Category: Diet

Hyperglycemia prevention strategies

Hyperglycemia prevention strategies

Stragegies KJ, Conigrave HHyperglycemia, Mittleman MA, Camargo Jr CA, Hyperglycemia prevention strategies MJ, Performance-enhancing foods WC, Rimm EB. However, prioritizing whole grains sfrategies processed ones and refined carbs provides greater nutritional value while helping decrease your blood sugar levels Knowler WC, Barret-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Eat more fiber. Read this article in Spanish.

Hyperglycemia prevention strategies -

Show references Robertson RP. Prevention of type 2 diabetes mellitus. Accessed April 12, American Diabetes Association. Prevention or delay of type 2 diabetes: Standards of Medical Care in Diabetes — Diabetes Care.

Diabetes mellitus. Merck Manual Professional Version. Accessed April 14, Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes — Your game plan to prevent type 2 diabetes.

National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 8, Melmed S, et al. Therapeutics of type 2 diabetes mellitus. Williams Textbook of Endocrinology. Elsevier; Interactive Nutrition Facts label: Dietary fiber. Food and Drug Administration. Accessed April 16, Department of Health and Human Services and U.

Department of Agriculture. Interactive Nutrition Facts label: Monounsaturated and polyunsaturated fats. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes — Products and Services Assortment of Health Products from Mayo Clinic Store A Book: The Essential Diabetes Book.

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Perhaps you have learned that you have a high chance of developing type 2 diabetes , the most common type of diabetes. You might be overweight or have a parent, brother, or sister with type 2 diabetes. Maybe you had gestational diabetes, which is diabetes that develops during pregnancy.

These are just a few examples of factors that can raise your chances of developing type 2 diabetes. Diabetes can cause serious health problems , such as heart disease, stroke, and eye and foot problems. Prediabetes also can cause health problems. The good news is that type 2 diabetes can be delayed or even prevented.

The longer you have diabetes, the more likely you are to develop health problems, so delaying diabetes by even a few years will benefit your health.

You can help prevent or delay type 2 diabetes by losing a modest amount of weight by following a reduced-calorie eating plan and being physically active most days of the week. Ask your doctor if you should take the diabetes drug metformin to help prevent or delay type 2 diabetes.

Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:. Ask your health care professional about what other changes you can make to prevent or delay type 2 diabetes.

Most often, your best chance for preventing type 2 diabetes is to make lifestyle changes that work for you long term. Get started with Your Game Plan to Prevent Type 2 Diabetes. Prediabetes is when your blood glucose , also called blood sugar, levels are higher than normal, but not high enough to be called diabetes.

Having prediabetes is serious because it raises your chance of developing type 2 diabetes. Many of the same factors that raise your chance of developing type 2 diabetes put you at risk for prediabetes.

Other names for prediabetes include impaired fasting glucose or impaired glucose tolerance. About 1 in 3 Americans has prediabetes, according to recent diabetes statistics from the Centers for Disease Control and Prevention.

If you have prediabetes, you can lower your chance of developing type 2 diabetes.

Open access peer-reviewed pervention. Submitted: 03 July Reviewed: 09 July Hyperglycdmia 04 October Hyperglycemia prevention strategies Edited by Juber Akhtar, Usama Ahmad, Badruddeen and Mohammad Irfan Khan. com customercare cbspd. Hyperglycemia is the elevation of blood glucose concentrations above the normal range. Hyperglycemia Hjperglycemia the technical term for high HHyperglycemia glucose blood sugar. High blood pdevention happens when the Chromium browser tabs has too little insulin or Belly fat burner pills the body can't use insulin properly. Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your glucose sugar levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia. You can often lower your blood glucose level by exercising.

Hyperglycemia prevention strategies -

Double daily dosing mg twice daily was more effective in preventing prednisone-induced hyperglycemia [ 21 ]. The limitations attached to the full exploitation of metformin use include its relative contraindications in many hospitalized patients who present with comorbidities like renal insufficiency or unstable hemodynamic status.

Emerging evidence shows that the established cut-off points for renal safety may be overly restrictive [ 56 ]. It has been argued that there is a need to relax these cut-offs and policies to allow use of this drug to patients with stable chronic kidney disease characterized by mild—moderate renal insufficiency [ 57 , 58 , 59 ].

