Hyperglycemia in Diabetes – Diagnosis and Treatment
Diagnosis
Checking Blood Sugar at Home
People with diabetes or those at risk often check their blood sugar levels at home using a blood glucose meter.
Health care providers set specific target ranges for each person, which may change based on age, health conditions, and type of diabetes.
Younger adults without other medical issues may have a lower target range. Older adults or those with other health problems may have a slightly higher target.
Here is an example of general target blood sugar levels:
| Group | Before Meals (mg/dL) | 2 Hours After Meals (mg/dL) |
|---|---|---|
| Under 60, no health issues | 80โ120 | <180 |
| Over 60 or with other conditions | 100โ140 | <180 |
Regular home testing helps people stay within these goals. If blood sugar levels rise above 240 mg/dL, people should use a urine test to check for ketones.
Ketones signal that the body may start breaking down fat for energy, which can cause serious problems. People should follow their health care provider’s advice if this happens.
Home blood sugar monitoring is especially important for people with type 1 diabetes, type 2 diabetes, and those with impaired glucose tolerance. Tracking at home helps prevent dangerous highs and lows.
This monitoring also shows patterns over time and guides changes in diet or medicine.
Blood Test for Average Blood Sugar: The A1C
A health care provider may use a hemoglobin A1C test to see how well blood sugar has been managed over the last two to three months.
The A1C measures the percentage of blood sugar attached to hemoglobin in red blood cells. This test helps detect both type 1 and type 2 diabetes. It also tracks long-term glucose control.
A1C results show if the current plan for managing diabetes is working.
- An A1C under 7% usually means blood sugar has stayed within a healthy range.
- An A1C over 7% means blood sugar has been higher than recommended.
- In some cases, such as with older adults or those with other medical concerns, a higher A1C goal (like 8%) may be chosen.
How often you need the A1C test depends on your type of diabetes and how steady your blood sugar has been. Most people get tested two to four times a year.
People with diabetes, especially those at risk for heart disease, benefit from regular A1C monitoring.
Additional Details on Blood Sugar Tests
Health care providers may use several tests besides daily home checks and the A1C. Two common tests are:
- Fasting Plasma Glucose Test: This test measures blood sugar after not eating for at least eight hours. High values may show impaired fasting glucose or diabetes.
- Oral Glucose Tolerance Test: You drink a sugary solution, and then your blood sugar is checked after two hours. This test helps find impaired glucose tolerance and type 2 diabetes.
Screening with these tests is important for people with type 2 diabetes, those with risk factors for heart or blood vessel problems, or people with a family history of diabetes.
Early detection and regular monitoring help lower the risk of long-term problems.
Treatment
Managing at Home
People with high blood sugar should work closely with their health care team to develop an effective plan. Exercise can help lower blood sugar by improving how the body uses insulin.
| Approach | Description |
|---|---|
| Exercise | Increases insulin sensitivity and lowers blood sugar (avoid with urine ketones). |
| Medication Management | Use drugs like metformin, sulfonylureas, or thiazolidinediones as prescribed. |
| Meal Planning | Prioritize portion control and limit sugary foods. |
| Blood Sugar Monitoring | Check levels regularly, especially when sick or at risk of low/high blood sugar episodes. |
| Insulin Dose Adjustments | Take supplemental insulin if needed, with medical guidance. |
If ketones are found in the urine, people should avoid exercise. Activity in this situation could make things worse.
Medications play a key role in controlling blood sugar. These might include metformin, which lowers glucose production in the liver, or other drugs like sulfonylureas and thiazolidinediones that help the body use insulin more effectively.
Some people need insulin therapy as part of their routine. Health care providers may recommend a temporary increase in insulin or an extra dose if blood sugar is especially high.
Having a meal plan and following it helps limit large spikes in blood sugar. This includes eating smaller portions, reducing sugary foods and drinks, and avoiding frequent snacks.
If someone struggles with their diet, a health care provider or dietitian can offer guidance.
Regular blood sugar checks are important, especially when feeling unwell or experiencing symptoms of severe high or low blood sugar. Adjustments to insulin or oral medications are often made based on these results.
Some people may also take statins or angiotensin-converting enzyme inhibitors to protect heart and kidney health, as diabetes increases the risk for related problems.
Urgent Interventions for High Blood Sugar
Severe hyperglycemia can cause dangerous conditions like diabetic ketoacidosis or hyperosmolar hyperglycemic state. These require immediate attention in a hospital.
Doctors start treatment with fluids given through a vein (IV) to replace what’s lost and help lower blood sugar to safer levels.
Patients often receive IV electrolytes like potassium, sodium, and chloride to correct imbalances. These are important for heart, muscle, and nerve function.
Doctors give insulin therapy through the vein to stop ketone buildup and lower blood sugar to the target range.
