Understanding And Correcting Hyperglycemia (High Blood Sugar) In Type 1 Diabetes

Medical Disclaimer: Nada Sami does not represent Matt Vande Vegte or FTF Warrior LLC in any way. Please consult your medical team and/or doctors before making any changes to your diabetes management, and seek immediate medical attention if you think your life may be in danger. This article is in no way medical advice.

A condition that every diabetic patient is likely to experience is Hyperglycemia. It is also one of the most common occurring states that happens to the body during diagnosis and is responsible for the famous “3Ps” symptoms of diabetes. But what is hyperglycemia?!

Hyperglycemia is the term describing “too” much glucose in your blood exceeding the normal levels during fasting greater than 7.0 mmol/L (126 mg/dl) or when it is greater than 11.0 mmol/L (200 mg/dl) 2 hours after having your meal. 

But what can happen to the body when it has higher than normal ranges of blood glucose levels? 

1. The major cause is missing a dose of insulin in the case of type 1 diabetes or glucose-lowering medications in the case of type 2 diabetes. 

2. Excess eating of food with a high glycemic index that the prescribed doses of your medications cannot lower such as sugars and carbohydrates that are more likely to raise sugar levels.

3. Being physically inactive. 

4. Another cause can be stress that can come from illness (such as cold or infections) or other stress types from our social lives can highly affect your sugar levels whether mental or physical.  

5. Some medications can increase your blood sugar levels so they have to be taken with caution in diabetics (like steroids). 

Your body will try to fight these abnormal levels by developing the famous 3Ps: 

1. Polydipsia: this is extreme thirst as your body tries to dissolve the sugars before they precipitate in your organs and damage them. 

2. Polyuria: increased urination that naturally comes after drinking lots and lots of water and this is considered the exit pathway for the increased glucose. 

3. Polyphagia: as no glucose-lowering medications/ insulin are being utilized to transport the glucose which is considered the fuel of the body, so your brain tells you “YOU NEED ENERGY, GO EAAAT” 

4. Blurred vision: High blood sugar causes the lens of the eye to swell, which changes your ability to see.

5. Headaches: this can develop also in hypoglycemia and mainly headaches occur more frequently when there is a lot of fluctuations in the glucose levels. The body gets confused and it releases neurotransmitters trying to control the situation as soon as possible, such as with epinephrine and norepinephrine, and these substances constrict the blood vessels in the brain causing headaches. 

If hyperglycemia is left untreated, some toxic acids (ketones) will build up in the blood and urine as a result of breaking down your body fats causing ketoacidosis and the symptoms will get worse: 

1. Dry Mouth as the state of dehydration gets worse and worse. 

2. Abdominal Pain that develops into nausea and vomiting with time.

3. Fruit- smelling breath as ketones continue to build up in the body. 

4. Confusion and coma in case of no immediate intervention. 

Chronic or untreated hyperglycemias for a long period of time will develop complications in the whole body as the sugar will have to precipitate in various organs, disturbing their functions: 

1. Neuropathy, which is nerve damage. 

2. Nephropathy, which is kidney damage that can lead to Acute Kidney Failure (AKF).

3. Retinopathy, which is eye damage mainly in the retina and the eye lens that in severe cases can progress to vision loss.

4. Foot problems mainly due to nerve damage and the inability of the blood to flow freely. 

5. Skin Infections such as bacterial and fungal infections take advantage of such a weak defense the body can have during hyperglycemia. Unfortunately, this may lead to limb amputations. 

6. Diabetic ketoacidosis (DKA) happens in type 1 patients and is considered an Emergency condition. It develops when there is not enough insulin and glucose cannot enter the cells to be utilized. As an alternative, the body begins to burn fats as a new source of energy, which produces some toxic ketone bodies. The excess ketones accumulate in the body and its only exit path is the urine. If again left untreated, DKA leads to diabetic coma and begins to be life-threatening. 

7. Diabetic hyperosmolar syndrome happens in type 2 diabetics where the blood glucose levels are more than 600 mg/dl for extended periods of time. This makes the kidneys excrete the glucose and when this happens the glucose takes an amount of water with it in the form of urine. This causes the blood to be concentrated and leads to high levels of sugar and sodium. Which therefore increases the water loss and worsens the state of dehydration. It is also considered an emergency condition and if left untreated, as it develops into a diabetic coma. 

The management of hyperglycemia goes as follows:

1. Check the blood glucose levels: It is always the first step for diabetics 

2. Adjust the insulin doses or take an extra correction dose of short-acting insulin. A correction is an insulin dose given to control the blood sugar levels when they are elevated. 

In case of the emergency conditions of diabetic hyperosmolar syndrome and diabetic ketoacidosis, the management is different: 

1. Fluid Replacement: usually through a vein until rehydration is achieved and they help dilate the excess sugar in the blood and replace the lost water of excessive urination. 

2. Electrolyte Replacement: Absence of insulin can lower the levels of electrolytes in the body disturbing the normal body functions. Electrolytes are administrated through the veins to help keep up the normal functions of the heart, muscles, and nerves. 

3. Insulin therapy: Along with fluids and electrolytes, insulin is administered to reverse the building up of ketones. 

Note: exercising is not recommended in case of ketones in urine as exercising may worsen the condition by making the levels go higher and higher. And some doctors advice not to exercise when sugar levels are above 250 mg/dl. 

Finally, as we read together how hyperglycemia can be life-threatening and can affect the way we live.

What can we do to prevent it from occurring? 

1. An essential key for diabetes management is the regular checking of blood glucose levels and try always to record them to always have quick access and recall.

2. Stick to the recommended doses of glucose-lowering drugs and insulin. 

3. Exercise as a lifestyle is really important in helping keep your sugar levels under control. 

4. Avoid consuming food that has a high glycemic index and substitute it with low glycemic index food. 

5. Stress controlling. 

Nada Sami is a fresh graduate of clinical pharmacy and a type 1 diabetic patient for more than 20 years. She is interested in the field of autoimmunity due to her diabetes, that made her the person she is today. Her career mainly involves educating and counseling patients about their medications and diseases as well.