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Health Education

Are You Suffering from Untreated Hyperglycemia?

Untreated hyperglycemia leads to serious complications. Signs are hard to identify, but self-monitoring and early treatment lowers these risks and improves quality of life.


Kelley Reeser, R.D. L.D.N. C.D.E.

December 5, 2017

Hyperglycemia, or high blood sugar, affects people who have diabetes. Since the symptoms are difficult to feel and easily go unnoticed, the condition often goes untreated. Prolonged hyperglycemia is the main cause of almost all the complications associated with diabetes but good blood sugar control can prevent them. The more you know about high blood sugar, the more likely you are to recognize it, treat it, and hopefully take steps to prevent it.

What is hyperglycemia?

Hyperglycemia is a fancy way to say “high blood sugar”. People without diabetes usually maintain a fasting blood sugar of less than 100 mg/dl. The goal for managing diabetes is to achieve glucose values as close to this as possible, but the recommended range is 80-130 mg/dl.  

There is no specific value used to define hyperglycemia in all individuals. In general, a glucose level above 160-180 mg/dl is considered hyperglycemia.  The best way to define it, though, is by talking with your medical team. Hyperglycemia is really defined as any blood sugar that is above the upper limit of your individualized range.

  • Fasting hyperglycemia is a blood sugar that is higher than the desirable level after 8 hours without food or drink.
  • Postprandial hyperglycemia is when the blood sugar is higher than 180 mg/dl 1-2 hours after eating a meal.

Both types of hyperglycemia may indicate the need to adjust your treatment plan. If you notice high blood sugars at the same time of day for 3 days in a row, this I considered a “pattern”. If you recognize a pattern, contact your doctor or dietitian for suggestions.  Tracking your blood sugar allows early recognition of possible patterns and is an important way to self-manage and start problem solving.

What causes hyperglycemia?

Hyperglycemia happens either when your body does not have enough insulin, or when your body is not using insulin correctly. There are a variety of things that can lead to this, including:

  • Inadequate insulin dosing

Individuals on insulin may be prescribed basal and/or bolus doses. Bolus doses are given for 2 reasons: 

  1. To cover carbohydrates intake for meals and snacks
  2. To correct high blood sugar

Basal doses are given to act as a “background” dose working over a 24-hour time frame. If either of these doses are too low, high blood sugar can occur. Expired or improperly stored medication may also cause hyperglycemia as these medications will not work as effectively.

  • Insulin resistance

Individuals with Type II Diabetes experience insulin resistance. Even though the body still produces insulin, the body’s cells may not recognize the insulin as effectively. When this happens, excess insulin remains in the bloodstream but does not bring glucose into the cells. This means that the glucose stays in the blood, causing high blood sugar.

  • Eating more than planned

Individuals with type I diabetes or those who dose insulin based on carbohydrate intake may, occasionally, underestimate their intake. When a person plans to eat 60 grams of carbohydrates but actually eats 90 grams, he/she will not have given enough insulin to cover the meal, leading to high blood sugar.

Since exercise lowers the blood sugar, most individuals decrease their insulin doses to avoid hypoglycemia when they anticipate that they will be active. If someone has decreased their insulin dose for exercise but then does not do the activity, it can cause high blood sugar.

  • Illness (cold, flu, etc.) or stress

Stress triggers a variety of hormone responses in the body. Generally, when the body senses stress, it wants to ensure that you have the energy needed for “fight or flight”. Sugar is the body’s preferred energy source, so the hormones work to make energy (sugar) more available. This is one reason why you may find that your blood sugar is elevated when you are sick or stressed.

  • Certain Medications

In some cases, medications may cause hyperglycemia. Glucocorticoids have been seen to cause high blood sugar. While the mechanism is not certain, it is likely that steroids impair the body’s ability to release insulin and may cause increased insulin resistance. This hyperglycemia usually resolves once you stop taking the steroid.

Food symbols inside a drop of blood

Symptoms of hyperglycemia

The symptoms of hyperglycemia are generic and difficult to pinpoint. Each person is different so one person may experience all symptoms while another may only recognize 1 or 2.  Most symptoms do not occur until the blood sugar is above 200 mg/dl, but depending on your personal control, this may vary. If you are accustomed to blood sugars around 70-100 mg/dl, you may recognize symptoms sooner than someone who’s blood sugar is usually 180-200 mg/dl or higher. Symptoms may include, but are not limited to:

The body may signal the need for more water to dilute and flush excess glucose.

  • Polyuria: excessive urination

With increased thirst and drinking comes increased urination. The body does this to encourage glucose release via the urine.

Even though the blood sugar is high, if there is not enough insulin to bring this sugar into the cells, the cells signal to the body that they want more energy. This promotes the release of hormones that trigger hunger.

  • Dry mouth or skin

Increased urination can lead to dehydration.

  • Fatigue

Extra sugar in the blood indicates unused energy. If there is not enough insulin to pull glucose into the cells, the cells become tired which can make you feel fatigued.

  • Blurred vision

High blood sugar can cause swelling and possible changes in shape of the lens in your eyes. This makes it hard to focus and things may look fuzzy.

High blood sugar stiffens the arteries and constricts blood vessels, which decrease blood flow. This limits oxygen and nutrient delivery to wounds and slows the healing process.

  • Frequent infections

Hyperglycemia alters the effectiveness of immune cells, which increases infection risk. Decrease blood flow also limits the number of white blood cells available to fight infections.

  • Frequent Headaches
  • Unexplained weight loss

This usually happens in individuals with type I diabetes if there is absolutely no insulin in the blood stream. When there is no insulin, glucose cannot enter our cells. When organs recognize that they do not have glucose, they send out signals begging for energy. In this situation, the body begins to breakdown fat for energy, which can lead to rapid weight loss.  This may sound desirable (who doesn’t want to burn fat for energy?!), but it is very dangerous situation that may indicate an emergency situation is coming. Since most people with type II diabetes still produce insulin, weight loss is not common with hyperglycemia because there is still some glucose available to the cells.

