Hyperglycemia

What is Hyperglycemia?

Hyperglycemia is a condition that occurs when there is too much sugar, or glucose, in the blood. This condition, also known as high blood sugar, happens when there is too little insulin hormone in the body or when the body does not use insulin properly.

Hyperglycemia commonly affects diabetes patients. There are several reasons for hyperglycemia in diabetes patients including diet and physical activity, illness, and non-diabetes related medication usage. Additionally, skipping doses or not taking enough insulin or other medication to reduce blood sugar can also lead to hyperglycemia.

Treating hyperglycemia is extremely important. If not treated, it can lead to a serious clinical condition requiring emergency care, including coma. Even without severe hyperglycemia, it can lead to health problems affecting the eyes, kidneys, nerves, and heart.

Causes of Hyperglycemia

Hyperglycemia is commonly caused by a lack of insulin. This condition can result from insulin resistance and/or issues with the pancreas, the organ that produces insulin. Other hormones can also contribute to the development of hyperglycemia. For example, excessive cortisol or growth hormone can lead to high blood sugar.

Insulin Resistance

The most common cause of hyperglycemia is insulin resistance, also known as impaired insulin sensitivity. It occurs when the cells in muscles, fats, and the liver do not respond properly to insulin.

When cells do not respond properly to insulin, the body needs increasingly more insulin to regulate blood sugar levels. Hyperglycemia results if the body does not produce enough insulin or if sufficient insulin is not injected.

Insulin resistance is the main cause of type 2 diabetes. However, individuals who are not diabetic, including those with other types of diabetes, can also experience this. It can appear temporarily or chronically. Common causes of insulin resistance include the following.

• Obesity
• Physical inactivity
• A diet consisting of processed, high-carbohydrate foods and saturated fats
• Corticosteroids
• Certain blood pressure medications
• Some HIV treatments
• Some psychiatric medications

Additionally, some hormones can also contribute to the development of insulin resistance, including:

• Excess cortisol
• Excess hormones
• Pregnancy

Insulin resistance can also be related to certain hereditary genetic conditions, which include:

• Rabson-Mendenhall syndrome
• Donohue syndrome
• Myotonic dystrophy
• Werner syndrome
• Alström syndrome

Pancreatic Problems

Damage to the pancreas, whatever the cause, can lead to a deficiency in insulin production. Pancreatic diseases that can cause hypoglycemia and diabetes include:

• Autoimmune disease
• Chronic pancreatitis
• Pancreatic cancer
• Cystic fibrosis

Transient Causes of Hyperglycemia

These situations can cause a temporary increase in blood sugar levels leading to hyperglycemia in both diabetics and non-diabetics. They include physical stress such as illness, surgery, and injury. Acute emotional stress such as trauma or work-related stress can also raise blood sugar levels due to the body's secretion of cortisol and/or epinephrine.

Causes of Hyperglycemia in Diabetics

Several factors contribute to the development of hyperglycemia in diabetic patients, including an imbalance of food and diabetes medications. Common situations that can cause hyperglycemia in diabetics include:

• Not taking enough insulin, injecting insulin incorrectly, using expired insulin, or problems with the injection
• Timing insulin and carbohydrate intake correctly
• Balancing the amount of carbohydrates consumed with the amount of insulin produced by the body or injected
• Taking an oral diabetes medication dose that is too low for your needs
• Being less physically active than usual

Symptoms of Hyperglycemia

Early symptoms of hyperglycemia include:

• Increased thirst or hunger
• Frequent urination
• Headache
• Blurred vision

Long-term symptoms of hyperglycemia include:

• Fatigue
• Weight loss
• Vaginal yeast infections
• Skin infections
• Slow healing cuts and wounds

The glucose level at which diabetic patients start experiencing symptoms varies. Many people do not experience symptoms until their blood sugar reaches 250 mg/dL or higher. Individuals not yet diagnosed with diabetes often experience these symptoms at lower levels.

Especially knowing the early signs of hyperglycemia and regularly monitoring blood sugar if using insulin or other medications for diabetes is important. If untreated, hyperglycemia can turn into diabetic ketoacidosis due to a lack of insulin or a high amount of ketones in the blood, turning acidic. It can also affect undiagnosed type 1 diabetes patients. This condition can lead to coma or death if not urgently treated.