The associated risk of lactic acidosis tends to deter the use of metformin in majority of the comorbid patients on drugs that predispose to the development of hyperglycemia.

However, the studies that made such recommendations used a small percentage of the patient population, thus limiting the extrapolation of these recommendations to the greater public [ 60 ]. Fortunately, the incidence of metformin-induced lactic acidosis is rare and can be significantly reduced in at-risk patients by observing the necessary precautions [ 27 , 56 ].

Other factors may also play a greater role in in being predictors of acidosis, such as dehydration, severe heart and renal failure. Thus, its benefits for use outweigh the potential risk of lactic acidosis. Supporting evidence on avoidance of metformin use in certain cases is poor and inconsistent such as in patients undergoing radio-contrast imaging which theoretically predisposes patients to media-induced nephropathy, increasing the risk of lactic acidosis [ 56 ].

The benefits of metformin in the prevention of hyperglycemia are unmatched despite its list of contraindications. This has facilitated its expanded use based on its well-founded glycemic effects as well as numerous benefits conferred such as the beneficial effect on reduction of development of cardiovascular risk factors [ 61 ].

It confers good glycemic management that yields a substantial and enduring decrease in the onset and progression of micro vascular complications [ 60 ]. Moreover, large based clinical trials and systematic reviews have shown its beneficial effect of enhancing weight loss, even the weight loss associated with medicaments like antipsychotic agents [ 62 , 63 ].

Metformin has been shown to reduce the incidence of hyperglycemia-related complications such as diabetes and risk factors for cardiovascular disease in patients with impaired glucose tolerance and fasting blood sugar [ 11 , 64 , 65 ]. This has led to its endorsement of use in patients with high risk of developing the aforementioned conditions [ 36 ].

Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Edited by Juber Akhtar.

Open access peer-reviewed chapter Prevention of Hyperglycemia Written By Lucy A. Ochola and Eric M. DOWNLOAD FOR FREE Share Cite Cite this chapter There are two ways to cite this chapter:.

Choose citation style Select style Vancouver APA Harvard IEEE MLA Chicago Copy to clipboard Get citation. Choose citation style Select format Bibtex RIS Download citation. IntechOpen Metformin Pharmacology and Drug Interactions Edited by Juber Akhtar.

From the Edited Volume Metformin - Pharmacology and Drug Interactions Edited by Juber Akhtar, Usama Ahmad, Badruddeen and Mohammad Irfan Khan Book Details Order Print. Chapter metrics overview Chapter Downloads View Full Metrics.

Impact of this chapter. Abstract Hyperglycemia is the elevation of blood glucose concentrations above the normal range. Keywords hyperglycemia hyperinsulinemia insulin metformin glucose.

Lucy A. Introduction Chronic hyperglycemia can lead to complications involving damage to the kidneys, retina, nervous system and cardiovascular system.

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The choice of sulfonylurea balances glucose-lowering efficacy, universal availability, and low cost with risk of hypoglycemia and weight gain. Pioglitazone , which is generic and another relatively low-cost oral agent, may also be considered in patients with specific contraindications to metformin and sulfonylureas.

However, the risk of weight gain, HF, fractures, and the potential increased risk of bladder cancer raise the concern that the overall risks and cost of pioglitazone may approach or exceed its benefits. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus" and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Potential indications'.

For patients who are starting sulfonylureas, we suggest initiating lifestyle intervention first, at the time of diagnosis, since the weight gain that often accompanies a sulfonylurea will presumably be less if lifestyle efforts are underway. However, if lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in glucose values after one or two weeks, then the sulfonylurea should be added.

Side effects may be minimized with diabetes self-management education focusing on medication reduction or omission with changes in diet, food accessibility, or activity that may increase the risk of hypoglycemia.

See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Suggested approach to the use of GLP-1 receptor agonist-based therapies' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Mechanism of action' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Mechanism of action' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Hypoglycemia'.

Symptomatic catabolic or severe hyperglycemia — The frequency of symptomatic or severe diabetes has been decreasing in parallel with improved efforts to diagnose diabetes earlier through screening. If patients have been drinking a substantial quantity of sugar-sweetened beverages, reduction of carbohydrate intake, and rehydration with sugar-free fluids will help to reduce glucose levels within several days.

See "Insulin therapy in type 2 diabetes mellitus", section on 'Initial treatment'. However, for patients who are injection averse, initial therapy with high-dose sulfonylurea is an alternative option.

