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1 - Hyperglycaemia

Published online by Cambridge University Press:  15 February 2010

Amanda Ogilvy-Stuart
Affiliation:
University of Cambridge
Paula Midgley
Affiliation:
University of Edinburgh
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Summary

Clinical presentation

  • Hyperglycaemia is usually picked up incidentally on routine blood glucose assessment or in response to finding glycosuria.

  • It may be noted as part of the workup of a sick baby.

Definition of hyperglycaemia

The upper end of the ‘normal’ range for blood sugar has not been clearly defined in neonatal practice, although levels of >7 mmol/L are unusual in healthy term babies. Most neonatologists would treat by reducing sugar intake or with insulin if the blood sugar is >10–12 mmol/L, especially if there is significant glycosuria causing an osmotic diuresis, particularly in sick preterm babies. However, tighter glucose control in intensive care patients may be more appropriate.

Approach to the problem

Hyperglycaemia usually occurs in very preterm or small-for-gestational age (SGA) babies due to impaired insulin secretion and/or insulin resistance as well as immaturity of the liver enzymes involved in glucose metabolism (dysregulation of glucose homeostasis).

If hyperglycaemia occurs out of context (such as a previously healthy appropriate-for-gestational-age, enterally fed infant), the cause needs to be identified.

Differential diagnosis

Commonly

  • Iatrogenic from excessive intravenous glucose delivery

  • Impaired glucose homeostasis in preterm/SGA baby

  • Sepsis

  • Stress

  • Drugs particularly corticosteroids

Rarely

  • Transient neonatal diabetes

  • Permanent neonatal diabetes

  • Pancreatic agenesis

Investigations

  • Measure the true blood glucose to confirm the diagnosis.

  • Calculate the glucose infusion rate (see Appendix 1) to exclude excessive glucose delivery.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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  • Hyperglycaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.002
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  • Hyperglycaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.002
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hyperglycaemia
  • Amanda Ogilvy-Stuart, University of Cambridge, Paula Midgley, University of Edinburgh
  • Book: Practical Neonatal Endocrinology
  • Online publication: 15 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544736.002
Available formats
×