Hyperglycemia

Hyperglycemia (High Blood Glucose)

Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can't use insulin properly.

What Causes Hyperglycemia?

A number of things can cause hyperglycemia:

·         If you have type 1, you may not have given yourself enough insulin.

·         If you have type 2, your body may have enough insulin, but it is not as effective as it should be.

·         You ate more than planned or exercised less than planned.

·         You have stress from an illness, such as a cold or flu.

·         You have other stress, such as family conflicts or school or dating problems.

·         You may have experienced the dawn phenomenon (a surge of hormones that the body produces daily around 4:00 a.m. to 5:00 a.m.).

What are the Symptoms of Hyperglycemia?

The signs and symptoms include the following:

·         High blood glucose

·         High levels of sugar in the urine

·         Frequent urination

·         Increased thirst

Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia.

How Do I Treat Hyperglycemia?

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.

What if it Goes Untreated?

Hyperglycemia can be a serious problem if you don't treat it, so it's important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy.

When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

·         Shortness of breath

·         Breath that smells fruity

·         Nausea and vomiting

·         Very dry mouth

Talk to your doctor about how to handle this condition.

Medical IDs

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency.

How Can I Prevent Hyperglycemia?

Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early — before it gets worse.

Hypoglycemia

Hypoglycemia (Low Blood Glucose)

Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. However, it is important to talk to your health care provider about your individual blood glucose targets, and what level is too low for you.

Hypoglycemia may also be referred to as an insulin reaction, or insulin shock.

Hypoglycemic symptoms are important clues that you have low blood glucose. Each person's reaction to hypoglycemia is different, so it's important that you learn your own signs and symptoms when your blood glucose is low.

The only sure way to know whether you are experiencing hypoglycemia is to check your blood glucose, if possible. If you are experiencing symptoms and you are unable to check your blood glucose for any reason, treat the hypoglycemia. Severe hypoglycemia has the potential to cause accidents, injuries, coma, and death.

Signs and Symptoms of Hypoglycemia (happen quickly)

·         Shakiness

·         Nervousness or anxiety

·         Sweating, chills and clamminess

·         Irritability or impatience

·         Confusion, including delirium

·         Rapid/fast heartbeat

·         Lightheadedness or dizziness

·         Hunger and nausea

·         Sleepiness

·         Blurred/impaired vision

·         Tingling or numbness in the lips or tongue

·         Headaches

·         Weakness or fatigue

·         Anger, stubbornness, or sadness

·         Lack of coordination

·         Nightmares or crying out during sleep

·         Seizures

·         Unconsciousness

Treatment

1. Consume 15-20 grams of glucose or simple carbohydrates
2. Recheck your blood glucose after 15 minutes
3. If hypoglycemia continues, repeat.
4. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

·         glucose tablets (follow package instructions)

·         gel tube (follow package instructions)

·         2 tablespoons of raisins

·         4 ounces (1/2 cup) of juice or regular soda (not diet)

·         1 tablespoon sugar, honey, or corn syrup

·         8 ounces of nonfat or 1% milk

·         hard candies, jellybeans, or gumdrops (see package to determine how many to consume)

Glucagon

If left untreated, hypoglycemia may lead to a seizure or unconsciousness (passing out, a coma). In this case, someone else must take over.

Glucagon is a hormone that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. Injectable glucagon kits are used as a medication to treat someone with diabetes that has become unconscious from a severe insulin reaction. Glucagon kits are available by prescription. Speak with your health care provider about whether you should buy one, and how and when to use it.

The people you are in frequent contact with (for example, family members, significant others, and coworkers) should also be instructed on how to administer glucagon to treat severe hypoglycemic events. Have them call 911 if they feel they can't handle the situation (for example, if the hypoglycemic person passes out, does not regain consciousness, or has a seizure, if the care taker does not know how to inject glucagon, or if glucagon is not available).

If glucagon is needed:

1. Inject glucagon into the individual's buttock, arm or thigh, following the manufacturer's instructions.
2. When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
3. If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

·         Inject insulin (will lower blood glucose even more)

·         Provide food or fluids (individual can choke)

·         Put hands in mouth (individual can choke)

Hypoglycemia Unawareness

Very often, hypoglycemia symptoms occur when blood glucose levels fall below 70 mg/dl. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night.

Hypoglycemia unawareness occurs more frequently in those who:

·         frequently have low blood glucose episodes (which can cause you to stop sensing the early warning signs of hypoglycemia)

·         have had diabetes for a long time

·         tightly control their diabetes (which increases your chances of having low blood glucose reactions)

If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes.

Blood Glucose testing

Diabetes is a common disease, yet every individual needs unique care. We encourage people with diabetes and their families to learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices. Good communication with a team of experts can help you feel in control and respond to changing needs.

