Islets of Hope for persons newly diagnosed with diabetes

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Article by Lahle Wolfe. For reprint information e-mail: Editor@isletsofhope.com

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Hyperglycemia

Onset:  Over time; hours or days.

Causes:  Too little insulin, stress, dehydration, illness, exercise or inactivity, too much food, certain medications, or a combination of these things.

ALERT:  Untreated highs can lead to diabetic ketoacidiosis (DKA) which can result in coma and/or death.

Over time, high blood glucose damages nerves and organs and disrupt normal digestive system processes.


Links to Insulin Information

How Insulin Works in The Body

About Hyperglycemia

Normal Blood Glucose Ranges and Targets

Causes of Hyperglycemia
--  
Diabetes-Related
--  
Non-Diabetic
Causes of Hyperglycemia Related to Insulin Pump Use
Causes of Hyperglycemia Related to Shot Therapy
Hyperglycemia at Night
--  
High-Fat Meals
--  
Dawn Effect
--  
Simogyi Effect
More Information


think like a pancreas  Gary Scheiner, CDE
Think Like a Pancreas:
 Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas"--that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books.


Newly Diagnosed (easier reading) Problems & Complaints with Diabetes

Comprehensive Information on Diabetes Problems & Complaints


new glucose revolution for living well with pcos  Brand-Miller/Farid
New Glucose Revolution: Living Well With PCOS:   Dr. Brand-Miller --author of the NY Times bestseller The New Glucose Revolution, the authoritative guide to the glycemic index--along with Dr. Nadir Farid and Kate Marsh, address the root cause of PCOS--insulin resistance--and show you how eating a low-GI diet can help alleviate even your most troublesome symptoms, including: weight gain, excess facial hair, fatigue, irregular periods, infertility, low blood sugar, acne, mood swings.

Filled with indispensable advice on switching to the low-GI diet, incorporating exercise into your lifestyle, and preserving your overall health and well-being, as well as thirty delicious recipes, this book can help you beat your PCOS symptoms and take back control over your life


Hyperglycemia and Diabetes: Doing Your Part

Signs and symptoms of hypoglycemia can vary from person to person. Get to know your own signs and describe them to your friends and family so they will be able to help you. If your child has diabetes, tell school staff about hyperglycemia and how to treat it.

Always carry with you a copy of emergency medical instructions in case you ever become unconscious.


Important Medical Disclaimer

All information and material presented on the IOH's web site is intended for personal informational purposes only .  No one should attempt to self-diagnose, self-treat, or alter a medical care plan without first consulting their physician

Newly Diagnosed Diabetes Information
Information for the Newly Diagnosed with Diabetes

What is hyperglycemia (high blood sugar)?


Hyperglycemia is often referred to as either high blood glucose, or high blood sugar.

Mini Site Index
About is hyperglycemia?
Causes of hyperglycemia
Diabetes-related hyperglycemia
Causes of hyperglycemia related to insulin pump use
Causes of hyperglycemia related to insulin shot therapy
Hyperglycemia at night
Fat-Induced hyperglycemia
The Dawn Effect (or, Dawn Phenomenon)
Somogyi Effect (or, rebound hyperglycemia)
Treatment for hyperglycemia
Bad insulin?

Related Information
What are normal and target blood sugar ranges? (chart)

About diabetes-related hyperglycemia

Some hyperglycemia (elevated blood sugar) is inevitable with diabetes.  Short-term, moderately elevated levels of blood sugar (i.e., after meals) don't present a serious danger to a person with diabetes (the exception being if a diabetic enters into a state called diabetic ketoacidosis ([DKA]).  But over time, high blood sugar (also called, blood guar) levels destroy nerves and eventually damage organs and tissues throughout the body.  Once this damage is done, serious life-long problems can occur.  

Why worry about hyperglycemia on a daily basis?  Isn't diabetes bad enough without having to deal with organ failure, amputation, and blindness (just some of the consequences of complications due to poor daily management)?  Hyperglycemia is the underlying reason for most complications that occur with diabetes.  The better control of your diabetes that you have each day, will help you have better health down the road.