After initial treatment, healthcare providers look for the cause of the severe event. They may adjust medications or suggest lifestyle changes based on what triggered the episode.
Getting Ready for Your Visit
Steps You Can Take Before the Appointment
Planning ahead can make your appointment more helpful and efficient. Preparing in advance helps your health provider understand your needs and make better choices for your care.
Here are some practical steps you can follow:
1. Ask About Food and Drink Restrictions
Some visits require fasting or not eating and drinking for several hours except for water. This is often needed for blood sugar or other lab tests.
Contact the clinic before your appointment to ask if there are any restrictions. Being prepared helps make sure your test results are accurate.
2. Keep Track of Your Health Details
Make a list of recent big changes in your life or times youโve felt stressed. These details may affect blood sugar and diabetes management.
3. Make a Medication List
Write down every medicine, vitamin, or supplement you are taking. Include the name, dose, and how often you use each one.
This information helps your provider spot anything that could affect your blood sugar, including possible side effects or interactions.
4. Organize Your Blood Sugar Results
If you check your blood sugar at home, bring a written or printed log. Show your readings, when you took them, and what medication you took at those times.
Bring your meter if possible. Regular tracking helps your doctor spot patterns and adjust your medicine.
5. List Your Questions and Concerns
Bring a list of questions for your provider. Here are some ideas:
- How often should I check my blood sugar?
- What should my blood sugar targets be?
- How do changes in exercise or eating affect my glucose?
- When should I check for ketones?
- How can I avoid both high and low blood sugar?
- Will I need to return for follow-up?
- Do I need to be concerned about low blood sugar symptoms?
6. Check Prescription Refills
Review your current prescriptions before the appointment. If you are running low, ask for refills while you are in the clinic.
7. Bring Notes on Daily Habits
Describe your exercise routine, eating pattern, and any recent lifestyle changes. Tracking physical activity and nutrition can help the health team suggest ways to improve your health.
Simple notes on when and how you exercise or changes in physical activity can guide your provider in offering advice that fits your life.
Table: Information to Bring With You
| What to Bring | Why It Matters |
|---|---|
| Recent blood sugar logs | Detect patterns and adjust your care plan. |
| List of prescriptions | Spot interactions and plan for refills. |
| Questions for provider | Get answers and clarify steps in your care. |
| Notes on diet and activity | Identify links between lifestyle and blood sugar. |
| Brief life events or stress list | Address factors affecting health management. |
Keeping this information organized helps make sure you do not miss anything important during your visit.
Being Ready for Sick Days
Preparing for illness is important in diabetes management. Fevers, infections, or other sicknesses can cause blood sugar to rise.
Having a clear “sick-day plan” helps prevent complications and keeps you safer when you do not feel well.
1. Check Blood Sugar More Often When Sick
When you are unwell, your body may need different care. Plan to monitor your blood sugar more often than usual.
Your provider will guide you on how often to test. Keeping a log helps them understand how your illness affects your levels.
2. Know What to Do About Your Diabetes Medicine
Ask your health provider if you need to change your dose of insulin or diabetes pills when you are sick. Get these instructions before you get ill so you are not left guessing.
3. When to Test for Ketones
Sometimes high blood sugar during illness can cause a buildup of ketones in the blood or urine. This can be dangerous.
Your provider can explain when and how to check for ketones, especially if your readings are high. Have supplies for testing at home.
4. What If You Can’t Eat or Drink?
Loss of appetite, vomiting, or dehydration can make diabetes management harder. Ask your provider what steps to take if you cannot eat solid food or keep fluids down.
You may need to adjust your medications or seek medical attention.
5. Know When to Call for Help
Make a list with your health provider about when to seek medical care. This might include:
- Ketones found in your urine or breath
- Blood sugar readings that stay too high or too low
- Signs of dehydration (such as extreme thirst, dry mouth, dark urine)
- Trouble breathing or chest pain
- Not being able to keep fluids down for several hours
When you feel sick, keep this information where it is easy to find.
List: Sick-Day Questions to Ask Your Provider
- How often should I monitor my blood sugar if I get sick?
- Do I need to change my insulin or other diabetes medicine during illness?
- When do I test for ketones, and how do I do this?
- What should I do if eating or drinking is hard?
- What symptoms mean I should call the office or seek urgent care?
Tips for Managing Lifestyle Changes When Unwell
- Reduce physical activity if you are feeling tired but try to move around as able.
- Choose lighter foods if you cannot eat as much as usual.
- Keep a notepad to jot down symptoms, food, fluids, and blood sugar levels for review with your provider.
- If your weight changes quickly, tell your provider since this could signal an issue with fluid balance.
Having a plan and checking in with your medical team helps you manage diabetes more calmly and lowers the risk of serious problems during illness.
