In some individuals, most commonly in type 2 DM, cells become resistant to insulin and cannot use it effectively. Glucose then builds up in the system because there is not enough insulin being produced to overcome the insulin resistance.
Insulin regulation can come from synthetic subcutaneous insulin or oral hypoglycemic medication. Counting carbohydrates is typically used to determine how much insulin should be given to cover a meal.
When the body becomes stressed from an illness or infection, hyperglycemia can occur. This is caused by the body releasing couterregulatory hormones and pro inflammatory cytokines that enhance glycogenolysis and gluconeogenesis.
Steroids come in a variety of forms. However, the effect on glucose in the body is similar by reducing glucose effect on certain cells and stimulating gluconeogenesis.
In normal individuals the blood glucose range is 80-120mg/dL. Clinical manifestations vary with each patient when hyperglycemia occurs. It is important to routinely check the blood sugar before each meal, and if the patient has any clinical changes. Severely elevated glucose levels can lead to medical emergencies such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic syndrome (HHS).
The first P refers to the patient experiencing excessive hunger or increased appetite as a result of glucose accumulating in the blood stream. This results in the body's cells being deprived of glucose and this lack of energy causes an increase in hunger.
The second P refers to the dehydration effect that polyuria has on the system causing the patient to have an unquenchable thirst.
The third P refers to increased urine output. Glucose is typically reabsorbed back into the blood stream when the kidneys filter it out to make urine. In patients with hyperglycemia there is too much glucose in the system, and it all cannot be reabsorbed. The glucose that is not being reabsorbed then pulls more water out of the system creating more urine.
Due to excess fluid being eliminated, patients can become hypovolemic and have a low blood pressure as a result. This dehydration and hypotension can cause shunting of the blood away from the digestive tract, leading to nausea, vomiting, and cramping.
Due to dehydration, typically from an increase in urine output and the patient’s inability to convert excess glucose into energy, patients will feel fatigued or drowsy.
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