreatic β-cell tumor, pheochromocytoma, acute myocardial infarction, septic shock, obesity, hyperlipoproteinemia, diffuse liver disease, gout, polycythemia vera, metabolic syndrome, diabetes, etc.
Medical treatment
Emergency (120) Indications
1. Existing symptoms of polydipsia and polyuria worsen, with obvious lack of energy, headache, fatigue, loss of appetite, nausea, vomiting, abdominal pain, etc.;
2. Deep breathing and faster breathing rate;
3. Symptoms of dehydration and shock such as chapped lips, dry skin, listlessness, confusion, and coma;
4. Self-measured blood sugar is extremely high, even reaching 30~50 or above;
5. Other emergency situations occur.
In all cases above, you must call the emergency number or go to the emergency room for treatment in time.
Outpatient Indications
1. The patient’s self-test or physical examination found that the fasting blood sugar value is greater than 6.1mmol/l, the blood sugar value 1 hour after a meal exceeds 11.1mmol/l, and the blood sugar value 2 hours after a meal is greater than 7.8mmol/l;
2. Accompanied by symptoms of thirst, polydipsia, polyuria, fatigue, and weight loss;
3. Accompanied by vision changes;
4. Accompanied by foot pain, skin lesions, and small ulcers;
5. Accompanied by numbness and paresthesia in the hands and feet;
6. Accompanied by repeated inflammation and infection, such as urethritis, vulvitis, balanitis, wounds that are prone to infection and difficult to heal, etc.
7. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Department
1. If your blood sugar is extremely high and you suspect acute complications of diabetes, you should go to the emergency department immediately and call the emergency number if necessary.
2. If the condition is stable, you can go to the endocrinology department for medical treatment.
3. Those with concurrent eye damage may consult an ophthalmologist.
4. Those with combined limb sensory dysfunction may consult a neurology department.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. You may need to undergo blood tests such as routine blood tests and blood sugar tests. Do not eat after 10 pm the night before the test and do blood congestion on an empty stomach the next day, but be careful to avoid hypoglycemia.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
4. If you have taken certain medications to control blood sugar recently, you can carry a medicine box.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask you
1. When did your blood sugar begin to rise? Has your blood sugar continued to rise over time?
2. How did you find out that your blood sugar level was elevated? Did you measure your blood sugar level before or after meals?
3. In addition to high blood sugar, do you have symptoms such as excessive drinking, excessive eating, frequent urination, fatigue, weight loss, etc.?
4. Have you ever had high blood sugar levels before? What caused it?
5. Have you ever used medication to treat high blood sugar levels? What medication?
6. Do you like to eat sweets on a daily basis? Do you have a regular diet?
7. Do you smoke? How long have you been smoking? How much do you smoke every day?
8. Do you like drinking alcohol, coffee or other beverages?
9. Does anyone among your relatives suffer from diabetes?
10. Do you have high blood pressure, heart disease, diabetes or other diseases? Are you taking medication to control them?
Questions patients can ask their doctors
1. What causes my high blood sugar?
2. Is my condition serious? Do I need to be hospitalized?
3. What tests do I need to do?
4. What treatment do I need now? Can it be cured?
5. If you take medication, what are the usage, dosage, and precautions?
6. Are there risks with these treatments?
7. I have other diseases. Will it affect my treatment?
8. What should I pay attention to in my daily life? How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Estimated inspection
The doctor will ask the patient to measure blood sugar and perform an oral glucose tolerance test (OGTT) to make a preliminary diagnosis, and then conduct a physical examination, blood routine, urine sugar measurement, glycated hemoglobin test, serum insulin and C-peptide level measurement, endocrine hormone measurement, CT, MRI, B-ultrasound, fundus examination and other examinations to further clarify the cause of the disease.
Physical examination
Observe changes in body temperature, respiration, pulse, and blood pressure, and find out whether there is exophthalmos, enlarged thyroid gland, hepatosplenomegaly, etc.
Laboratory tests
1. Blood routine test
It is of great significance for the diagnosis of infectious diseases and blood diseases.
2. Blood glucose measurement
It is of great significance for the diagnosis and monitoring of diabetes. Increased blood sugar is the main basis for diagnosing diabetes and the main indicator for judging the condition and control of diabetes. At present, glucose oxidase or hexokinase method is mostly used to measure blood sugar. A single blood sugar measurement (fasting blood sugar, blood sugar 2 hours after a meal or blood sugar at any point) only represents the instantaneous blood sugar level (spot value blood sugar); multiple blood sugar measurements within a day (before and after three meals and before going to bed, 2 days a week, if nocturnal hypoglycemia is suspected, blood sugar should be measured in the early morning) can more accurately reflect the blood sugar control situation.
