Diabetes mellitus

Chronic hyperglycemia that persists even in fasting states is most commonly caused

by diabetes mellitus. In fact, chronic hyperglycemia is the defining characteristic of the disease.

Intermittent hyperglycemia may be present in prediabetic states. Acute episodes of hyperglycemia

without an obvious cause may indicate developing diabetes or a predisposition to the disorder.

In diabetes mellitus, hyperglycemia is usually caused by low insulin levels (Diabetes mellitus type 1)

and/or by resistance to insulin at the cellular level (Diabetes mellitus type 2), depending on the type

and state of the disease. Low insulin levels and/or insulin resistance prevent the body from

converting glucose into glycogen (a starch-like source of energy stored mostly in the liver), which in

turn makes it difficult or impossible to remove excess glucose from the blood. With normal glucose

levels, the total amount of glucose in the blood at any given moment is only enough to provide

energy to the body for 20–30 minutes, and so glucose levels must be precisely maintained by the

body’s internal control mechanisms. When the mechanisms fail in a way that allows glucose to rise

to abnormal levels, hyperglycemia is the result.

Ketoacidosis may be the first symptom of immune-mediated diabetes, particularly in children and

adolescents. Also, patients with immune-mediated diabetes, can change from modest fasting

hyperglycemia to severe hyperglycemia and even ketoacidosis as a result of stress or an infection.

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