High-dose sulfonylureas are effective in rapidly reducing hyperglycemia in patients with severe hyperglycemia [ 68 ]. Metformin monotherapy is not helpful in improving symptoms in this setting, because the initial dose is low and increased over several weeks.

However, metformin can be started at the same time as the sulfonylurea, slowly titrating the dose upward. Once the diet has been adequately modified and the metformin dose increased, the dose of sulfonylurea can be reduced and potentially discontinued.

Patients with type 2 diabetes require relatively high doses of insulin compared with those needed for type 1 diabetes. Insulin preparations, insulin regimens, and timing of dosing are discussed in detail elsewhere.

See "Insulin therapy in type 2 diabetes mellitus". See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Administration'. We typically use glimepiride 4 or 8 mg once daily.

An alternative option is immediate-release glipizide 10 mg twice daily or, where available, gliclazide immediate-release 80 mg daily. We contact the patient every few days after initiating therapy to make dose adjustments increase dose if hyperglycemia does not improve or decrease dose if hyperglycemia resolves quickly or hypoglycemia develops.

See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Sulfonylureas'. Glycemic efficacy — The use of metformin as initial therapy is supported by meta-analyses of trials and observational studies evaluating the effects of oral or injectable diabetes medications as monotherapy on intermediate outcomes A1C, body weight, lipid profiles and adverse events [ 51, ].

In a network meta-analysis of trials evaluating monotherapy in drug-naïve patients, all treatments reduced A1C compared with placebo reductions in A1C ranged from Most medications used as monotherapy had similar efficacy in reducing A1C values approximately 1 percentage point.

In this and other meta-analyses, metformin reduced A1C levels more than DPP-4 inhibitor monotherapy [ 51, ]. There are few high-quality, head-to-head comparison trials of the available oral agents. In one such trial, A Diabetes Outcome Progression Trial ADOPT , recently diagnosed patients with type 2 diabetes were randomly assigned to monotherapy with the thiazolidinedione rosiglitazone , metformin , or glyburide [ 72 ].

At the four-year evaluation, 40 percent of the subjects in the rosiglitazone group had an A1C value less than 7 percent, as compared with 36 percent in the metformin group and 26 percent in the glyburide group. Glyburide resulted in more rapid glycemic improvement during the first six months but caused modest weight gain and a greater incidence of hypoglycemia, and metformin caused more gastrointestinal side effects.

Rosiglitazone caused greater increases in weight, peripheral edema, and concentrations of low-density lipoprotein LDL cholesterol.

There was also an unexpected increase in fractures in women taking rosiglitazone. The study was limited by a high rate of withdrawal of study participants.

Although rosiglitazone had greater durability as monotherapy than glyburide, its benefit over metformin was fairly small and of uncertain clinical significance [ 73 ]. See "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Safety'. Cardiovascular outcomes — Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin.

See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Monotherapy failure'.

The cardiovascular effects of diabetes drugs are reviewed in the individual topics. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Insulin therapy in type 2 diabetes mellitus".

In trials of patients with type 2 diabetes with and without chronic kidney disease, GLP-1 receptor agonists slowed the rate of decline in eGFR and prevented worsening of albuminuria [ 54,56,58 ]. These trials and other trials evaluating microvascular outcomes are reviewed in the individual topics.

Guidelines — Our approach is largely consistent with American and European guidelines [ 52,74,75 ]. A consensus statement regarding the management of hyperglycemia in type 2 diabetes by the American Diabetes Association ADA and the European Association for the Study of Diabetes EASD was developed in and has been updated regularly, with the most recent revision published in [ 75 ].

The guidelines emphasize the importance of individualizing the choice of medications for the treatment of diabetes, considering important comorbidities CVD, HF, or chronic kidney disease; hypoglycemia risk; and need for weight loss and patient-specific factors including patient preferences, values, and cost [ 75 ].

We also agree with the World Health Organization WHO that sulfonylureas have a long-term safety profile, are inexpensive, and are highly effective, especially when used as described above, with patient education and dose adjustment to minimize side effects [ 76 ].

Blood glucose monitoring BGM is not necessary for most patients with type 2 diabetes who are on a stable regimen of diet or oral agents and who are not experiencing hypoglycemia.

