Hyperglycemia – Part 3

Yes, emergency complications of hyperglycemia happen all too frequently, especially among the elderly and occasionally the not so elderly that are in severe depression.  If blood sugar rises high enough for a prolonged period, it can lead to two serious conditions.

• Diabetic ketoacidosis. Diabetic ketoacidosis develops when you have too little insulin in your body. Without enough insulin, glucose can't enter your cells for energy. Your blood sugar level rises and your body begins to break down fat for energy. This process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually "spill over" into the urine. Left untreated, diabetic ketoacidosis can lead to diabetic coma and be life threatening.

• Hyperglycemic Hyperosmolar Nonketotic Syndrome. This condition occurs when people produce insulin, but it doesn't work properly. Blood glucose levels may become very high, greater than 600 mg/dl (33.3 mmol/L). Because insulin is present but not working properly, the body can't use either glucose or fat for energy. Glucose is then dumped in the urine, causing increased urination. Left untreated, diabetic hyperosmolar syndrome can lead to coma and life-threatening dehydration. Prompt medical care is essential.

Illness or infections can cause your blood sugar to rise, so it's important to plan for these situations. Talk to your doctor about creating a sick-day plan. Questions to ask include:

• How often should I monitor my blood sugar during an illness?
• Does my insulin injection or oral diabetes pill dose change when I'm sick?
• When do I test for ketones?
• What if I'm unable to eat or drink?
• When do I seek medical help?

Some people will tell you to let your doctor set your blood glucose target, but I say that they should not. They can make suggestions and help guide you, but they should never set your goals. Too often, doctors only use the ADA target blood glucose levels. For many people who have diabetes, target levels set by the American Diabetes Association (ADA) are:

• Fasting at least eight hours (fasting blood sugar level) — between 90 and 130 mg/dl (5 and 7 mmol/L)
• Before meals — between 70 and 130 mg/dl (4 and 7 mmol/L)
• One to two hours after meals — lower than 180 mg/dl (10 mmol/L)

Your target blood glucose range should differ, especially if you're pregnant or you develop diabetes complications. Your target blood glucose range may change as you get older, too. Sometimes reaching your target blood glucose range is a challenge. But the closer you get, the better you'll feel.

If you have any signs or symptoms of severe hyperglycemia, even if they're subtle, check your blood sugar level. If your blood sugar level is 240 mg/dl (13.1 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. You'll need your doctor's help to lower your blood sugar level safely.  During an appointment, your doctor should conduct an A1c test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood glucose attached to hemoglobin, the oxygen-carrying protein in red blood cells.

An A1c level of 7 percent or less means that your treatment plan is working and that your blood sugar was consistently within the normal range. If your A1c level is higher than 7 percent, your blood glucose, on average, was above the normal range. In this case, your doctor may recommend a change in your diabetes treatment plan.

Keep in mind that the normal range for A1c results may vary somewhat among labs. If you consult a new doctor or use a different lab, it's important to consider this possible variation when interpreting your A1c test results.

How often you need the A1c test depends on the type of diabetes you have, The medications you are taking, and how well you're managing your blood sugar. Most people with type 2 diabetes, on no or oral medications are mostly tested twice per year. If you are type 1 or type 2 on insulin, you should be tested at least four times per year.