One of the most important parts of managing diabetes is monitoring your blood sugar levels.  Next time you check your blood sugar and notice that it is elevated, take note of anything that might feel a little different in your body. Since the common symptoms of hyperglycemia are hard to recognize, it is important to keep track of your personal “red flags”.

Complications of hyperglycemia

Most of the complications of hyperglycemia are related to more long-term, prolonged high blood sugar, but there are 2 situations that are considered emergencies.

  • Diabetic Ketoacidosis (DKA): This is usually only seen in individuals with type I diabetes when there is no insulin available. If there is no insulin, glucose cannot be used. If the body thinks there is no glucose, it breaks down fat for energy. This leads to the production of ketones. When ketones build up in the blood, the pH of the blood decreases, making it more acidic and life threatening.  Eventually, ketones spill into the urine. Signs and symptoms of DKA are:
  1. Blood sugar greater than 250 mg/dl
  2. pH less than 7.3
  3. Large ketones in the urine
  4. Nausea and vomiting
  5. “Fruity” smelling breath
  6. Labored breathing
  7. Lethargy or complete loss of consciousness
  • Hyperglycemia hyperosmolar syndrome (HHS): This is more common in individuals with type II diabetes who still produce some insulin. In this situation, there is enough insulin to prevent the breakdown of fat for energy, but not enough to maintain normal blood sugar levels.  Many people who experience HHS have not, yet, been diagnosed with diabetes. Signs and symptoms include:
  1. Blood sugar usually greater than 600 mg/dl
  2. pH greater than or equal to 7.3 (no acidosis)
  3. No ketones in the urine
  4. Signs of dehydration: loss of skin turgor, dry skin and chapped lips, tachycardia, low blood pressure
  5. Progressive loss of consciousness (can happen over days to weeks)
  6. Altered sensorium: difficulty concentrating

If not treated, both emergent complications can lead to coma and possibly death, but early detection and quick treatment make this very rare.

Most of us hear more about the complications related to prolonged untreated hyperglycemia, which are much more common. These include:

  • Neuropathy: damage to the nerves, causing weakness, numbness, and/or pain
  • Retinopathy: damage to the retina in the eye (usually due to decreased blood flow) that can lead to visual impairment
  • Nephropathy: progressive kidney disease related to decreased blood flow to the kidneys
  • Heart Disease: damage to blood vessels can lead to decreased blood flow to the heart and brain and may increase risk for CHF and a variety of other heart conditions.

All complications, both immediate and long-term, can be treated but early detection is the best way to lower the risk of all of the possible complications.

How to treat hyperglycemia

Just as there are immediate complications of hyperglycemia and long-term complications of hyperglycemia, there are also immediate and long-term treatment recommendations.

If you or someone you know are showing signs of either DKA or HHS, emergency treatment is required either via the emergency room or admission into the hospital.

Most instances of hyperglycemia are not emergent, though and can be treated at home in a variety of ways.

  • Fast-acting insulin: Individuals with type I diabetes and those with type II diabetes on sliding scale insulin can use a bolus of fast-acting insulin to correct hyperglycemia.  Insulin injection is the only way to immediately treat high blood sugar. You should start to see the blood sugar drop within about one hour, but you will not see the full effect for about 3-4 hours after injection. If your blood sugar does not start to come down after 3 hours, consider checking your insulin vile to make sure that it has not passed the expiration date or that there is nothing floating in the bottle that might have contaminated the medication. Contact your doctor if there’s  no improvement in blood sugar.  Oral medications work in a variety of ways, but none of them are used to treat high blood sugar in the moment.

If you notice a pattern of hyperglycemia, there are a variety of lifestyle changes that you can make to improve your overall control. Making these changes will help decrease the risk of the long-term complications of hyperglycemia. Consider changes you might be able to make in the following:

  • Physical activity: regular physical activity (150 minutes per week) decreases blood sugar but should be avoided if ketones are present.
  • Dietary modifications: Limiting sugary beverages and maintaining consistent carbohydrate intake throughout the day helps stabilize blood sugar.
  • Medications: take medications as prescribed, track your glucose levels, and follow up with your medical team to determine if changes need to be made to your medication doses or regimen.

A diagnosis of diabetes can be overwhelming and it can be difficult to know where to start.  Take things one step at a time. Set SMART goals and check in with your progress frequently. Treating hyperglycemia is just one part of managing diabetes.

How to avoid hyperglycemia

One high blood sugar reading does not indicate failure. People with diabetes should expect that their blood sugar will fluctuate. Rather than viewing an episode of hyperglycemia as something bad, looking at it as a learning experience may give us some benefit for the future. What caused the episode?  Did I eat something different? Did I move more or less than usual?  Was I ill or stressed?  Taking the time to problem solve to avoid these situations in the future is one way to take control of your health.

The main goal of managing diabetes is to maintain a blood sugar as close to normal as possible. Recommendations for avoiding hyperglycemia are the same as the general recommendations for treating diabetes:

It is important to do whatever you can to prevent, detect, and treat hyperglycemia.  Regular follow up with your physician, and a dietitian are the best ways to stay ahead of the disease. Since diabetes is a progressive condition, maintaining a blood sugar within the recommended range allows us to prevent or slow the progression of complications of hyperglycemia. If you are suffering from one or more complications of high blood sugar, there is help! 

Dietitians at Home has a staff of Registered Dietitians who will come to your home. Our dietitians will support you in achieving your healthy lifestyle goals.


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