Hyperglycemia

High Blood Sugar

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 13.3 mmol/L 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.

A temporary high blood glucose level does not require any emergency measures at all. Always check for ketones in the urine. The absence of urine ketones means that the cells are not starved. If you feel well, measure the blood glucose level again before your next meal and if necessary, add another 1-2 units of short acting insulin to your pre-meal dose if levels are still high.

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. 

DKA (Ketoacidosis) & Ketones

Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick.

High levels of ketones can poison the body. When levels get too high, you can develop DKA. DKA may happen to anyone with diabetes, though it is rare in people with type 2.  Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly.

What are the Warning Signs of DKA?

DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Early symptoms include the following:

  • Thirst or a very dry mouth
  • Frequent urination
  • High blood glucose (blood sugar) levels
  • High levels of ketones in the urine

Then, other symptoms appear:

  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting, or abdominal pain
    (Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)
  • Difficulty breathing
  • Fruity odor on breath
  • A hard time paying attention, or confusion

Warning! Ketoacidosis (DKA) is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the nearest emergency room of your local hospital.

How Do I Check for Ketones?

You can detect ketones with a simple urine test using a test strip, similar to a blood testing strip. Ask your health care provider when and how you should test for ketones. Many experts advise to check your urine for ketones when your blood glucose is more than 13.3 mmol/L.

When you are ill (when you have a cold or the flu, for example), check for ketones every 4 to 6 hours. And check every 4 to 6 hours when your blood glucose is more than 13.3 mmol/L
Also, check for ketones when you have any symptoms of DKA.

What If I Find Higher-than-normal Levels of Ketones?

If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone.
Call your health care provider at once if you experience the following conditions:

  • Your urine tests show high levels of ketones.
  • Your urine tests show high levels of ketones and your blood glucose level is high.
  • Your urine tests show high levels of ketones and you have vomited more than twice in four hours.

DO NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

What Causes DKA?

Here are three basic reasons for moderate or large amounts of ketones:

  • Not enough insulin
    Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness.
  • Not enough food
    When you're sick, you often don't feel like eating, sometimes resulting in high ketone levels. High levels may also occur when you miss a meal.
  • Insulin reaction (low blood glucose)

If testing shows high ketone levels in the morning, you may have had an insulin reaction while asleep.