Hyperglycemia In Diabetes

Hyperglycemia or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma.

This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l(~250–300 mg/dl).

A subject with a consistent range between ~5.6 and ~7 mmol/l (100–126 mg/dl) (American Diabetes Association guidelines) is considered hyperglycemic; while above 7 mmol/l (126 mg/dl) is generally held to have diabetes. Chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage.

Symptoms of hyperglycaemia in diabetes depend on the rate of rise in blood sugar. Patients with mild elevations in blood sugar may remain asymptomatic for a long while.

Patients with chronic elevations in blood sugar may have impact on various organ systems like kidney, cardiovascular, nervous system which can have fatal consequences for the patient.

The following symptoms are associated with hyperglycemia with first three being a diagnostic triad:

• Polyuria
• Polydypsia
• Polyphagia
• Blurred vision
• Fatigue
• Weight loss
• Poor wound healing
• Dry mouth
• Dry and itchy skin
• Tingling in feets
• Erectile dysfunction
• Recurrent infections
• Stupor
• Coma
• Arrythmia
• Seizures

A number of things can cause hyperglycemia in diabetes:

• If you have type 1, you may not have given yourself enough insulin.
• If you have type 2, your body may have enough insulin, but it is not as effective as it should be.
• You ate more than planned or exercised less than planned.
• You have stress from an illness, such as a cold or flu.
• You have other stress, such as family conflicts or school or dating problems.
• You may have experienced the dawn phenomenon (a surge of hormones that the body produces daily around 4:00 a.m. to 5:00 a.m.).

Diagnosis of hyperglycemia in diabetes is on the basis of history and physical examination. Patient gives history of symptoms quite diagnostic of hyperglycemia.

Physical examination includes mainly examining for the chronic complications of hyperglycemia like: eye examination to detect changes in fundus, neurological examination to exclude neuropathy like to detect for vibration sense, posture, etc. Vibration is the first sensation to go in hyperglycemic subjects.

The US Department of Health and Human Services recommends diabetes testing for anyone overweight at the age of 45 years and over, alongside anyone under the age of 45 with one or more of the following risk factors:

• Hypertension (high blood pressure)
• High cholesterol
• History of diabetes in the family
• African-American, Asian-American, Latino/Hispanic-American, Native American or Pacific Islander background
• History of gestational diabetes (diabetes during pregnancy) or delivering a baby over 9 lbs

Certain blood tests for the detection of hyperglycemia include:

• Fasting blood glucose: Fasting blood glucose above 126mg/dl is suggestive of high blood glucose. Fasting implies no food for at least 8 hrs before the test.
• Random blood sugars of above 200 mg/dl are suggestive of hyperglycemia.

• Glycosylated hemoglobin HbA1C: This is considered the best marker for determination of status of blood sugar control over past 2 or 3 months. To make an initial diagnosis, an HbA1c reading must be 6.5% or higher. An A1C result between 5.7% and 6.4% indicates prediabetes and a risk of type 2 diabetes. 

  The HbA1c is the preferred blood test for diagnosis because - while it is more expensive than the FPG test - it has advantages, including:

• Greater convenience (no need for fasting)
• Less day-to-day variation during stress and illness
• Urine tests for diabetes were once common but are no longer considered reliable.

Treatment strategy of hyperglycemia in diabetes is directed towards underlying diabetes that is causing high blood sugar levels in your body. If your blood glucose level is consistently too high, talk with your doctor about what you can do to keep it in a more normal range.

He or she may suggest:

• Medication Adjustment: Your doctor may adjust your insulin (or glucose-lowering medication) dose or when you take it to help prevent hyperglycemia.
• Meal Plan Help: A healthy diet and proper meal planning can help you avoid hyperglycemia. This includes eating often, watching intake of sugar and carbohydrates, limiting use of alcohol, and eating a diet rich in vegetables, fruit and whole grains. If you are having difficulty planning meals, talk to your doctor or dietitian.
• Exercise: Regular exercise is important (even if you don't have diabetes). Maintaining a healthy level of activity can help you keep your blood glucose level in a normal range.

However, if you develop hyperglycemia and/or ketones are present in your urine, don't exercise. Hyperglycemia and/or ketones in the urine mean exercise will cause your blood glucose to rise higher.

To prevent hyperglycemia, talk to your health care provider about managing your blood sugar. Different treatments can help keep your glucose levels within your goal range.

Your health care provider sets your target blood sugar range. Your target blood sugar range may differ if you are pregnant. It may change as you get older, too.

Monitor your blood sugar with a blood glucose meter. This is the best way to be sure that your treatment plan is keeping your blood sugar in your goal range. Check your blood sugar as often as your health care provider recommends.

To prevent and treat hyperglycemia, your health care provider may suggest the following:

• Exercise.
• Medicine.
• A diabetes eating plan.
• Adjusting your insulin to control hyperglycemia.

Regular exercise is often an effective way to control your blood sugar. But you should not exercise if ketones are present in your urine. This can drive your blood sugar even higher.

Your health care provider may adjust the dose or timing of your medication if you have frequent episodes of hyperglycemia.

If you have diabetes, you should avoid beverages and foods with sugar. If you're having trouble sticking to your diabetes meal plan, ask your health care provider or dietitian for help. Monitor your blood glucose as directed by your health care provider. Check more frequently if you are ill or stressed.