Symptoms of ketoacidosis include:

• Nausea and vomiting
• Dehydration
• Abdominal pain
• Smelling like fruit
• Deep, labored breathing or hyperventilation
• Rapid heartbeat
• Confusion
• Disorientation
• Loss of consciousness

Diagnostic Criteria for Hyperglycemia

To diagnose hyperglycemia, a healthy sugar range is established for the patient. A blood test measured as fasting sugar can be used to diagnose hyperglycemia. Generally accepted normal blood sugar levels are as follows:

• For individuals under 59 without any disease, between 80 to 120 milligrams per deciliter
• For individuals aged 60 and above with other conditions such as heart, lung, or kidney disease, who have a history of low blood sugar, or who have difficulty recognizing the symptoms of hypoglycemia, between 100 to 140 milligrams per deciliter

For diabetic patients, the generally targeted blood sugar levels are between 80 to 130 mg/dl before meals, and less than 180 mg/dl two hours after meals.

Home Blood Sugar Testing

Routine monitoring of blood sugar with a glucometer is extremely important for diabetic patients. This allows for keeping blood sugar levels within the normal range. Individuals experiencing serious hyperglycemia symptoms should measure their blood sugar immediately.

If the blood sugar level is 240 mg/dl or higher, it is advisable to use an over-the-counter urine ketone test kit. A positive test could indicate the onset of diabetic ketoacidosis.

Hemoglobin A1C Test

This test helps to understand the average blood sugar level of patients over the past 2-3 months. It works by measuring the percentage of blood sugar attached to hemoglobin, the protein in red blood cells responsible for carrying oxygen.

An A1C level of 7% or lower is an indicator that the treatment is working effectively. If the level is higher, it may be necessary to adjust the treatment plan.

In some individuals, especially the elderly and those with different health issues, an A1C level of 8% or higher may be considered normal.

Treatment Methods for Hyperglycemia

There are several methods available for maintaining blood sugar levels within the normal range at home. Different treatment methods help keep blood sugar within the targeted range.

Being Physically Active

Regular physical exercise is one of the best solutions for keeping blood sugar under control. However, exercise should not be performed if ketones are present in the urine as this can potentially raise blood sugar levels further.

Regular Medication Use

In individuals frequently experiencing hyperglycemia, medication doses need to be adjusted. Additionally, patients should take their medications as prescribed by their doctors in terms of timing and dosage.

Following a Dietary Plan

Another important aspect for diabetic patients is to adhere to their dietary plans. Eating small portions frequently helps keep patients away from sugary foods and snacks.

Monitoring Blood Sugar

Blood sugar measurements should be made regularly as directed by a doctor. It is important for individuals who frequently experience hyperglycemia to have more frequent checks.

Adjusting Insulin Doses

Making changes to the insulin regimen or adding short-acting insulin can help manage hyperglycemia. Patients with high blood sugar should discuss this issue with their doctors.

Emergency Treatment Methods for Severe Hyperglycemia

In the event of diabetic ketoacidosis or severe hyperosmolar hyperglycemia, patients should seek emergency medical care. The treatment options in emergency care include:

Fluid Replacement

This involves the intravenous administration of fluids to replenish those needed by the body, replacing fluids lost through urination. This also helps dilute the excess sugar in the blood.

Electrolyte Replacement

Electrolytes are minerals necessary for the proper functioning of tissues. A lack of insulin can reduce mineral levels in the blood, which may hinder the proper functioning of the heart, muscles, and nerve cells. Therefore, electrolyte supplementation is given intravenously during emergency interventions.

Insulin Therapy

Insulin therapy can reverse the process of ketone accumulation in the blood. It is generally administered intravenously along with fluids and electrolytes.

Hyperglycemia and Nutrition

People with hyperglycemia need to be mindful of how much they consume of each food type to prevent sudden spikes in blood sugar. It is recommended that they work with their doctors or dietitians. Here are some points patients can focus on:

Low Glycemic Index Foods and Carbohydrate Intake

The glycemic index (GI) ranks foods based on how they affect blood sugar levels after consumption. Therefore, it is possible to assess foods based on their digestion rate. The faster a food is digested, the higher its GI value.

For individuals with hyperglycemia, monitoring their carbohydrate intake is important because carbohydrates raise blood sugar levels. The digestive system quickly breaks down carbohydrates, releasing sugar into the bloodstream.

By keeping this in mind, choosing foods with a low GI value can help prevent fluctuations in blood sugar. Maintaining blood sugar levels by consuming an equal amount of carbohydrates at each meal makes it easier for patients to track their carbohydrate intake. Additionally, consuming carbohydrates with protein and fats can help slow the rise in blood sugar.

