Blood Glucose Management: Hyperglycemia
~ by Jo Jordan
When you have diabetes, there are often issues that go hand in hand with the disease. Hyperglycemia – which means high blood glucose (sugar) – is one of them. The condition occurs when the body has too little, or not enough, insulin or when it is unable to properly use insulin. A serious problem if not treated, hyperglycemia is a contributing factor in many diabetes complications.
There are two primary types of hyperglycemia:
- Fasting hyperglycemia – blood glucose level is greater than 130 mg/dL (milligrams per deciliter) after an eight-hour fast
- Post-prandial hyperglycemia – blood glucose level is consistently more than 180 mg/dL after a meal
What Causes Hyperglycemia?
Various factors cause high blood glucose. If you have type 1 diabetes, you may not have administered an adequate amount of insulin. If you have type 2 diabetes, your body may not be using insulin effectively. Eating more than necessary, exercising less than required, or the stress brought on by fighting off a cold or flu can also cause hyperglycemia. Emotional stress can trigger hyperglycemia. Other possible causes include bulimia nervosa and certain medications.
Hyperglycemia Signs and Symptoms
Symptoms of high blood glucose include frequent urination and increased thirst, high blood glucose levels, and high levels of sugar in the urine.
Signs of chronic hyperglycemia include blurred vision, dry mouth, fatigue, impotence, itchy skin, poor wound healing, recurrent infections, and weight loss.
Signs of severe hyperglycemia include abdominal pain, difficulty breathing, lack of movement, nausea, rapid heart rate, unusual drowsiness, and vomiting.
Treatment and Prevention of Hyperglycemia
Regular blood glucose level checks are a crucial part of hyperglycemia management. Checking blood sugar levels often, and early treatment will enable you to avoid other hyperglycemic symptoms. Without immediate attention, hyperglycemia can lead to ketoacidosis (increased organic compounds [aka ketones] in your urine) and diabetic coma.
Hyperglycemia treatment normally requires eliminating the underlying cause, diabetes for example. In most cases, severe and acute hyperglycemia can be treated with insulin.
Treatment can often be accomplished through exercise. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If ketones are present, do not exercise; doing so may make cause blood glucose levels to soar even higher.
Sometimes working with a dietitian to make appropriate meal plan changes and/or a reduction in food intake is helpful. Eating a number of small meals vs. three large meals can prevent large blood sugar level increases.
Increased water intake helps to ensure excess glucose is passed in urine, and prevent dehydration. Restoring electrolyte balance via intravenous fluids and salts is sometimes indicated.
Diagnosis of hyperglycemia involves several steps. The first symptoms are often extreme thirst and frequent urination. If diabetes is a factor, it’s important to determine the time of one’s last insulin injection.
Confirm whether or not medications known to increase the risk of hyperglycemia – such as anti-psychotic agents, beta blockers, corticosteroids, L-asparaginase, niacin, pentamidine, protease inhibitors, and thiazide-based diuretics – are being taken.
After an eight-hour fast, it’s important to test serum glucose levels. Again, fasting hyperglycemia is defined by a level greater than 130 mg/dL. Check for post-prandial hyperglycemia, defined by a serum glucose level consistently above 180 mg/dL after eating.
To identify your plasma glucose level over a long period of time (chronic hyperglycemia), a glycosylated hemoglobin A1C test is performed.
If blood sugar control is maintained, you will certainly feel better. And studies indicate that with proper management of blood glucose levels, the possibility of delaying and/or preventing the development of complications from diabetes – such as blood vessel, eye, kidney, and nerve damage – is increased. Learning to detect and treat hyperglycemia early, before it progresses, is the key to management.
When to Test Blood Glucose Levels
The American Diabetes Association recommends regular blood glucose monitoring if you have diabetes and are1
- Experiencing severely low blood glucose levels or ketones as a result of high blood glucose levels
- Having difficulty controlling blood glucose levels
- On intensive insulin therapy
- Taking insulin or diabetes pills
Logging the results of blood glucose testing is crucial to determining lifestyle habits that work for you, and those which do not. For example, if levels are too high for several days in a row at the same time of day, it may be necessary to alter the way you eat, how much you consume, and how often you eat.
Blood glucose levels are taken by sticking a finger with a needle, a lancet, to obtain a drop of blood. The blood is then read by a small computerized machine: a blood glucose meter. Your blood glucose level will appear numerically on the screen. Ask your health care provider to advise you as to how to use the meter, as well as how to interpret the numbers.
