High blood glucosehyperglycaemia

One aim of the management of diabetes is to restore the blood glucose towards normal. This is not the only aim—resolution of symptoms, prevention and treatment of tissue damage, control of other metabolic imbalance, and, above all, a good quality of life are important.

Before defining hyperglycaemia, consider what blood glucose levels are desirable in each patient—the target zone. In most instances, the aim should be to maintain the blood glucose between 4 and 8 mmol/l for most of the time. The occasional random value up to 11.0 mmol/l is no worry. The fasting glucose should be below 7.0 mmol/l, ideally 4-6 mmol/l. The pre-bed blood glucose should be over 6 mmol/l in insulin-treated patients to protect them from nocturnal hypoglycaemia. (See Tables 8.1 and 9.1.)

These guidelines assume that the patient is capable of looking after themselves and not frail or vulnerable. In an elderly person with insulin-treated diabetes who lives alone it is probably better to aim for blood glucose levels between 6 and 11 mmol/l to avoid hypoglycaemia. Sometimes, for example if the patient is terminally ill, the aim is solely to avoid symptoms of uncontrolled diabetes with minimum discomfort to the patient. Tailor the target zone to the patient. Patients who keep their blood glucose under 8 mmol/l all the time may suffer from frequent hypoglycaemia.

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