Differential Diagnosis

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A. Type 1 DM. Low or absent levels of endogenously produced insulin. New-onset and poorly controlled type 1 DM can both lead to hyperglycemia.

B. Type 2 dM. Receptors on cells are resistant to insulin. Condition is exacerbated postoperatively as well as in patients who are unable to take their medications.

C. Stress-Induced Hyperglycemia. Sepsis, trauma (especially head injury), and postoperative states can cause a stress reaction leading to decreased metabolism of glucose.

D. TPN-Induced Hyperglycemia. Glucose is one of the major calorie sources in TPN solutions. A higher concentration of glucose is present in the solution when it is received centrally. Hyperglycemia can occur when the solution is advanced too quickly or an excessive amount is administered.

E. Medications. Pulse steroids, thiazide diuretics, theophylline, and phenytoin can induce hyperglycemia.

F. Factitious Hyperglycemia. Be sure the specimen was not drawn from or above an IV line that is infusing a solution that contains glucose. If in doubt, repeat the test.

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