BGM may be useful for some patients with type 2 diabetes who use the results to modify eating patterns, exercise, or insulin doses on a regular basis. See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'Type 2 diabetes'. The balance among efficacy in lowering A1C, side effects, and costs must be carefully weighed in considering which drugs or combinations to choose.

Avoiding insulin, the most potent of all hypoglycemic medications, at the expense of poorer glucose management and greater side effects and cost, is not likely to benefit the patient in the long term. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Our approach'.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetic kidney disease". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest.

Weight reduction through diet, exercise, and behavioral modification can all be used to improve glycemic management, although the majority of patients with type 2 diabetes will require medication. See 'Diabetes education' above. Glycemic targets are generally set somewhat higher for older adults and for those with comorbidities or a limited life expectancy and little likelihood of benefit from intensive therapy.

See 'Glycemic management' above and "Glycemic control and vascular complications in type 2 diabetes mellitus", section on 'Choosing a glycemic target'. In the absence of specific contraindications, we suggest metformin as initial therapy for most patients Grade 2B.

Although some guidelines and experts endorse the initial use of alternative agents as monotherapy or in combination with metformin, we prefer initiating a single agent typically metformin and then sequentially adding additional glucose-lowering agents as needed.

See 'Metformin' above and 'Glycemic efficacy' above. We suggest initiating metformin at the time of diabetes diagnosis Grade 2C , along with consultation for lifestyle intervention. See 'When to start' above.

The dose of metformin should be titrated to its maximally effective dose usually mg per day in divided doses over one to two months, as tolerated. See 'Contraindications to or intolerance of metformin' above. See 'Established cardiovascular or kidney disease' above.

The majority of patients in the cardiovascular and renal outcomes trials had established cardiovascular disease CVD or diabetic kidney disease DKD with severely increased albuminuria, and therefore, these are the primary indications for one of these drugs.

See 'Without established cardiovascular or kidney disease' above. Each one of these choices has individual advantages and risks table 1. Choice of medication is guided by efficacy, patient comorbidities, preferences, and cost.

Sulfonylureas remain a highly effective treatment for hyperglycemia, particularly when cost is a barrier.

Side effects of hypoglycemia and weight gain can be mitigated with careful dosing and diabetes self-management education. For patients who are injection averse, initial therapy with high-dose sulfonylurea is an alternative, particularly for patients who have been consuming large amounts of sugar-sweetened beverages, in whom elimination of carbohydrates can be anticipated to cause a reduction in glucose within several days.

See 'Symptomatic catabolic or severe hyperglycemia' above and "Insulin therapy in type 2 diabetes mellitus". Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result and in some settings, the results of blood glucose monitoring [BGM].

See 'Monitoring' above. See "Management of persistent hyperglycemia in type 2 diabetes mellitus" and "Insulin therapy in type 2 diabetes mellitus". Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you.

Select the option that best describes you. View Topic. Font Size Small Normal Large. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English.

Author: Deborah J Wexler, MD, MSc Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jan This topic last updated: Dec 23, TREATMENT GOALS Glycemic management — Target glycated hemoglobin A1C levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy.

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ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.

Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes.

Rawshani A, Rawshani A, Franzén S, et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.

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J Clin Endocrinol Metab ; Utzschneider KM, Carr DB, Barsness SM, et al. Diet-induced weight loss is associated with an improvement in beta-cell function in older men. Wing RR, Blair EH, Bononi P, et al.

Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care ; Lean ME, Leslie WS, Barnes AC, et al.

Primary care-led weight management for remission of type 2 diabetes DiRECT : an open-label, cluster-randomised trial. Delahanty LM. The look AHEAD study: implications for clinical practice go beyond the headlines.

J Acad Nutr Diet ; Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial.

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Your blood Chromium browser tabs strategeis is the range you Hyperglycemia prevention strategies Blood sugar crash and cognitive function reach as Hperglycemia as possible. Read preventioh Monitoring Your Strategoes Sugar and All Preventikn Hyperglycemia prevention strategies A1C. Staying in your Fat burn lifestyle range can also help improve your energy and mood. Find answers below to common questions about blood sugar for people with diabetes. Use a blood sugar meter also called a glucometer or a continuous glucose monitor CGM to check your blood sugar. A blood sugar meter measures the amount of sugar in a small sample of blood, usually from your fingertip. A CGM uses a sensor inserted under the skin to measure your blood sugar every few minutes.

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