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.

Many variables, some of which are described here, can upset the delicate balance that is necessary for the best diabetes control. When dealing with diabetes, you will inevitably experience some if not all of the following issues.

Food
If you eat more food than is balanced with your physical activity and, in some cases, diabetes medicines, your blood glucose level may rise above your goal range. Carbohydrate-containing foods directly affect your blood glucose level after eating, so reviewing the amount of carbohydrate in your meals and snacks may be helpful in determining the cause of hyperglycemia. Carefully reading nutrition labels on food products and measuring portions will help you to meet your carbohydrate goals. On packaged foods, the total carbohydrate per serving is listed on the Nutrition Facts panel of the label. Meals that are high in fat may contribute to prolonged elevations in blood glucose after eating. Working with a registered dietitian, preferably one with experience in diabetes management, can be helpful in fine-tuning your meal-planning and carbohydrate-counting skills.

If you experience hyperglycemia in spite of sticking to your meal plan most of the time, it may indicate that the medicines included in your diabetes regimen need adjusting. If this is the case, undereating will not help lower your blood glucose level; you should consult your physician.

Exercise
Exercise usually lowers blood glucose levels because it improves your cells’ sensitivity to insulin and helps cells burn glucose for energy. But if your blood glucose level is high before you exercise, it may go higher during exercise. When you begin exercising, your liver pumps out extra glucose to fuel your muscles. If your body has too little insulin circulating in the bloodstream to allow the cells to use the extra glucose, your blood glucose level will rise. High blood glucose levels with exercise can also be a sign that you are working too hard and your body is under stress. If this is the case, you need to slow down and gradually work up to a more strenuous level of activity.

For people with Type 1 diabetes, the ADA advises avoiding exercise if fasting blood glucose levels are above 250 mg/dl and ketones are present in blood or urine; caution should be used if blood glucose levels are above 300 mg/dl and no ketones are present. People with Type 2 diabetes may wish to consult their diabetes care team for individual recommendations.

Medication
Insulin and diabetes pills are taken to lower blood glucose levels, so forgetting a dose, taking the wrong dose, or taking the right dose at the wrong time can contribute to hyperglycemia. If you develop hyperglycemia, here are some questions you may want to ask yourself regarding your medicine(s):

• Did you take the proper dose? Double-check to make sure your dose was accurate. Sometimes different doses of the same oral diabetes medicine or insulin are prescribed at different times of day. Did the correct dose coincide with the correct time?
• Could you have forgotten to take your medicine? It is only human to forget things from time to time, even parts of your daily routine. If you think you may have forgotten to take your medicine, ask yourself if you specifically remember taking it. Can you backtrack to determine if you took it? If you seem to forget to take your medicine regularly, look for patterns: Are you having difficulty remembering a certain dose? If so, you may want to brainstorm some ways to remember it, such as setting an alarm for dose time or posting a note to yourself in a place you can’t miss. Insulin pumps generally have a review screen that allows you to see whether doses have been delivered.
• Has the medicine expired? Check the expiration date on your medicine to see if it is still good. Most pills have a long shelf life, but insulin does not. In addition, the expiration date on the insulin packaging is for unopened, refrigerated vials, disposable pens, or pen cartridges. Once opened, most vials of insulin last for 28 days, but many pens and pen cartridges are good for only 7, 10, or 14 days. Pump users should change their infusion set and the insulin in the pump reservoir every two to three days. These limits should be noted in the insulin package insert. If you’re not sure how long your opened container of insulin will last, ask a member of your diabetes care team or your pharmacist or call the manufacturer’s customer service number.
• Is your technique for taking your medicine adequate? If you take pills, be sure you’re taking them at the right time of day. Some pills must be taken right before meals to work effectively; others do not. If you take insulin by pen or syringe, review your injection technique with your diabetes care team. You should be aware that if you switch to a different syringe or insulin pen or from one to the other, the injection technique may differ.
• Are you storing your medicine properly? Insulin, as well as oral medicines, can lose potency if exposed to heat, cold, or moisture. Your best bet is usually to store opened containers of medicines you are currently using at room temperature. Unopened pills can also be stored at room temperature. Insulin that has not been opened should be stored in the refrigerator. Be careful not to place insulin in the particularly cold areas of the refrigerator—typically the meat compartment and at the backs of the main shelves—where it may freeze.
• Is your insulin being delivered adequately? If you use an insulin syringe or insulin pen, do you always use the same size needle? Some people find that a change in the needle length can disrupt their control. If you use an insulin pump, review the set-up of your infusion set with your diabetes care team to assure accurate insulin delivery. If you order pump supplies by mail, double-check your order when it arrives to make sure you received the correct supplies. Using a different size catheter or a different tubing length than usual may change the amount of priming necessary. (All pump users should have alternative methods of insulin delivery on hand should their pump malfunction or stop delivering insulin for any reason.) In addition, check your injection or infusion sites periodically. If toughening or scarring of the skin is present, this may affect absorption of your insulin.
• If you use an insulin pump, is the battery power sufficient? Avoid going to sleep at night or becoming preoccupied with other things when your battery is low. Be attentive to low battery warning alarms, and change your batteries promptly when they sound. Don’t wait until you’ve used the last drop of energy in your battery.
• Are you taking any other medicines that could affect your blood glucose level? Certain types of drugs—including prescription drugs, over-the-counter drugs, and herbal preparations—may contribute to hyperglycemia. Common prescription drugs that have a tendency to increase blood glucose levels include corticosteroids (used to treat inflammation) and thiazide diuretics (used to treat high blood pressure).

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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