3. Oral glucose tolerance test (OGTT)
When blood sugar is higher than the normal range but does not meet the diagnostic criteria for diabetes, an OGTT is required. The OGTT should be performed in the early morning on an empty stomach after no calorie intake for 8 hours. Adults take 75g of anhydrous glucose orally, dissolved in 250-300ml of water, and drink it within 5-10 minutes. The fasting and venous plasma glucose levels are measured 2 hours after the start of glucose water drinking. The amount of sugar taken by children is calculated as 1.75g/kg, and the total amount does not exceed 75g.
4. Urine sugar determination
Positive urine sugar is an important clue for diagnosing diabetes. However, positive urine sugar only indicates that the blood sugar value exceeds the renal glucose threshold (about 10mmol/L), so negative urine sugar cannot rule out the possibility of diabetes. When kidney disease is complicated, the renal glucose threshold increases, and although the blood sugar increases, the urine sugar is negative. When the renal glucose threshold decreases, although the blood sugar is normal, the urine sugar may be positive.
5. Glycated hemoglobin test
It can effectively reflect the blood sugar control status of diabetic patients in the past 1 to 2 months and is used as a monitoring indicator for diabetes control.
6. Serum insulin and C-peptide level determination
It reflects the reserve function of pancreatic B cells. In the early stage of type 2 diabetes or obesity, serum insulin is normal or increased. As the disease progresses, pancreatic function gradually declines and the ability to secrete insulin decreases.
7. Endocrine hormone measurement
Including adrenal cortex hormones, thyroid hormones, pituitary hormones, diabetic hormones, etc., can measure the content of related hormones in the body.
Imaging tests
1. CT and MRI
Space-occupying lesions throughout the body can be discovered and preliminarily characterized and located.
2. Ultrasound
You can learn about the condition of your heart, breasts, and abdominal organs.
Other tests
Fundus examination is an important examination that can observe the condition of fundus structures such as the retina, vitreous body, and choroid, and determine whether eye complications occur.
diagnosis
Diagnostic principles
Hyperglycemia can be diagnosed based on the corresponding medical history and typical manifestations of high blood sugar, combined with blood sugar measurement and oral glucose tolerance test (OGTT), and then physical examination, blood routine, urine sugar measurement, glycosylated hemoglobin detection, serum insulin and C-peptide level measurement, endocrine hormone measurement, CT, MRI, B-ultrasound, fundus examination and other examinations are performed to further clarify the cause.
Differential Diagnosis
1. Diabetes
(1) Type 1 diabetes: The onset is rapid and the disease is common at a young age. Symptoms include thirst, polydipsia, polyuria, polyphagia, fatigue, emaciation, and rapid weight loss. The blood sugar level is high, and many patients have ketosis as the first symptom. The serum insulin and C-peptide levels are low, and there is an absolute insulin deficiency, which requires insulin treatment.
(2) Type 2 diabetes: mainly affects middle-aged and elderly people. Most patients are obese and only have mild fatigue and thirst. Macrovascular and microvascular complications often occur before a clear diagnosis. Serum insulin levels are normal or elevated in the early stages and low in the late stages. They are not completely dependent on insulin treatment.
2. Hyperthyroidism
Symptoms include palpitations, tachycardia, insomnia, irritability and even anxiety, often accompanied by exophthalmos, eyelid edema, and decreased vision. Patients often increase their food intake due to hypermetabolism, leading to increased blood sugar after meals. It can be diagnosed by combining thyroid hormone tests.
3. Hyperpituitarism
In the early stage, the main symptoms are emotional instability, irritability, anxiety, restlessness, impatience, anger, insomnia, forgetfulness, tension, etc. In the later stage, there are mental depression, dullness, indifference, less movement and less speech. Some patients may have elevated blood sugar. Neurological symptoms include headache, tinnitus, narrowed visual field, blurred vision, optic disc edema and atrophy, and some patients may develop neuritis. Typical clinical manifestations combined with pituitary hormone measurement can be used for diagnosis.
4. Pheochromocytoma
Symptoms include palpitations, high metabolic state, high blood sugar, and excessive sweating. Blood and urine catecholamine and its metabolite determination, B-ultrasound, CT, magnetic resonance imaging, etc. can locate the tumor.