Foods with a low GI value are represented by a GI of 55 or less. It is also recommended that daily carbohydrate intake generally remain below 130 grams.

Water Consumption

Water is not only vital for general health but is also the best drink choice for individuals with hyperglycemia. Other water-based beverages can provide hydration, but water is preferred due to the goal of minimizing sugar intake.

Additionally, adequate water consumption helps prevent and manage hyperglycemia. Studies have shown that people who consume less water daily are more likely to experience frequent episodes of hyperglycemia.

Soluble Fiber and Legumes

Adding soluble fiber to the diet can reduce the risk of developing diabetes and may also help lower the glycemic index (GI). Additionally, consuming fiber-rich foods significantly reduces fasting blood sugar and triglyceride levels.

Because the digestion of fiber-rich foods takes longer, it can help individuals feel full for extended periods. This, in turn, helps reduce the amount of food consumed throughout the day, aiding in maintaining more stable blood sugar levels.

Oats, containing beta-glucan, help reduce glucose and insulin responses and also support heart health. Here are some fiber-rich foods:

• Oat bran
• Oatmeal
• Barley
• Broccoli
• Citrus fruits
• Legumes

Legumes are an important source of soluble fiber and also aid in reducing hyperglycemia and managing glycemic index. Legumes with the lowest GI include:

• Beans
• Chickpeas
• Lentils

The recommended daily fiber intake is 25 grams for adult women and 38 grams for adult men.

Fish

Fish is another glycemic-friendly food that diabetic patients should include in their diet. Research shows that consuming 75-100 grams of fish daily without any side effects has a positive impact on Type 2 diabetes. It is important to ensure that the fish consumed is low in fat. However, there is insufficient evidence that fish consumption prevents Type 2 diabetes.

Certain Dairy Types

Most dairy products have a low GI level. Studies have shown that both low and high-fat dairy products do not have a negative effect on Type 2 diabetes. Regular consumption of unsweetened and unflavored yogurt can also reduce the risk of Type 2 diabetes.

Garlic

Garlic is highly effective in managing hyperglycemia, among many other benefits. Studies show that garlic can lower glycemic and lipid levels.

How to Reduce Hyperglycemia?

Important considerations for lowering and maintaining blood sugar levels include:

• Managing carbohydrate intake
• Regular exercise
• Consuming plenty of water
• Sufficient and quality sleep
• Increasing intake of fibrous foods
• Consuming foods rich in probiotics
• Eating low glycemic index foods
• Portion control
• Managing stress
• Maintaining an ideal weight
• Eating foods rich in magnesium and chromium
• Choosing healthy snacks

Risk Factors for Hyperglycemia

There are several risk factors that play a role in the development of hyperglycemia. These risk factors include:

• Not using enough insulin or diabetes medication
• Not following a diabetic diet plan
• Being inactive
• Illness or infection
• Use of steroids or other immunosuppressive drugs
• Injury
• Undergoing surgery
• Stress

Complications of Hyperglycemia

Complications from hyperglycemia can emerge both quickly and over time. The complications associated with hyperglycemia include:

Long-Term Complications

Keeping blood sugar levels within a healthy range can help prevent complications related to diabetes. Long-term complications from untreated hyperglycemia include:

• Cardiovascular disease
• Nerve damage
• Kidney damage
• Kidney failure
• Blindness due to damage to the blood vessels of the retina
• Skin infections, ulcers, and the potential for amputation due to damaged nerves and poor blood flow
• Bone issues
• Joint disorders
• Dental and gum infections

Short-Term Complications

Extremely high blood sugar levels, if left untreated, can lead to two emergency conditions. The first is diabetic ketoacidosis. High blood sugar occurs because there isn't enough insulin in the blood. As a result, sugar cannot enter cells and provide them with the necessary energy. The body then starts to break down fats for energy, which leads to the production of toxic substances known as ketones. If not treated, this can lead to coma.

Another short-term complication of hyperglycemia is hyperosmolar hyperglycemic state. In this condition, enough insulin is present but it does not function properly. As a result, sugar cannot enter cells, and there is no fat breakdown for energy. This leads to extremely high blood sugar levels above 600 mg/dl without the presence of ketones. Subsequently, sugar passes into the urine, increasing urine output. If not treated, it can lead to life-threatening dehydration and coma.