Symptoms of hyperglycemia (high blood sugar)

Symptoms vary from person-to-person, but the following are some of the more common symptoms of hyperglycemia:

  • Increased thirst and urination
  • Urine may contain ketones
  • Labored breathing
  • Fatigue
  • Increase in appetite, or decrease in appetite
  • Headache, stomachache
  • General aches and pain
  • Changes in behavior or temperament


Causes of diabetes-related hyperglycemia

  • Too little insulin either as a food or correction bolus, or basal(background)insulin
  • Poorly time insulin injection or pump bolus
  • Stress (even seeing and being attracted to someone can elevate blood sugar!)
  • Illness
  • Dehydration
  • Inactivity (being sedentary)
  • Too much food
  • High fat food meals
  • The Dawn Effect
  • The Somogyi Effect
  • High altitude
  • Insulin resistance or not rotating injection sites often enough
  • Exercising without sufficient water, insulin or snacks
  • Certain medications, including steroids, or
  • A combination of these things.  


Causes of hyperglycemia related to insulin pump use

If you are on an insulin pump, you will set basal insulin rates.  Basal (or background insulin) administered through a pump consists of small, frequent amounts of insulin automatically infused into the body via a canula, (flexible tube or needle-type) inserted under the skin.  If basal rates are set too low, hyperglycemia can occur.  If they are set too high, low blood sugar can result.  Basal rates can vary according to the time of day and even day of the week.  Women may require different basal rates during their pre-period days, and on active days, many pumpers reduce their basal rates to compensate for the increase in exercise.

Another reason for hyperglycemia on insulin pump therapy has to do with the site of the canula.  Some parts of the body are more sensitive to insulin that are other parts (i.e., a person may require less insulin when the site is placed on the thighs or buttocks than on the tummy area).  Using the same site repeatedly for canula insertion can damage tissue sensitivity and even cause scarring.  This will result in less absorption at the site and cause blood sugar to elevate.  It is important to change sites every 2-3 days and rotate the location of the needle.

Another cause of hyperglycemia with canula sets is when the canula "kinks" or becomes bent under the skin.  This does not occur with metal needle style canulas, but may occur with those made of flexible, soft plastic.  With both types of canulas (metal or flexible) the insertion can work loose so that it appears attached, but is not sufficiently under the skin and basal and bolus insulin leak outside the skin.

If you use an insulin pump, anytime your blood sugar levels are high two readings in a row, you should change out the site and take an injection of insulin to correct the high.  If this does not work, immediately call your doctor.

Your doctor can help you understand how to set basal rates, determine your insulin needs, and how to go on "mini-fasts" to test your basals.  For more information on insulin pumps and how to use them, see our "Diabetes Treatment" page.


Causes of hyperglycemia related to insulin shot therapy

Shots need to be timed.  Different types of insulin begin to work at different times, peak at different intervals, and last for varying durations.  Timing insulin and meals can be more challenging than rocket science, but, with the support and advice of your doctor and a diabetes-trained dietitian it can be done.

For those in conventional therapy (1-3 shots per day with minimal blood sugar testing of 4-5 times per day) you may be experiencing either high or low blood sugar levels throughout the day or night that can go undetected.  Be sure to have regular HbA1c tests done, the help determine if you are chronically above target range.

Persons on insulin pumps, or other intensive therapy (sometimes also called flexible therapy) are required to test their blood sugar levels more frequently.  Most persons on intensive therapy test 8-12 times per day and make adjustments via a correction bolus to bring down high blood sugar levels as soon as 2 hours after eating.

Other possibilities for hyperglycemia occurring while on shot therapy include:

  • Not getting all the insulin under the skin.  If any leaks out, hyperglycemia may result.
  • Not rotating injection sites (sites become desensitized to insulin over time).
  • Not making adjusts for using different sites (i.e., tummy injections, or other areas where there is more body fat may require more insulin than injecting into a muscle).

If you are experiencing hyperglycemia on shot therapy it is important that you speak with your doctor.  He/She can help determine if you need a different type of insulin, more insulin, or time it differently.  You should always talk with your doctor before making adjustments in your insulin dose.


