From the Guidelines
Hyperglycemia is a condition characterized by elevated blood glucose levels, typically above 140 mg/dL 1.
Definition and Management
The definition of hyperglycemia is based on blood glucose levels, with levels above 140 mg/dL considered hyperglycemic 1.
- Management involves lifestyle modifications and pharmacological interventions, such as metformin (500-1000 mg orally twice daily) as a first-line treatment, with potential addition of sulfonylureas (e.g., glipizide 5-10 mg orally daily) or dipeptidyl peptidase-4 inhibitors (e.g., sitagliptin 100 mg orally daily) for inadequate glycemic control.
- In severe cases, insulin therapy (e.g., basal insulin glargine 10-20 units subcutaneously daily) may be initiated, with dose adjustments based on individual patient response and glucose monitoring results.
Blood Glucose Targets
The target blood glucose range may vary depending on the patient population and clinical setting, but a range of 7.7–10 mmol/l (140–180 mg/dl) has been suggested for perioperative care 1.
- Hyperglycemia can impair neutrophil function and cause overproduction of reactive oxygen species, inflammatory mediators, and free fatty acids, contributing to direct cellular damage as well as vascular and immune dysfunction 1.
- Treatment with insulin to reduce hyperglycemia can reduce complications, and use of a variable rate insulin infusion may be appropriate intraoperatively and postoperatively until the patient is more stable 1.
From the Research
Definition of Hyperglycemia
- Hyperglycemia refers to high blood sugar levels, which can be a sign of diabetes or other health conditions 2, 3, 4, 5, 6
- It is a common and serious healthcare problem, especially in hospitalized patients, and is associated with increased morbidity and mortality 3, 4, 6
Causes of Hyperglycemia
- Hyperglycemia can be caused by various factors, including diabetes, certain medications, and medical conditions such as glucocorticoid-induced hyperglycemia and immunotherapy-induced hyperglycemia 2, 5
- It can also occur during chemotherapy, with glucocorticoids and L-asparaginase being well-known to cause acute hyperglycemia 5
Management of Hyperglycemia
- Insulin therapy remains a mainstay of glycemic management in the inpatient setting, with the goal of maintaining blood glucose levels less than 180 mg/dL 3, 4
- Non-insulin antidiabetic drugs may also be used, but their safety and efficacy in the hospital setting are limited 4
- Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of blood glucose levels, and simple guidelines are provided to facilitate conversion from insulin infusion to a subcutaneous insulin-delivery regimen 6