Hyperglycemia in diabetes
`Overview
`High blood sugar, also called hyperglycemia, aects people who have diabetes. Several factors can play a role in
`hyperglycemia in people with diabetes. They include food and physical activity, illness, and medications not related to
`diabetes. Skipping doses or not taking enough insulin or other medication to lower blood sugar also can lead to
`hyperglycemia.
`
`It's important to treat hyperglycemia. If it's not treated, hyperglycemia can become severe and cause serious health
`problems that require emergency care, including a diabetic coma. Hyperglycemia that lasts, even if it's not severe, can
`lead to health problems that aect the eyes, kidneys, nerves and heart.
`Symptoms
`Hyperglycemia usually doesn't cause symptoms until blood sugar (glucose) levels are high — 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 symptoms may become. But some people who've had type 2 diabetes for a long time may not show any
`symptoms despite high blood sugar levels.
`Early signs and symptoms
`Recognizing early symptoms of hyperglycemia can help identify and treat it right away. Watch for:
`Frequent urination
`Increased thirst
`Blurred vision
`Feeling weak or unusually tired
`Later signs and symptoms
`If hyperglycemia isn't treated, it can cause toxic acids, called ketones, to build up in the blood and urine. This condition is
`called ketoacidosis. Symptoms include:
`Fruity-smelling breath
`Dry mouth
`Abdominal pain
`Nausea and vomiting
`Shortness of breath
`Confusion
`Loss of consciousness
`When to see a doctor
`Seek immediate help from your care provider or call 911 if:
`You have ongoing diarrhea or vomiting, and you can't keep any food or fluids down
`
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`Your blood glucose levels stay above 240 milligrams per deciliter (mg/dL) (13.3 millimoles per liter (mmol/L)) and you
`have symptoms of ketones in your urine
`Causes
`During digestion, the body breaks down carbohydrates from foods — such as bread, rice and pasta — into sugar
`molecules. One of the sugar molecules is called glucose. It's one of the body's main energy sources. Glucose is absorbed
`and goes directly into your bloodstream after you eat, but it can't enter the cells of most of the body's tissues without the
`help of insulin. Insulin is a hormone made by the pancreas.
`
`When the glucose level in the blood rises, the pancreas releases insulin. The insulin unlocks the cells so that glucose can
`enter. This provides the fuel the cells need to work properly. Extra glucose is stored in the liver and muscles.
`
`This process lowers the amount of glucose in the bloodstream and prevents it from reaching dangerously high levels. As
`the blood sugar level returns to normal, so does the amount of insulin the pancreas makes.
`
`Diabetes drastically reduces insulin's eects on the body. This may be because your pancreas is unable to produce
`insulin, as in type 1 diabetes. Or it may be because your body is resistant to the eects of insulin, or it doesn't make
`enough insulin to keep a normal glucose level, as in type 2 diabetes.
`
`In people who have diabetes, glucose tends to build up in the bloodstream. This condition is called hyperglycemia. It
`may reach dangerously high levels if it is not treated properly. Insulin and other drugs are used to lower blood sugar
`levels.
`Risk factors
`Many factors can contribute to hyperglycemia, including:
`
`Not using enough insulin or other 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 or immunosuppressants
`Being injured or having surgery
`Experiencing emotional stress, such as family problems or workplace issues
`
`Illness or stress can trigger hyperglycemia. That's because hormones your body makes to fight illness or stress can also
`cause blood sugar to rise. You may need to take extra diabetes medication to keep blood glucose in your target range
`during illness or stress.
`Complications
`Long-term complications
`Keeping blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications
`of hyperglycemia that isn't treated include:
`Cardiovascular disease
`Nerve damage (neuropathy)
`Kidney damage (diabetic nephropathy) or kidney failure
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`Damage to the blood vessels of the retina (diabetic retinopathy) that could lead to blindness
`Feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations
`and, in some severe cases, amputation
`Bone and joint problems
`Teeth and gum infections
`Emergency complications
`If blood sugar rises very high or if high blood sugar levels are not treated, it can lead to two serious conditions.
`Diabetic ketoacidosis. This condition develops when you don't have enough insulin in your body. When this
`happens, glucose can't enter your cells for energy. Your blood sugar level rises, and your body begins to break down
`fat for energy.
`
`When fat is broken down for energy in the body, it produces toxic acids called ketones. Ketones accumulate in the
`blood and eventually spill into the urine. If it isn't treated, diabetic ketoacidosis can lead to a diabetic coma that can
`be life-threatening.
`Hyperosmolar hyperglycemic state. This condition occurs when the body makes insulin, but the insulin doesn't
`work properly. Blood glucose levels may become very high — greater than 600 mg/dL (33.3 mmol/L) without
`ketoacidosis. If you develop this condition, your body can't use either glucose or fat for energy.
`
`Glucose then goes into the urine, causing increased urination. If it isn't treated, diabetic hyperosmolar hyperglycemic
`state can lead to life-threatening dehydration and coma. It's very important to get medical care for it right away.
`Prevention
`To help keep your blood sugar within a healthy range:
`Follow your diabetes meal plan. If you take insulin or oral diabetes medication, be consistent about the amount and
`timing of your meals and snacks. The food you eat must be in balance with the insulin working in your body.
`Monitor your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level
`several times a week or several times a day. Careful monitoring is the only way to make sure that your blood sugar
`level stays within your target range. Note when your glucose readings are above or below your target range.
`Carefully follow your health care provider's directions for how to take your medication.
`Adjust your medication if you change your physical activity. The adjustment depends on blood sugar test results
`and on the type and length of the activity. If you have questions about this, talk to your health care provider.
`
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