Hyperglycemia
Hyperglycemia
Hyperglycemia
Hyperglycemia occurs when you have a higher than usual level of glucose in your blood. This can happen shortly after you have eaten a big meal and is not a problem if your glucose level returns to normal.
Cells remove glucose from the blood in response to insulin. If your 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)
3. Without glucose, your cells are unable to make energy and can't function properly.
Is hyperglycemia the same as diabetes
Diabetes mellitus is a disease that occurs when the body can't use glucose properly. Hyperglycemia is a symptom of diabetes; however, you can have hyperglycemia without having diabetes.
Symptoms of hyperglycemia
The most common symptoms of hyperglycemia are increased urination, excessive thirst or hunger, and unexplained weight loss.
Causes hyperglycemia and diabetes?
Treatment with HIV protease inhibitors (PIs)
4 and infection with hepatitis C virus increase the risk of hyperglycemia and diabetes in people with HIV. The risk of developing hyperglycemia is about the same with all PIs.
People who are older, overweight, have family members with diabetes, or are from certain ethnic groups are also at greater risk for developing hyperglycemia.
I am taking a PI and am worried about hyperglycemia. What should I do?
Tell your doctor if you have symptoms of hyperglycemia and discuss other risk factors you may have for hyperglycemia or diabetes. Do your best to maintain a healthy body weight.
A fasting blood glucose test measures the level of glucose in your blood and is used to diagnose hyperglycemia. You should have this test every 3 to 4 months during the first year you take a PI.
What happens if I develop hyperglycemia?
You and your doctor will discuss your treatment options. For most people, hyperglycemia goes away if they stop taking PIs. Don't stop taking any medication without first talking with your doctor. Together you may decide to make changes to your HIV treatment regimen.
You and your doctor may decide to continue using PIs in your treatment regimen despite your hyperglycemia. Your doctor may suggest you take hypoglycemic medicationsmedications (by mouth) or insulin
2 (injected under the skin) to decrease your blood glucose levels.
Target range for Blood Glucose and Hemoglobin A1C by age
|
Age
|
Pre-meal Glucose (mg/dL)
|
Post-meal Glucose (mg/dL)
|
A1c (%)
|
|
Toddlers and Preschool Children 0–6 years
|
100–180
|
110–200
|
<8.5 (but >7.5)
|
|
School age, 6–12 years
|
90–180
|
100–180
|
<8
|
|
Adolescents
|
90–130
|
90–150
|
<7.5
|
|
|
Goals should be individualized and lower goals may be reasonable based on benefit-risk assessment.
|
Post-meal blood sugar levels should be measured when there is a disparity between pre-meal levels and A1C.
|
A lower goal of <7.0% is reasonable if it can be achieved without excessive hypoglycemia.
|
Management of Severe Hyperglycemia or Diabetic Ketoacidosis
- Monitor blood glucose and ketone levels frequently–at a minimum of every 2 hours, and perhaps as often as every 30-60 minutes.
- Inject a corrective dose of rapid- or short-acting insulin.
- Attempt oral hydration with water or electrolyte-containing fluids. Replacement of fluids should take precedence over trying to give food.
- Call health care provider if:
- person is ill, vomiting, lethargic or having trouble breathing
- blood glucose stays elevated
- moderate to severe ketones do not clear
- Care givers may consider treatment of nausea and vomiting with anti-nausea suppositories [such as promethazine hydrochloride (Phenergan)]. These agents must be given with extreme caution so as to not mask an acute abdomen or worsening ketosis.
1 Hypoglycemic medications: medications used to decrease the level of glucose in the blood. Common oral hypoglycemic medications include Amaryl, Avandia, Glucophage, and Glucotrol.
2 Insulin: a hormone made by the pancreas. Insulin directs cells to take up glucose from the blood.
3 Insulin resistance: Insulin resistance occurs when cells are unable to respond to (resist) insulin's message to take up glucose from the blood.
4 Protease inhibitor (PI): class of anti-HIV medication. PIs work by blocking protease, a protein that HIV needs to make copies of itself. The PIs approved by the FDA are Agenerase, Aptivus, Crixivan, Fortovase, Invirase, Kaletra, Lexiva, Norvir, Reyataz, and Viracept.