Hyperglycemia at night

There are three main causes of hyperglycemia during the night:  

  • Eating too much fat at dinner, or before bedtime
  • The Dawn Effect
  • Somogyi Effect  

High-fat meal induced hyperglycemia

Eating a high-fat snack close to bedtime (for others, even having a high-fat dinner) can cause delayed hyperglycemia.  This means that blood sugar may appear in range shortly after eating, but elevate higher over time. Fat can also keep blood sugar levels elevated many hours after eating.  During the night, when you may not be checking your blood sugar as frequently your blood sugar can elevate and stayed raised due to a high-fat meal.

Many people mistake a high-fat meal that induces nighttime hypoglycemia for the Dawn Effect.  

The Dawn Effect (also called "Dawn Phenomenon")

The dawn effect is an increase in insulin resistance (decrease in insulin sensitivity) caused by hormones released about two hours before you wake. These hormones are under the control of the pituitary gland, and thus the brain. The dawn effect is influenced by testosterone and tends to be more significant in men.  It is highly variable from person to person.

Your overnight insulin is taken to counter the dawn effect, and on average, diabetics take 20% of their insulin overnight due to an increase in metabolic needs during the night.  Persons on insulin pumps often have increased basal rates after 3 a.m. for this reason.

It is a normal occurrence in all people to experience a slight rise in blood sugar levels before rising, but this phenomenon is more pronounced in persons who need to take insulin.  The dawn effect is also the most common cause of nighttime highs.  

The Somogyi Effect (also called "rebound" hyperglycemia

The Somogyi Effect occurs after an episode of hypoglycemia (low blood sugar).  It can occur after any low, but most commonly occurs after an undetected (untreated) low, or a low that was not treated fast enough.  When the brain detects low levels of blood sugar, it can trigger the liver to release the hormone glucagon which in turn causes the body to release stored energy called "glycogen."  This release often raises blood sugar levels too high.  

The best way to avoid rebound highs is to check your blood sugar often and promptly treat all episodes of hypoglycemia and hyperglycemia.


Treatment for hyperglycemia

Know your target range for blood sugar as set for you specifically by your doctor and follow the care plan he/she set up for you when you are experiencing hyperglycemia.  When your blood sugar is above range for 2 or 3 readings in a row call your doctor for additional instructions.

When your blood sugar is high:

  • Give an insulin correction bolus as indicated by your doctor
  • Test blood sugar frequently to make sure levels are coming down.
  • Anytime that blood sugar is over 240 mg/dL check urine for ketones.
  • Always call your doctor when ketones are in the moderate to heavy range.
  • Limit physical activity and avoid become overheated or dehydrated.
  • Drink plenty of water or other fluids that do not contain sugar.
  • High blood sugar can trigger an increase in appetite.  Avoid eating carbohydrates and fat until sugar return to a safe range. Nibble sugar-free Jello, fat-free broth, or have a small protein-only snack.

When is it safe to treat hyperglycemia according to my pre-determined diabetes care plan?

When your blood sugar is not in range and you are not spilling moderate to heavy ketones in your urine, it is generally safe to follow instructions in your diabetes care plan provided by your doctor.  The exception might be if you were also sick, dehydrated, or under some significant stress.

When is it not safe to treat hyperglycemia without calling the doctor?

When ketones are in the moderate to heavy range, it may be a sign of diabetic ketoacidosis (DKA).  Because DKA can lead to coma and death you should always contact your doctor immediately (even after office hours) whenever you are testing positive for moderate of higher ketones. Untreated, or, improperly treated, DKA can cause life-threatening complications. DKA should only be treated under the strict guidance of your physician or at the hospital.

Bad Insulin?

Insulin should be, but does not have to be, refrigerated.  Once you remove the cap and insert a needle into the vial stopper the insulin begins to degrade.  Even if the expiration date on the package is still good, you should discard all opened insulin that has been refrigerated after 30 days.  Opened, unrefrigerated insulin should be discarded after one week.

 

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Page Updated 02/24/2006