Hyperglycemia in diabetes can occur for many reasons. Know the causes, symptoms and treatments of high blood sugar and when to get emergency help.
High blood sugar (hyperglycemia) affects people who have diabetes. Several factors can contribute to hyperglycemia in people with diabetes, including food and physical activity choices, illness, nondiabetes medications, or skipping or not taking enough glucose-lowering medication.
It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as a diabetic coma. In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting your eyes, kidneys, nerves and heart.
Hyperglycemia doesn't cause symptoms until glucose values are significantly elevated — usually above 180 to 200 milligrams per deciliter (mg/dL), or 10 to 11.1 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious the symptoms become. However, some people who've had type 2 diabetes for a long time may not show any symptoms despite elevated blood sugar levels.
Recognizing early signs and symptoms of hyperglycemia can help you treat the condition promptly. Watch for:
If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include:
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 glucose level in your blood rises, it signals your pancreas to release insulin. The insulin 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 lowers insulin's effects on your body. This may be because your pancreas is unable to produce insulin (type 1 diabetes), or it may be 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 (hyperglycemia) and may reach dangerously high levels if not treated properly. Insulin or other drugs are used to lower blood sugar levels.
Many factors can contribute to hyperglycemia, including:
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 transient 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.
Keeping your blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of untreated hyperglycemia can include:
If blood sugar rises high enough or for a prolonged period of time, it can lead to two serious conditions.
Diabetic ketoacidosis. Diabetic ketoacidosis develops when you don't have enough insulin in your body. When this happens, sugar (glucose) can't enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy.
This process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually "spill over" into the urine. Left untreated, diabetic ketoacidosis can lead to a diabetic coma and be life-threatening.
Hyperglycemic hyperosmolar state. This condition occurs when people produce insulin, but it doesn't work properly. Blood glucose levels may become very high — greater than 1,000 mg/dL (55.6 mmol/L). Because insulin is present but not working properly, the body can't use either glucose or fat for energy.
Glucose is then spilled into the urine, causing increased urination. Left untreated, diabetic hyperglycemic hyperosmolar state can lead to life-threatening dehydration and coma. Prompt medical care is essential.
The following suggestions can help keep your blood sugar within your target range:
Your doctor sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals:
For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:
Your target blood sugar range may differ, especially if you're pregnant or you have developed diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes, reaching your target blood sugar range is a challenge.
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 (13.3 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.
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 the oxygen-carrying protein in red blood cells (hemoglobin).
An A1C level of 7% or less means that your treatment plan is working and that your blood sugar was consistently within the target range. If your A1C level is higher than 7%, your blood sugar, on average, was above the normal range. In this case, your doctor may recommend a change in your diabetes treatment plan.
However, for some people, especially older adults and those with certain medical conditions or limited life expectancy, a higher A1C level of up to 8% may be appropriate.
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.
Talk to your doctor about managing your blood sugar and understand how different treatments can help keep your glucose levels within your goal range. Your doctor may suggest the following treatments:
If you have signs and symptoms of diabetic ketoacidosis or hyperglycemic hyperosmolar state, 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:
As your body chemistry returns to normal, your doctor will consider what may have triggered the severe hyperglycemia. Depending on the circumstances, you may need additional evaluation and 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.
If you have trouble keeping your blood sugar within the desired range, schedule an appointment to see your doctor. He or she can help you make changes to better manage your diabetes.
Here's some information to help you get ready for your appointment and to know what to expect from your doctor.
For hyperglycemia, questions you may want to ask include:
Illness or infections can cause your blood sugar to rise, so it's important to plan for these situations. Talk to your doctor about creating a sick-day plan. Questions to ask include:
December 22nd, 2020