5. Obesity
The lipid metabolism of obesity is more active, while the glucose metabolism is relatively suppressed. This metabolic change is involved in the formation of insulin resistance. The active lipid metabolism of obesity is often accompanied by metabolic disorders, such as hypertriglyceridemia, hypercholesterolemia, and low high-density lipoprotein cholesterol. Glucose metabolism disorders manifest as abnormal glucose tolerance and diabetes, especially in people with central obesity.
6. Glucagonoma
The prominent symptoms of this disease are rash and diabetes. The manifestation of the rash has certain characteristics, which is clinically called epidermal necrotizing migratory erythema. It is mainly regional erythema at the beginning, but can also be desquamative red papules and macules, often in annular or arcuate shapes, and can be bullous, erosive, and scabby. Because it is easily infected by bacteria and yeast, necrotic and lytic bullous macules appear. When the lesion begins to heal, pigmentation remains at the healing site, and the lesion can move from one site to another. The erythema can occur in various parts of the body, but it is more common in the trunk, lower abdomen, groin, buttocks, perineum, lower limbs, and the middle 1/3 of the face. It takes 1 to 2 weeks for the lesion to heal from the appearance.
More than 95% of patients have symptoms of diabetes, which are mostly mild and can often be controlled by diet control or oral medication; occasionally the condition is more serious and requires large doses of insulin to control.
treat
Expected treatment
Physiological hyperglycemia usually does not require treatment. Pathological hyperglycemia requires treatment for the underlying disease. Diabetes, pheochromocytoma, and glucagonoma are the main causes of pathological hyperglycemia. Based on a clear diagnosis, the doctor will provide relevant treatment measures, mainly including drug therapy and surgical treatment.
Treatment
1. Diabetes
(1) General treatment: Educate diabetic patients on the basics of diabetes and build their confidence in overcoming the disease. At the same time, teach patients to monitor their blood sugar levels.
(2) Drug treatment: Commonly used oral drugs for controlling blood sugar include metformin, voglibose, acarbose, repaglinide, etc. Those whose blood sugar is not stable after drug control need to take insulin.
(3) Exercise therapy: Increasing physical activity can improve the body’s sensitivity to insulin, reduce body weight, reduce body fat, enhance physical strength, and improve work ability and quality of life. The intensity and duration of exercise should be determined according to the patient’s overall health condition, and find the amount of exercise that is suitable for the patient and the items that the patient is interested in. There are many forms of exercise, such as walking, brisk walking, aerobics, dancing, Tai Chi, running, swimming, etc.
(4) Dietary therapy: The intake of fat, protein and carbohydrates needs to be controlled.
2. Pheochromocytoma
Once a pheochromocytoma is diagnosed and located, the tumor should be removed promptly, otherwise there is a potential risk that the tumor will suddenly secrete a large amount of catecholamines and cause a hypertensive crisis. In recent years, with the development of biochemical tests and imaging technology, the qualitative and localized diagnostic techniques of pheochromocytoma have been greatly improved, thus improving the success rate of surgery. Before surgery, alpha receptor blockers should be used to lower blood pressure, reduce cardiac load, and expand the originally reduced blood vessel capacity to ensure the success of the operation.
3. Glucagonoma
(1) Treatment of skin lesions: In the early stages of the disease, when specific skin lesions have not yet manifested themselves or before the diagnosis has been made, oral corticosteroids or azathioprine can be taken to relieve skin lesions. In recent years, the use of zinc supplements and topical corticosteroids can also relieve skin lesions, but they are ineffective for other symptoms.
(2) Surgical removal of the tumor: After the diagnosis is confirmed, surgical treatment should be adopted in a timely manner. If there is any doubt, surgical exploration should also be performed. Symptoms can improve rapidly after tumor removal. Skin lesions often improve significantly on the second day after surgery and disappear completely after 2 weeks. Severe skin lesions and fused bullae can also return to normal 3 weeks after surgery. Patients with diabetes can be cured after a few days of insulin treatment, but glucose tolerance will recover later.
(3) Chemotherapy: For cases with metastasis that cannot be removed or for cases where the primary lesion has been removed, chemotherapy can be used after surgery.
Related drugsMetformin, voglibose, acarbose, repaglinide
daily
Nursing principles
1. Monitor blood sugar regularly and learn how to deal with hypoglycemia.
2. Avoid high-sugar diets, reasonably control total calories, pay attention to dietary diversity, eat small meals frequently, eat at regular times and in regular amounts, and avoid irregular eating.
3. Exercise reasonably and avoid short-term strenuous exercise.
4. Keep a calm mind and avoid getting emotional.
prevention
PrecautionsPatients should pay attention to a healthy lifestyle, maintain a reasonable weight, and monitor their blood sugar regularly.