Detailed Explanation of Clinical Classification, Diagnosis, and Blood Glucose Control Standards for Hyperglycemia

Clinical Classification: Hyperglycemia can be classified into three types during its development: latent hyperglycemia, chemical hyperglycemia, and clinical hyperglycemia. Latent hyperglycemia is the incubation period of diabetes and generally has no specific symptoms. Chemical hyperglycemia usually does not present with clinical symptoms of diabetes, and fasting blood glucose is normal. However, it may present with postprandial hyperglycemia and glycosuria, along with symptoms of diabetic complications such as peripheral neuropathy or macrovascular disease. Clinical hyperglycemia presents with typical diabetic symptoms, including elevated fasting blood glucose, and can be diagnosed without a glucose tolerance test.

Clinical hyperglycemia is further divided into three categories: juvenile-onset, adult-onset, and young-onset. Juvenile-onset hyperglycemia, also known as insulin-dependent hyperglycemia, requires insulin treatment to prevent ketoacidosis. Adult-onset hyperglycemia, also known as insulin-independent hyperglycemia, generally does not require insulin treatment. Young-onset and adult-onset hyperglycemia are milder forms of hyperglycemia with dominant genetic characteristics.

Diagnostic and Control Criteria: The simplest method for diagnosing hyperglycemia is to check urine glucose. A normal adult excretes 32-39 mg of glucose in their urine daily. Diabetes mellitus (GD) refers to the excretion of more than 150 mg of glucose in the urine, which is reflected in a glucose tolerance test. The highest urinary glucose concentration occurs 2 hours after a meal. In hyperglycemia, urinary glucose is directly proportional to blood glucose levels; glucose will be present in the urine when blood glucose exceeds 160% (CW/W).

In individuals with good blood glucose control, 24-hour urinary glucose levels are generally below 5 grams, while those with poor control often have levels above 5 grams. Generally, 5 grams is used as the control standard in short-term clinical practice, but it is difficult to maintain urinary glucose below 5 grams for long-term treatment. Therefore, for mild cases, 24-hour urinary glucose should be controlled at 5-10 grams, and for severe cases, at 10-20 grams, not exceeding 25 grams. While complications may still occur if this standard is achieved, they are not severe.

A satisfactory standard for blood glucose control is a fasting blood glucose level not exceeding 130% (CW/W). Elderly individuals often have lower renal thresholds for blood glucose, so urinary glucose may not reflect blood glucose levels, thus requiring fasting blood glucose testing.