Diabetes Self-Management Articles

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Managing Hyperglycemia

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and Belinda O'Connell, MS, RD, CDE

During periods of stress, the body releases so-called stress hormones, which cause a rise in blood glucose level. In the short term, this gives the body the extra energy it needs to cope with the stress. But if a person doesn’t have adequate insulin circulating in his bloodstream to enable his cells to use the extra energy, the result will be hyperglycemia. And if stress becomes chronic, hyperglycemia can also become chronic. Stress hormones may be released during physical, mental, and emotional stresses.

Physical stress. Injury, illness, infection, and surgery are some examples of physical stresses that often cause hyperglycemia. In fact, hyperglycemia may be a clue that an otherwise symptomless infection is present. Resolving hyperglycemia caused by physical stress generally involves both treating the underlying cause and treating the hyperglycemia itself with changes to the usual diabetes treatment regimen.

Because everyone can expect to be ill at some point, people with diabetes are encouraged to work out a sick-day plan in advance with their diabetes care team. Your sick-day plan should have specifics on what to eat and drink when you’re sick, over-the-counter products that are safe to use, as well as details on taking your usual medicines and adding supplemental insulin if needed. It should also indicate when to call your health-care provider.

Mental and emotional stresses. Psychological stresses such as difficulties with relationships, job pressures, financial strain, and even concerns about self-worth can contribute to hyperglycemia. If these issues become overwhelming, decreased attention to the diabetes treatment plan may also contribute to hyperglycemia. Learning stress-reduction techniques may help over the long term, and your diabetes care team may be able to help you identify other resources that can help you deal with feelings of overwhelming stress.

Hormones other than stress hormones can affect blood glucose levels, as well. Premenopausal women may experience higher-than-usual blood glucose levels about a week prior to menstruation, when levels of progesterone, estrogen, and other hormones involved in ovulation are changing. In addition, some women find that they have a tendency to eat more during this phase of the menstrual cycle, which may further increase blood glucose levels. It can be useful to track your menstrual cycle along with your blood glucose levels to determine whether your cycle is affecting your blood glucose levels and to learn to make adjustments to your diabetes regimen when needed.

During perimenopause, which can last for several years before the complete cessation of menstruation, the menstrual cycle becomes less and less consistent. This can upset the balance of blood glucose control due to the unpredictability of hormonal levels.

Pregnancy hormones also affect blood glucose control. In fact, insulin adjustments are often necessary every 7–10 days during pregnancy, especially during the second and third trimesters, to adjust for changes in hormone levels as well as for the weight increases that come with pregnancy. Because hyperglycemia can contribute to a number of complications during pregnancy, close monitoring of blood glucose control is essential during and ideally before pregnancy.

In men with diabetes, low testosterone levels may contribute to increased insulin resistance, which can contribute to hyperglycemia. However, while testosterone replacement therapy has become a topic of great interest among both consumers and medical professionals, few studies have examined the long-term effects of testosterone replacement. Men concerned about low testosterone should seek individual guidance from their doctors.

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.

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