Hyperglycaemia
Hyperglycaemia is defined as a plasma glucose>7.0 mmol/L. By far the most common cause is diabetes mellitus.
Symptoms and Signs
The most common symptoms include polydipsia, polyuria, polyphagia, fatigue, weight loss and blurred vision. Acute hyperglycaemia may present as hyperventilation, stupor or coma as part of a diabetic ketoacidotic crisis. Recurrent infections are common, especially of the skin.
The patient may have a history of diabetes or the symptoms may be the first presentation of the disease. Type 1 diabetes usually occurs in younger age groups, whereas type 2 generally affects older individuals, with obesity being a common accompanying condition.
A thorough drug history is important. Steroids are used for a large number of conditions and therefore the dose and duration of treatment should be evaluated. The patient may complain of features of Cushing’s syndrome such as excessive appetite, weight gain and weakness.
Enquire about recent severe illness such as heart attack or stroke. Hyperglycaemia may develop during the binge phase of bulimia when a large caloric load is ingested. Ask about episodes of binge eating, vomiting, significant shifts in weight over time and possible abuse of emetics. The history of bulimia may be obtained from relatives. Enquire about current or recent pregnancy.
Examination may reveal complications of diabetes such as vascular disease, retinopathy, neuropathy and Charcot joints may be present. Skin infection is common in diabetes, especially boils and abscesses. Obesity is frequent in type 2 diabetics. Look for the features of Cushing’s syndrome, including central obesity, moon face, hirsutism, cataracts, weakness, striae and hypertension. Complications of myocardial infarction may be present such as heart failure. Neurological examination will reveal upper motor neurone signs following stroke.
Examination findings in bulimia include tooth decay, oral trauma, dehydration and swollen salivary glands. The latter stages of pregnancy should be self-evident.
