Hyperglycemia

Normal fasting glucose is <110 mg/dL, impaired fasting glucose is 111–125 mg/dL, and diabetes mellitus is defined as a fasting glucose >126 mg/dL. Several values above normal are indicated before making a diagnosis of impaired fasting glucose or diabetes.

Differential Diagnosis

• Impaired fasting glucose

• Medications
  –Corticosteroids are a common cause
  –Common medications include growth hormone, estrogen (including oral contraceptives), nicotinic acid, salicylates and NSAIDs, thiazide and loop diuretics, phenytoin, and epinephrine
• Diabetes mellitus type I
  –Diabetic ketoacidosis
• Diabetes mellitus type II
• Pancreatic disease
  –Acute or chronic pancreatitis
  –Pancreatectomy
  –Pancreatic carcinoma
  –Hemochromatosis
  –Cystic fibrosis
• Increased counter-regulatory hormones associated with acute disease
  –Myocardial infarction
  –Stroke or other neurologic disease
  –Renal insufficiency
  –Hepatic insufficiency
• Acromegaly
• Cushing's syndrome
• Pheochromocytoma
• Hyperthyroidism (thyroid storm)
• Glucagonoma
• Gestational diabetes
• Amyloidosis

Workup and Diagnosis

• History and physical examination
  –Symptoms of hyperglycemia include fatigue, polyuria, polyphagia, polydipsia, and stomach discomfort
  –Complete medication history is essential
  –Examination is most commonly normal, but patients occasionally present with acanthosis nigricans (hyperpigmented, velvety lesions commonly on the back of the neck and/or axilla), or necrobiosis lipoidica diabeticorum (atrophic, shiny, erythematous or pale macules on anterior shins).
  –Complicating problems of diabetes (end-organ dysfunction) involve many systems (e.g., diabetic retinopathy, peripheral neuropathy, diabetic nephropathy, hypertension, coronary artery disease)

• Initial presentation may be dramatic, with greatly elevated glucose and significant electrolyte abnormalities
• Both type I and type II result in elevated levels of insulin
  –In type I disease, exogenous insulin is often abnormally elevated
  –In type II disease, endogenous insulin is often abnormally elevated
• C-peptide is increased in type II and decreased in type I

Treatment

• IV fluids
• Acute treatment includes insulin administration (IV or subcutaneous) or oral hypoglycemic medications
• Remove offending medications if possible
• Treat the underlying etiology
• Acute treatment of diabetic ketoacidosis involves fluid repletion, correction of electrolyte disturbances, insulin administration, and very frequent monitoring of glucose and electrolytes (intensive care admission is often necessary for initial stages of treatment)
• Long-term management includes regular testing of Hb_A1C, glucose (home readings), blood pressure, lipid profile, renal function, and regular podiatric and ophthalmology examinations

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Diabetes-like symptoms: Introduction (review 216 causes)
• Next Book Extract About Diabetes-like symptoms: Hyperglycemia (In A Page: Pediatric Signs and Symptoms)
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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Hyperglycemia (In A Page: Pediatric Signs and Symptoms)

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• GLYCOSURIA (Differential Diagnosis in Primary Care)
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• POLYDIPSIA (Differential Diagnosis in Primary Care)

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