For hyperglycemia

When asparaginase is administered to a patient witii diabetes, die risk for hyperglycemia is increased a dosage adjustment of die oral antidiabetic drug may be necessary. Glucocorticoids decrease die effectiveness of aldesleukin. When aldesleukin is administered witii antihypertensive drugs, tiiere is an additive hypotensive effect Etoposide may decrease the immune response to live viral vaccines. 

Hyperglycemia is the most common metabolic complication. A too rapid infuson of amino add-carbohydrate mixtures may result in hyperglycemia, glycosuria, mental confuson, and loss of consciousness Blood glucose levels may be obtained every 4 to 6 hours to monitor for hyperglycemia and guide the dosage of dextrose and insulin (if required). To minimize these complications the primary health care provider may decrease the rate of administration, reduce the dextrose concentration, or administer insulin. 

Corticosteroids Prednisone (or equivalent) 50-100 mg daily 5-7 days 3-4 days 0.5-3 mg/dL Monitor for hyperglycemia, insomnia, immunosuppression. 

Intravenous lipid emulsions are also a source of calories. The typical daily dose in adults is approximately 0.5 to 1 g/kg per day. In the absence of hypertriglyceridemia, substituting a portion of dextrose calories with lipid calories may be beneficial in situations where dextrose infusion may lead to complications (e.g., hyperglycemia). Some examples include patients with diabetes mellitus or pancreatic disease and patients under severe stress (e.g., trauma or burns) who are at risk for hyperglycemia. The maximum of dose of lipid emulsions is 2.5 g/kg per day,7 or 60% of total daily calories, although doses this high are used rarely in practice. 

In a study of high-dose somatropin (0.1 mg/kg/day) in 20 patients with severe burns (a condition that causes insulin resistance), 60% of the treated patients required insulin therapy for hyperglycemia compared with 25% of the controls (59). This study was limited by the fact that the treated patients had more severe burns than the controls. 

Gabir MM, Hanson RL, Dabelea D, Imperatore G, Roumain J, Bennett PH, et al. The 1997 American Diabetes Association and 1999 World Health Organization criteria for hyperglycemia in the diagnosis and prediction of diabetes. Diabetes Care 2000 23 1108-1112. 

Why is it important to monitor for hyperglycemia when initiating parenteral nutrition support therapy The pancreas may not have time to adjust to the hypertonic dextrose solution, which is high in glucose. Hyperglycemia is usually temporary and dissipates once the pancreas adjusts. 

Check for hyperglycemia (polyuria, polyphagia, and polydipsia) nausea and vomiting, dim vision, fatigue, deep rapid breathing. 

Pui C-H, Burghen GA, Bowman WP, Aur RJA. Risk factors for hyperglycemia in children... 

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

Insulin glargine is given SC once daily at bedtime This type of insulin is used in the treatment of adults and children with type 1 diabetes mellitus and in adults widi type 2 diabetes who need long-acting insulin for die control of hyperglycemia. 

MANAGING HYPERGLYCEMIA AND KETOACIDOSIS. Capillary blood specimens are obtained and tested in the same manner as for insulin (see Fhtient and Family Teaching Checklist, p. 497). The nurse notifies the health care provider if blood sugar levels are elevated... 

Know the symptoms of hypoglycemia and hyperglycemia and the health care provider s method for terminating a hypoglycemic reaction. 

Facilitates the breakdown of protein in the muscle, leading to increased plasma amino acid levels. Increases activity of enzymes necessary for glucogenesis producing hyperglycemia, which can aggravate diabetes, precipitate latent diabetes, and cause insulin resistance... 

Thyroid hormone replacement therapy in patients with diabetes may increase the intensity of the symptoms or the diabetes. The nurse closely monitors the patient with diabetes during thyroid hormone replacement therapy for signs of hyperglycemia (see Chap. 49) and notifies the primary health care provider if this problem occurs. 

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