Updated April 02, 2007

Managing Hyperglycemia

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Belinda O'Connell, M.S., R.D., C.D.E.

DCCT. The DCCT followed 1,441 people with Type 1 diabetes for an average of about seven years. The subjects were divided into two groups: the “conventional” treatment group, and the “intensive” treatment group. While the group that was treated intensively did not achieve normal, nondiabetic blood glucose levels, they were able to achieve an average blood glucose level of 155 mg/dl. The conventionally treated group’s blood glucose level averaged 231 mg/dl. During the study period, the intensively treated group had an approximate 60% reduction of risk for neuropathy, nephropathy, and retinopathy. Intensive therapy not only delayed the onset of complications but it also slowed the progression of complications in those who already had them, regardless of age, sex, or duration of diabetes.

UKPDS. The UKPDS examined the effects of varying levels of blood glucose control in 5,102 individuals with Type 2 diabetes, who were followed for an average of 10 years. The intensively treated group achieved an average blood glucose level of 150 mg/dl, while the conventionally treated group’s average blood glucose levels were approximately 177 mg/dl. In this study, intensive blood glucose control resulted in a 25% reduction of risk for neuropathy, nephropathy, and retinopathy. Furthermore, the study concluded that for every percentage drop in glycosylated hemoglobin (HbA1c, a measure of long-term blood glucose control), there was a 35% reduction in the risk of complications.

As these studies make clear, it is worth the effort to take steps to control your blood glucose, but how do you do that? And how do you know if you have hyperglycemia in the first place?

Identifying hyperglycemia
The best way to identify hyperglycemia is to routinely monitor your blood glucose levels on a schedule determined by you and your health-care team and to get regular HbA1c tests, also on a schedule agreed on by you and your health-care team (usually two to four times a year). That’s because hyperglycemia may not cause any symptoms until blood glucose levels are much higher than recommended ranges. So just because you feel OK doesn’t necessarily mean your blood glucose level is well controlled.

When they do occur, symptoms of hyperglycemia may include frequent urination, hunger, dry mouth, thirst, blurred vision, numbness or tingling in the hands and feet, decreased sexual function, and fatigue. All of these symptoms should prompt immediate action, starting with checking your blood glucose level with your meter to see if it’s high. What you do next will depend in large part on how you normally treat your diabetes.

Because regimens for treating diabetes vary widely, there is no “one size fits all” plan for treating hyperglycemia. If you currently treat your Type 2 diabetes with meal planning and exercise, for example, you may be instructed to add several minutes to your usual exercise routine or to decrease your carbohydrate intake at your next meal when your blood glucose level is high. If you have Type 1 diabetes and use an insulin pump, you may be instructed to take more insulin (possibly via syringe or insulin pen), and your diabetes care team will teach you how to determine how much insulin to take based on your blood glucose level. It’s extremely important to work with your diabetes care team to develop an individualized hyperglycemia action plan for you.

No matter what type of diabetes you have or how you treat it, part of your hyperglycemia action plan will likely be more frequent blood glucose monitoring, at least temporarily, to help determine why your blood glucose is high and what you can do to avoid future episodes of hyperglycemia. Indeed, prevention is the best and most effective way to treat hyperglycemia.

Laura Hieronymus is the program coordinator/nurse educator at Drs. Borders & Associates, PSC, an American Diabetes Association–recognized education service in Lexington, Kentucky. Belinda O’Connell is a Diabetes Nutrition Specialist in the Minneapolis, Minnesota, area and a freelance health and science writer.

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