dysglycemia

Dysglycemia is a general term used to describe any abnormality in blood glucose levels. It encompasses both hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), as well as intermediate or prediabetic states such as impaired fasting glucose or impaired glucose tolerance. The thresholds used to define abnormal glycemia vary slightly by guideline, but common definitions include hypoglycemia as a plasma glucose below 70 mg/dL (3.9 mmol/L) and hyperglycemia as fasting plasma glucose at or above 126 mg/dL (7.0 mmol/L) or a random glucose at or above 200 mg/dL (11.1 mmol/L) with symptoms. HbA1c is used to assess longer-term glycemic control, with levels above 6.5% typically meeting criteria for diabetes in many guidelines.

Causes of dysglycemia are diverse. In people with diabetes, medication effects (notably insulin or secretagogues) are a frequent cause of hypoglycemia or hyperglycemia. Non-diabetic dysglycemia can occur with acute illness, liver or kidney disease, hormonal disorders, alcohol misuse, malnutrition, or pregnancy. Gestational dysglycemia refers to abnormal glucose tolerance during pregnancy and is detected by screening during pregnancy or by postpartum follow-up.

Clinical presentation and diagnosis depend on the glucose level and clinical context. Hypoglycemia presents with autonomic and neuroglycopenic symptoms such as sweating, tremor, palpitations, confusion, or weakness. Hyperglycemia can cause polyuria, polydipsia, weight loss, fatigue, and blurred vision; severe hyperglycemia may lead to dehydration or coma.

Management is condition-specific. Hypoglycemia is treated with fast-acting carbohydrates, followed by a longer-acting carbohydrate if needed, with glucagon or intravenous dextrose for severe cases. Hyperglycemia requires addressing the underlying cause and, in emergencies, protocols for diabetic ketoacidosis or hyperosmolar hyperglycemic states, including fluids, insulin, and electrolyte management. Ongoing prevention focuses on weight management, diet, physical activity, adherence to therapy, and regular screening for dysglycemia progression.