Sweet Hearts Not So Sweet
< Feb. 27, 2008 > -- According to a statement released earlier this week by the American Heart Association, a national effort is needed to deal with the effects of high blood sugar in heart patients.
The statement highlights a number of unanswered questions about the condition, also known as hyperglycemia, in people hospitalized with acute coronary syndrome (ACS). ACS includes heart attack and a variety of other cardiovascular conditions.
"Although studies indicate that one-fourth to one-half of ACS patients have hyperglycemia when they arrive at [the] hospital, elevated blood sugar is frequently ignored despite being strongly associated with increased mortality," writing committee chair Dr. Prakash Deedwania, chief of cardiology at the VA Medical Center and the University of California, San Francisco, in Fresno, says.
Which Comes First, Hyperglycemia or Heart Damage?
A number of studies have shown that patients hospitalized with ACS who also have high blood sugar are at an increased risk of in-hospital complications and death.
But there may be more to learn about the link between hyperglycemia and poor outcomes in these patients. For example, it is unclear whether elevated blood sugar levels in ACS patients are a marker for heart muscle damage or actually a cause of the damage, Dr. Deedwania notes.
According to the American Diabetes Association, when stress occurs, the body prepares to take action. This preparation is called the fight-or-flight response. In the fight-or-flight response, levels of many hormones shoot up. Their net effect is to make a lot of stored energy - glucose and fat - available to cells. These cells are then primed to help the body get away from danger.
In people who have diabetes, the fight-or-flight response does not work well. Insulin is not always effective at moving glucose, so glucose accumulates in the blood. Thus, researchers will need to determine whether the hyperglycemia triggers the ACS or vice versa.
Controlled Blood Sugar is Key
Since evidence about how best to approach glucose management in ACS patients is still being gathered, the AHA statement provides "a general reference" for medical teams treating these patients.
The statement recommends that all ACS patients with elevated blood sugar be screened for diabetes or prediabetes as part of their in-hospital evaluation.
Blood sugar should be kept in the range of 90 to 140 milligrams per deciliter (mg/dL) for ACS patients who have significant hyperglycemia on admission and are placed in the intensive care unit. Blood sugar levels should be kept below 189 mg/dL for ACS patients who are not in the ICU.
Symptoms of Hyperglycemia
The best way for a person with diabetes to tell if he or she has hyperglycemia is to check the blood sugar. Other signs that you may have high blood sugar include feeling sick, thirsty, nauseated, tired, or faint. Vomiting and blurred vision may also occur. However, each individual may experience symptoms differently.
People who do not have diabetes may experience some effects from eating concentrated sweets, such as a surge of energy; however, the body quickly responds with insulin to maintain a normal blood sugar level, so hyperglycemia is not a problem unless you have diabetes.
Early recognition of symptoms and prompt treatment helps to prevent complications.
Always consult with your physician for more information.
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Hyperglycemia Spotlight for People with Diabetes
According to the American Diabetes Association (ADA), high blood glucose (hyperglycemia) can occur any time blood glucose is above the target range.
Good control means getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 90 and 130 mg/dl before meals, and less than 180 two hours after starting a meal.
You should set your goals with your doctor. Keeping a normal level all the time is not practical. And it is not needed to get results. Every bit you lower your blood glucose level helps to prevent complications.
Hyperglycemia is caused by having too much glucose and/or not enough insulin in the body. In fact, the symptoms of diabetes are the same as the symptoms of hyperglycemia. That is because diabetes itself causes hyperglycemia.
The two main reasons for having hyperglycemia are poor blood glucose control and getting sick. If your blood glucose levels are frequently above the target range, it is probably time to change your diabetes treatment. Talk to your doctor about how to better control your blood glucose.
Always consult your physician for more information.
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