Summary about Disease
Stress-induced hyperglycemia (SIH) refers to elevated blood glucose levels that occur in response to physiological stress. This stress can be due to acute illness, trauma, surgery, or severe psychological stress. While not necessarily indicative of diabetes, it is often observed in hospitalized patients, especially those in intensive care units. SIH can negatively impact patient outcomes, increasing the risk of complications such as infections, delayed wound healing, and prolonged hospital stays. The condition typically resolves once the underlying stressor is removed.
Symptoms
Stress-induced hyperglycemia often has no specific symptoms in itself. The symptoms observed are generally related to the underlying illness or injury causing the stress. However, if hyperglycemia is severe, possible symptoms might include:
Increased thirst (polydipsia)
Frequent urination (polyuria)
Blurred vision
Fatigue Many patients in the hospital setting will not be able to report symptoms. Hyperglycemia will be detected through blood glucose monitoring.
Causes
The primary cause of stress-induced hyperglycemia is the body's response to stress. This involves the release of stress hormones such as cortisol, glucagon, and epinephrine (adrenaline). These hormones trigger the following physiological changes:
Increased glucose production: The liver produces more glucose (sugar) to provide energy for the body to cope with the stress.
Decreased insulin sensitivity: The body's cells become less responsive to insulin, making it harder for glucose to enter the cells and leading to elevated blood sugar levels.
Inflammation: Stress can trigger inflammation, which also contributes to insulin resistance.
Underlying conditions: pre-existing insulin resistance, undiagnosed diabetes or pre-diabetes. Specific stressors include:
Acute illness (e.g., pneumonia, sepsis)
Trauma (e.g., burns, injuries)
Surgery
Severe psychological stress
Certain medications (e.g., corticosteroids)
Medicine Used
The primary medications used to manage stress-induced hyperglycemia are insulin and, in some cases, oral hypoglycemic agents. The specific choice of medication and dosage depends on the severity of the hyperglycemia, the patient's overall condition, and whether the patient has pre-existing diabetes.
Insulin: Insulin is often administered intravenously (IV) in a hospital setting for rapid and precise blood sugar control. Subcutaneous insulin injections may be used for less severe cases or after the initial stabilization.
Oral Hypoglycemic Agents: In some cases, oral medications like metformin or sulfonylureas may be considered, but they are less commonly used for SIH due to their slower onset of action and potential for side effects.
Is Communicable
No, stress-induced hyperglycemia is not communicable. It is a physiological response to stress and is not caused by an infectious agent that can be transmitted from person to person.
Precautions
Precautions focus on managing the underlying stressor and monitoring blood glucose levels:
Manage Underlying Condition: Treat the underlying illness, injury, or source of stress.
Frequent Blood Glucose Monitoring: Regularly check blood glucose levels, especially in hospitalized patients or those under significant stress.
Insulin Therapy: Administer insulin as prescribed by a healthcare provider to maintain blood glucose within a target range.
Nutritional Support: Provide appropriate nutrition to support the body's energy needs and aid in recovery.
Medication Review: Assess medications that may contribute to hyperglycemia (e.g., corticosteroids).
Patient Education: Educate patients and caregivers about the importance of blood glucose monitoring and the management of hyperglycemia.
Stress Management: Encourage stress-reducing techniques to lower stress.
How long does an outbreak last?
The duration of stress-induced hyperglycemia depends entirely on the length and severity of the underlying stressor. It typically resolves when the acute stress subsides.
Acute Illness or Trauma: Hyperglycemia may last for several days to weeks.
Surgery: It usually resolves within a few days after the surgery.
Psychological Stress: It lasts as long as the person is experiencing the stress.
How is it diagnosed?
Stress-induced hyperglycemia is diagnosed primarily through blood glucose testing.
Blood Glucose Monitoring: Elevated blood glucose levels (typically above 140 mg/dL) are detected through routine or point-of-care blood glucose monitoring.
Review Medical History: Consider the patient's medical history, including any pre-existing diabetes or risk factors.
Assess Stressors: Identify any recent or ongoing stressors, such as illness, injury, or surgery.
Rule out other causes: If the hyperglycemia persists, further testing may be required to rule out underlying diabetes.
Timeline of Symptoms
As SIH is usually asymptomatic, the timeline is less about symptoms and more about blood sugar elevation. The elevation of blood glucose occurs relatively quickly after the onset of the stressor.
Within Hours: Blood glucose levels begin to rise within hours of the onset of acute stress.
Peak: The blood glucose levels typically peak within a day or two if the stressor persists.
Resolution: Once the stressor is removed or adequately managed, blood glucose levels typically return to normal within a few days to a week, depending on the severity and duration of the stress.
Important Considerations
Not Always Diabetes: Stress-induced hyperglycemia does not necessarily indicate that the individual has diabetes, although it can unmask undiagnosed diabetes or pre-diabetes.
Hospital Setting: SIH is commonly seen in hospitalized patients and those in intensive care units.
Impact on Outcomes: Elevated blood glucose levels can negatively affect patient outcomes, increasing the risk of complications.
Insulin Management: It is often essential to use insulin to control blood glucose levels.
Underlying Conditions: Always assess for pre-existing diabetes.
Stress Management: Integrating stress-reducing techniques can play a role in controlling SIH.
Discharge Planning: Patients who experienced SIH during hospitalization should be followed up after discharge to assess for persistent hyperglycemia or diabetes.