Hyperglycemia Facts

Hyperglycemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. Hyperglycemia needs to be treated immediately as it is a major cause of complications among people with diabetes.

Hyperglycemia happens when there is no insulin in the blood, not enough insulin in the blood, or the

insulin in the blood is not working properly.

The main reason for hyperglycemia for a patient who is being treated for diabetes type 1 is that he/she has not given himself enough insulin. For a type 2 diabetic it could be the same reason, but also his/her insulin is less effective than it should be.

For a patient with diabetes, overeating can bring on hyperglycemia, as can too little exercise on a given day. Mental stress can also bring it on. Remember that your body's supply of insulin is determined by how much you give yourself, and when. For a person who does not have diabetes his/her body will respond automatically with appropriate quantities of insulin.

Causes

During digestion, your body breaks down carbohydrates from foods — such as bread, rice and pasta — into various sugar molecules. One of these sugar molecules is glucose, a main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter the cells of most of your tissues without the help of insulin — a hormone secreted by your pancreas.

When the level of glucose in your blood rises, it signals your pancreas to release insulin. The insulin, in turn, unlocks your cells so that glucose can enter and provide the fuel your cells need to function properly. Any extra glucose is stored in your liver and muscles in the form of glycogen.

This process lowers the amount of glucose in your bloodstream and prevents it from reaching dangerously high levels. As your blood sugar level returns to normal, so does the secretion of insulin from your pancreas.

Diabetes drastically diminishes the effects of insulin on your body, either because your pancreas doesn't produce enough insulin (type 1 diabetes) or because your body is resistant to the effects of insulin or doesn't produce enough insulin to maintain a normal glucose level (type 2 diabetes). As a result, glucose tends to build up in your bloodstream and may reach dangerously high levels (hyperglycemia) if not treated properly. Insulin or other drugs are used to lower blood sugar levels.

Factors that contribute to hyperglycemia

Many factors can contribute to hyperglycemia, including:

• Not using enough insulin or oral diabetes medication
• Not injecting insulin properly or using expired insulin
• Not following your diabetes eating plan
• Being inactive
• Having an illness or infection
• Using certain medications, such as steroids
• Being injured or having surgery
• Experiencing emotional stress, such as family conflict or workplace challenges

Illness or stress can trigger hyperglycemia because hormones produced to combat illness or stress can also cause your blood sugar to rise. Even people who don't have diabetes may develop hyperglycemia during severe illness. But people with diabetes may need to take extra diabetes medication to keep blood glucose near normal during illness or stress.

Symptoms

If you have diabetes, it is important to know the early signs of hyperglycemia. If hyperglycemia is left untreated, it may develop into ketoacidosis (if you have type 1 diabetes) or HHNS (if you have type 2 diabetes), both of which are serious emergencies.

Early signs of hyperglycemia in diabetes may include:

• Increased thirst
• Headaches
• Difficulty concentrating
• Blurred vision
• Frequent urination
• Fatigue (weak, tired feeling)
• Weight loss
• Blood sugar more than 180 mg/dL

Prolonged hyperglycemia in diabetes may result in:

• Vaginal and skin infections
• Slow-healing cuts and sores
• Decreased vision
• Nerve damage causing painful cold or insensitive feet, loss of hair on the lower extremities, and/or erectile dysfunction
• Stomach and intestinal problems such as chronic constipation or diarrhea
• Damage to your eyes, blood vessels, or kidneys

Complications

Hyperglycemia can be a serious problem if not treated in time. In untreated hyperglycemia, a condition called ketoacidosis (contrast ketosis) could occur. Ketoacidosis develops when the body does not have enough insulin. Without insulin, the body isn't able to utilize the glucose for fuel, so the body starts to break down fats for energy.

Ketoacidosis is a life-threatening condition which needs immediate treatment. Symptoms include: shortness of breath, breath that smells fruity (such as pear drops), nausea and vomiting, and very dry mouth. Chronic hyperglycemia (high blood sugar) injures the heart in patients without a history of heart disease or diabetes and is strongly associated with heart attacks and death in subjects with no coronary heart disease or history of heart failure.

Diagnosis

Your doctor sets your target blood sugar range. For many people who have diabetes, target levels are:

• Fasting at least eight hours (fasting blood sugar level) - between 90 and 130 mg/dL (5 and 7 mmol/L)
• Before meals - between 70 and 130 mg/dL (4 and 7 mmol/L)
• One to two hours after meals - lower than 180 mg/dL (10 mmol/L)

Your target blood sugar range may differ, especially if you're pregnant or you develop diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes reaching your target blood sugar range is a challenge. But the closer you get, the better you'll feel.

Home blood sugar monitoring

Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your goal range. Check your blood sugar as often as your doctor recommends.

If you have any signs or symptoms of severe hyperglycemia, even if they're subtle, check your blood sugar level. If your blood sugar level is 240 mg/dL (13 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. You'll need your doctor's help to lower your blood sugar level safely.

Glycated hemoglobin (A1C) test

During an appointment, your doctor may conduct an A1C test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

An A1C level of 7 percent or less means that your treatment plan is working and that your blood sugar was consistently within the normal range. If your A1C level is higher than 7 percent, your blood sugar, on average, was above the normal range. In this case, your doctor may recommend a change in your diabetes treatment plan.

Keep in mind that the normal range for A1C results may vary somewhat among labs. If you consult a new doctor or use a different lab, it's important to consider this possible variation when interpreting your A1C test results.

How often you need the A1C test depends on the type of diabetes you have and how well you're managing your blood sugar. Most people with diabetes, however, receive this test between two and four times a year.

Treatment

You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise.

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level.

Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

Emergency treatment for severe hyperglycemia

If you have signs and symptoms of diabetic ketoacidosis and diabetic hyperosmolar syndrome, you may be treated in the emergency room or admitted to the hospital. Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes:

• Fluid replacement. You'll receive fluids- either orally or through a vein (intravenously), until you're rehydrated. The fluids replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.
• Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through your veins to help keep your heart, muscles and nerve cells functioning normally.
• Insulin therapy. Insulin reverses the processes that cause ketones to build up in your blood. Along with fluids and electrolytes, you'll receive insulin therapy- usually through a vein.

As your body chemistry returns to normal, your doctor considers what may have triggered the severe hyperglycemia. Depending on the circumstances, you may need additional treatment.

If your doctor suspects a bacterial infection, he or she may prescribe antibiotics. If a heart attack seems possible, your doctor may recommend further evaluation of your heart.

Prevention

To prevent hyperglycemia in diabetes, make sure you are following your meal plan, exercise program, and medicine schedule.

• Know your diet, count the total amounts of carbohydrate that you are consuming
• Test your blood sugar regularly.
• Know when to contact your health care provider if you have repeated abnormal blood sugar readings.
• Make sure you always wear medical identification that states you have diabetes so you can receive proper treatment in the event of an emergency.