Dysglycemia in critical care practice

Abstract

Dysglycemia is defined as a disorder in the metabolism and regulation of blood glucose levels, including two components: (1) sustained chronic hyperglycemia that exerts its effects through both excessive protein glycation and activation of oxidative stress and (2) acute glucose fluctuations. Glycemic variability seems to have more deleterious effects than sustained hyperglycemia in the development of diabetic complications as both upward (postprandial glucose increments) and downward (interprandial glucose decrements) changes activate the oxidativestress. The American Diabetes Association and American Association of Clinical Endocrinologists consensus on inpatient hyperglycemia defined stress hyperglycemia or hospital-related hyperglycemia as any blood glucose concentration > 7.8 mmol/l (140 mg/dl) without evidence of previous diabetes. A plasma glucose concentration below 70 mg/dl is the most common threshold used to define hypoglycemia. Hypoglycemia could be considered symptomatic and documented (typical symptom of hypoglycemia with a measure of glycemia below 70 mg/dl); probably symptomatic (symptom of hypoglycemia without a glucose measurement); or biological (measure of glycemia below 70 mg/dl without symptoms). In general terms, hypo-glycemia is considered to be severe if the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitation actions is required. These episodes may be associated with neuroglycopenia symptoms. Keywords: Dysglycemia, hyperglycemia, hypoglycemia.