High blood sugar, known as hyperglycaemia, occurs when blood glucose levels are greater than normal. According to the medical book "Clinical Diagnosis and Treatment Emergency Medicine," severe hyperglycaemia is an emergency requiring medical intervention. Blood sugars greater than 500 ml/dL can occur in diabetic ketoacidosis or in a hyperosmolar hyperglycaemic state. Without treatment, extremely high blood glucose levels can result in death.
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Diabetes is a chronic condition that occurs either because the body does not produce insulin or does not use it effectively. Insulin is a natural hormone produced by the pancreas that controls the level of glucose in the blood. When insulin is not present or effective, the body is unable to break down glucose that the cells need for energy. If the body cannot break down glucose, high blood sugars will result. The buildup of glucose, or hyperglycaemia, will present problems with fluid, electrolyte and acid-base balance.
When blood glucose reaches extreme levels, two conditions to test for are diabetic ketoacidosis, or DKA, and hyperosmolar hyperglycaemic state, or HHS. Both will cause hyperglycemia. Limits set in the medical book "Clinical Practice of Emergency Medicine" indicates that in DKA, the blood glucose can be as high as 600 ml/dL, and with HHS, the blood glucose will be greater than 600 ml/dL. A glucose level over 500 ml/dL may indicate either of these diseases.
DKA is a serious complication of insulin-dependent, or type 1, diabetes. Patients with type 1 diabetes have an absolute insulin deficiency. A patient with DKA can have a blood glucose level as high as 600 mg/dL, with ketones in the urine. Ketones are a waste product produced when the body burns stored fat for energy, which will be excreted in urine. The patient will also complain of increased thirst, increased hunger and increased urination. Because of the fluid and electrolyte imbalances, the patient may experience headaches, nausea, vomiting and fatigue.
HHS defined by "Clinical Practice in Emergency Medicine" is the presence of a blood glucose greater than 600 mg/dL and hypersomolarity greater than 320 mOsm/kg. Osmolarity reflects the concentration of body fluids. High levels of osmolarity indicate dehydration. In HHS, the patient does not have the large amount of ketones lost that the DKA patient has. HHS is more often seen in type 2 diabetes. In addition to the high glucose level, high osmolarity and fewer ketones, the patient with HHS may be drowsy or unresponsive, and seizures can occur.
In DKA, the high blood glucose is caused because the body is not able to produce insulin. The patient will need insulin, fluids and electrolytes to treat the condition. With HHS, the patient will also need insulin to help reduce the blood glucose level, but HHS patients will require significantly more fluid rehydration because of the severe dehydration associated with HHS.
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