Checking Your Blood Glucose

Blood glucose (blood sugar) monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time.

Who Should Check?

Talk to your doctor about whether you should be checking your blood glucose. People that may benefit from checking blood glucose include those:

·         taking insulin

·         that are pregnant

·         having a hard time controlling blood glucose levels

·         having low blood glucose levels

·         having low blood glucose levels without the usual warning signs

·         have ketones from high blood glucose levels

How Do I Check?

1. After washing your hands, insert a test strip into your meter.
2. Use your lancing device on the side of your fingertip to get a drop of blood.
3. Touch and hold the edge of the test strip to the drop of blood, and wait for the result.
4. Your blood glucose level will appear on the meter's display.

Note: All meters are slightly different, so always refer to your user's manual for specific instructions.

Other tips for checking:

·         With some meters, you can also use your forearm, thigh or fleshy part of your hand.

·         There are spring-loaded lancing devices that make sticking yourself less painful.

·         If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.

What Are the Target Ranges?

Blood glucose targets are individualized based on:

·         duration of diabetes

·         age/life expectancy

·         comorbid conditions

·         known CVD or advanced microvascular complications

·         hypoglycemia unawareness

·         individual patient considerations.

The American Diabetes Association suggests the following targets for most nonpregnant adults with diabetes. More or less stringent glycemic goals may be appropriate for each individual.

·         HbA1C: 7%
HbA1C may also be reported as eAG: 154 mg/dl

·         Before a meal (preprandial plasma glucose): 80–130 mg/dl

·         1-2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than 180 mg/dl

Autonomic Neuropathy

Autonomic neuropathy affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs.

Paralysis of the bladder is a common symptom of this type of neuropathy. When this happens, the nerves of the bladder no longer respond normally to pressure as the bladder fills with urine. As a result, urine stays in the bladder, leading to urinary tract infections.

Autonomic neuropathy can also cause erectile dysfunction (ED) when it affects the nerves that control erection with sexual arousal. However, sexual desire does not usually decrease.

Diarrhea can occur when the nerves that control the small intestine are damaged. The diarrhea occurs most often at night. Constipation is another common result of damage to nerves in the intestines.

Sometimes, the stomach is affected. It loses the ability to move food through the digestive system, causing vomiting and bloating. This condition, called gastroparesis, can change how fast the body absorbs food. It can make it hard to match insulin doses to food portions.

Scientists do not know the precise cause of autonomic neuropathy and are looking for better treatments for his type of neuropathy.

Symptoms

This type of nerve damage affects the nerves in your body that control your body systems. It affects your digestive system, urinary tract, sex organs, heart and blood vessels, sweat glands, and eyes. Look at the list below and make a note about any symptoms you have. Bring this list to your next office visit.

About my digestive system

·         I get indigestion or heartburn.

·         I get nauseous and I vomit undigested food.

·         It seems like food sits in my stomach instead of being digested.

·         I feel bloated after I eat.

·         My stomach feels full, even after I eat only a small amount.

·         I have diarrhea.

·         I have lost control of my bowels.

·         I get constipated.

·         My blood glucose levels are hard to predict. I never know if I'll have high or low blood glucose after eating.

About my urinary tract

·         I have had bladder control problems, such as urinating very often or not often enough, feeling like I need to urinate when I don't, or leaking urine.

·         I don't feel the need to urinate, even when my bladder is full.

·         I have lost control of my bladder.

·         I have frequent bladder infections.

About my sex organs

·         (For men) When I have sex, I have trouble getting or keeping an erection.

·         (For women) When I have sex, I have problems with orgasms, feeling aroused, or I have vaginal dryness.

About my heart and blood vessels

·         I get dizzy if I stand up too quickly.

·         I have fainted after getting up or changing my position.

·         I have fainted suddenly for no reason.

·         At rest, my heart beats too fast.

·         I had a heart attack but I didn't have the typical warning signs such as chest pain.

About my body's warning system for low blood glucose levels (hypoglycemia)

·         I used to get nervous and shaky when my blood glucose was getting too low, but I no longer have those warning signals.

About my sweat glands

·         I sweat a lot, especially at night or while I'm eating.

·         I no longer sweat, even when I'm too hot.

·         The skin on my feet is very dry.

About my eyes

·         It's hard for my eyes to adjust when I go from a dark place into a bright place or when driving at night.

Diagnosis

To diagnose this kind of nerve damage, you will need a physical exam and special tests as well. For example, an ultrasound test uses sound waves to check on your bladder. Stomach problems can be found using x-rays and other tests. Reporting your symptoms plays a big part in making a diagnosis.

Treatment

There are a number of treatments for damage to nerves that control body systems. For example, a dietitian can help you plan meals if you have nausea or feel full after eating a small amount. Some medications can speed digestion and reduce diarrhea. Problems with erections can be treated with medications or devices.