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.

Other causes
Some people with diabetes allow their blood glucose levels to run higher than recommended because they are afraid of developing hypoglycemia (low blood glucose). This fear is certainly normal, since hypoglycemia can cause a person to lose bodily control, but a better response to this fear is to learn to prevent episodes of hypoglycemia while keeping your blood glucose levels in the best possible control. If fear is causing you to let your blood glucose level run high, talk with your diabetes care team to work out a plan that will help you avoid both lows and highs.

Another potential cause of hyperglycemia is the intentional or deliberate omission of insulin doses. This behavior is often linked to the presence of an eating disorder. Omitting needed insulin allows blood glucose levels to run high enough to cause the body to eliminate glucose through the urine and therefore decrease calorie absorption. This practice can enable a person to control his weight and, over time, to lose weight, which may be the desired result. However, repeated omission of insulin can lead to diabetes complications, worsen existing complications, and even lead to coma and death. If you or someone you know is intentionally omitting insulin doses as a means of weight control, it is urgent that you seek help from your diabetes care team or a qualified mental health professional. Eating disorders can be treated; left untreated, they can cause devastating health consequences.

Severe hyperglycemia
Managing hyperglycemia is important both to avoid long-term complications and to avoid the acute hyperglycemic states known as ketoacidosis and hyperosmolar hyperglycemia. These disorders can occur in people with Type 1 diabetes as well as those with Type 2 diabetes, although the risk of ketoacidosis is higher among people with Type 1 and the risk of hyperosmolar hyperglycemia is higher among elderly people with Type 2.

Ketoacidosis is characterized by high blood glucose levels (over 250 mg/dl), the presence of ketones in the blood or urine, and dehydration. In hyperosmolar hyperglycemia, blood glucose levels are typically extremely high (over 600 mg/dl), and small amounts of ketones may be detectable in blood or urine. Emergency care in the hospital may be needed to reverse ketoacidosis or hyperosmolar hyperglycemia.

Infection, which, as noted earlier, causes the release of stress hormones, is the most common precipitating factor in the development of both problems. An interruption in insulin delivery from a pump or taking inadequate amounts of insulin by pen or syringe is also a common underlying factor in the development of ketoacidosis. Other factors that may lead to acute hyperglycemia are stroke, alcohol abuse, pancreatitis, heart attack, trauma, and certain drug therapies.

Preventing episodes of severe hyperglycemia involves knowing the causes and symptoms of hyperglycemia, monitoring blood glucose levels often enough to catch hyperglycemia in its early stages, and having a plan to deal with hyperglycemia should it occur. The fact that infection is what commonly leads to ketoacidosis and hyperosmolar hyperglycemia underscores the importance of discussing sick-day management with your diabetes care team before you become sick.

Staying in check
The only way you can truly know your blood glucose level is to check it with your meter. You should discuss when and how often to monitor with your diabetes care team. A diabetes educator can help you determine the type of equipment that is best for you, as well as make sure you are familiar with how the equipment works. More important, with your doctor’s help, your diabetes educator can help you learn to self-manage your diabetes by working through the challenges of managing 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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