A1C Hyperglycemia Testing
Unlike a fasting blood glucose test or a daily finger stick, which measure blood sugar level at a specific time, the A1C test (also known as glycated hemoglobin or HbA1c test) is a valuable measure of the overall effectiveness of blood glucose control over a two- to three-month period of time.
Like all proteins, hemoglobin links with sugars such as glucose. But if you have uncontrolled diabetes, there is an abundance of sugar in the bloodstream. The extra glucose enters the red blood cells and links (or glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin gets glycated; in other words, the hemoglobin reacts with the sugar. So by measuring the percentage of A1C in the blood, an overview of your average blood glucose control over the past 120 days – the lifespan of a red blood cell – is demonstrated.
When checking for ketones, use a freshly dated keytone strip. You will need to obtain a urine sample in a clean container, and then put the strip into the sample. The directions will tell you how long to wait. Once the strip pad has changed color, compare the results to the color chart on the strip bottle for the amount of ketones in your urine, and note the results.
Trace amounts of ketones can indicate that ketones are beginning to accumulate. If there is a moderate or large amount of ketones in your urine, contact your health care provider immediately.
When to test for ketones:2
- Your blood glucose is more than 300 mg/dl
- You feel nauseated, are vomiting, or have abdominal pain
- You are ill with a cold or flu
- You feel tired all the time
- You are thirsty or have a very dry mouth
- Your skin is flushed
- You have difficulty breathing and/or your breath smells fruity
- You feel confused or in a fog
Other Considerations in the Management of Hyperglycemia
Research illustrates that regular exercise and weight loss substantially decreases the risk for onset of diabetes. To help maintain healthy blood sugar levels, physical activity is a must. Adequate exercise also increases the body’s sensitivity to insulin.
Various minerals and vitamins affect insulin function and the metabolizing of glucose.3 Research shows that a large percent of people who have diabetes are deficient in nutrients and micronutrients.4 Multi-vitamin supplementation can fill in the nutritional gaps commonly present in pre-diabetics and diabetics. Look for a multi-vitamin that contains,
- Folic acid
- Vitamin A/Beta-carotene
- Vitamin B6
- Vitamin C
- Vitamin D
- Vitamin E
Sufficient fiber intake may reduce diabetes risk by improving blood sugar control, and promoting weight loss. Adequate fiber levels are also linked to decreasing heart disease risk. High-fiber foods include beans, fruits, nuts, seeds, vegetables, and whole grains.5
Whole grains help to maintain healthy blood sugar levels. Foods made from whole grains include breads, cereals, and pasta products. Check the label to ensure wheat content is whole grain.
The Glycemic Index: Foods that Act Like Sugar6
Healthy eating is one of the basic management tools for hyperglycemia. When considering what to eat in order to stay healthy if you are prone to hyperglycemia and/or have diabetes, it’s important to know that there are many foods that behave the same way sugar does once they’re in our system.
Dr. Scott Olson has written an insightful book about sugar addiction; Sugarettes examines the way in which we eat, how (and why) it is literally killing us, and what we can do about it. Dr Olson presents the Glycemic Index, a measure of how much certain foods increase blood sugar levels.
Click here to read an excerpt from Dr. Olson’s book. A comprehensive, printable, Glycemic Index chart – which lists various foods and the level to which they increase blood sugar levels – is included.
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1. The American Diabetes Association, “Checking Your Blood Glucose,” http://www.diabetes.org/type-2-diabetes/blood-glucose-checks.jsp (accessed April 30, 2009).
3. Tufts Ebcam: Tufts University Program in Evidence-based Complementary and Alternative Medicine, “Multivitamins and Type 2 Diabetes,” http://www.tufts.edu/med/ebcam/nutrition/multi-diabetes.html (accessed April 1, 2009).
4. Melissa Diane Smith, “The Importance of a Daily Multivitamin and Mineral Supplement For People with Diabetes and Prediabetes,” Diabetes in Control.com, June 21, 2005, Issue 26, http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2865 (accessed April 1, 2009).
5. Mayo Foundation for Medical Education and Research (MFMER), “Diabetes: Prevention,” http://www.mayoclinic.com/health/diabetes/DA99999 / (accessed April 1, 2009).
6. Dr. Scott Olson, Sugarettes, 2008, http://olsonnd.com/sugarettes/.