Watch your levels if you are concerned about severe hyperglycemia or low blood sugar, also known as hypoglycemia. Adjusting your insulin program or taking an extra dose of short acting insulin can help control hyperglycemia. The extra dose is used to help temporarily correct a high blood sugar level.

Seek medical care if you have very high blood sugar. Emergency treatment can lower your blood sugar to a normal range.

Treatment usually includes:

• Fluid replacement.
• Electrolyte replacement.
• Insulin therapy.

You will receive fluids either orally or intravenously until you are rehydrated. The fluids replace those you have lost through increased urination. They also help manage the excess sugar in your blood.

Not having enough insulin in your blood can lower the level of electrolytes. You will receive electrolytes through your veins to help keep your heart, muscles and nerve cells working normally. Insulin reverses the processes that cause ketones to build up in your blood.

Along with fluids and electrolytes, you will receive insulin therapy, usually through a vein. Your health care provider will consider what may have triggered the severe hyperglycemia. Depending on the cause, you may need additional treatment.

Several alternative and homeopathic remedies exist for hyperglycemia in diabetes.

Homeopathy has complete say in curing of High Blood Sugar

• Phosphorus: to stabilize sugar levels.
• Syzygium Jambolanum: reduces level of sugar immediately, use 5 drops of it after every 6 hours.
• Aurum Metallicum: reduces craving for sugar with the patients.
• Uranium Nitricum: improves nephritis problems.
• Arsenicum Bromatum: normalize excessive thrust and hunger, common with diabetes.
• Insulinum: helps to improve the functioning of pancreas.
• Phosphoric acid has remarkable power to cure sugar in the early stage.
• Lactic acid shows good result with patients.

Unani Medicine for blood sugar

Unani strongly believes the total cure of High Blood Sugar is possible through energizing the pancreatic cells. The oil of black pepper, fennel, and juniper has a restoring and rejuvenating effect on the pancreas. Insulin stimulant oils are carrots, eucalyptus, fennel, geranium and lemon oils.

Easy home remedies for blood sugar

• Use bitter melon in your diet to control it.
• Drink 1 cup of Methi juice every morning to bring down glucose level.
• Amla and Orange contain vitamin C, quite beneficial for high glucose in blood.
• 5 mango leaves + 1 glass of water left for overnight, drink after filtering to reduce sugar level.
• Take curry leaves twice a day for good result.
• Take about ½ tsp each of ground bay leaf + turmeric + aloe vera gel before lunch and dinner.
• ½ cup of bitter gourd juice in the morning is one of the best remedies for Diabetes.
• Honey + Turmeric powder + dried gooseberry powder is shown to reduce glucose level.
• Such patients should chew 4-5 Jamun leaves in the morning and evening.
• Chew 2 leaves each of Neem and Bilva to minimize the impact of it.
• Overnight drenched almond is also useful.
• Leaves of Basil + Neem + Belpatras + 1 glass of water help to cure hypoglycemia.
• Diabetic patients should take apple juice.
• Use of garlic, bitter gourd, onion and soybean should be abundant in diet to overcome sugar level.
• Drink more water in the morning before exercise.

Lifestyle modifications are necessary in order to cope with hyperglycemia in diabetes.

Work with your healthcare team to have a diet, exercise and weight-loss plan tailored to your needs. There is no magic diet. The key to success is adherence.

Diet:

Insulin sensitivity can improve just a few days after starting a diet with lower calories. Studies have shown that the Mediterranean diet has worked well for people with diabetes. Try to eat whole fresh foods that are low on the glycemic index and are high fiber. Good choices are vegetables, beans, fruit, and whole grains.
Eat plenty of vegetables, especially green vegetables. Try to get an assortment of colors in your fruits and vegetables to help fill all your nutritional bases and minimize cravings due to nutritional deficiencies. Eat small frequent meals throughout the day.

• Carbs: Aim for a moderately low-carb diet (45%-65% of total calories). How many carbs are good for you? Work with your doctor or dietitian. Listen to your body. If you experience carb cravings after a meal or snack, it might be worth your effort to try fewer carbs next time.
• Fats: Avoid bad saturated fats and aim for moderate amounts of healthy monounsaturated fats and omega-3 fats (25%-35% of daily calories). Good monounsaturated choices are olive oil, avocados and nuts. Examples of omega-3 fats are fish and walnuts. Limit saturated fat to less than 7% of daily calories and trans-fats to less than 1%.
• Protein: Opt to get protein (12%-20% of daily calories) from legumes, fish, and chicken. Make sure and talk to your doctor about how much protein you can consume. Some conditions, such as kidney disease, may put limitations on how much protein you can have.

Exercise:

Exercise helps make cells more receptive to insulin. Exercise delivers a triple benefit in diabetes: lowering blood sugar levels, lowering insulin levels and increasing insulin sensitivity. Overall health is improved.
Even a person with a less-than-ideal body mass index (BMI) who is fit improves their quality of life and lessens the chances of diabetes-related death. Try to get at least 30 minutes of moderate-intensity cardiovascular exercise most days of the week. Every day is better. Cardiovascular exercise lowers risk for heart disease.
If you have not exercised in a while, start slowly. For optimal results, include resistance and flexibility exercises. Make sure to get your doctor's approval and guidance before starting an exercise regimen. Hard exercise is not recommended if you have uncontrolled diabetes.

To reduce health risk:

To improve blood sugar levels, maintain weight and reduce risk for heart disease, get 150 minutes per week of moderate cardiovascular exercise. Exercise at least three days a week with no more than two days in between.

For increased risk reduction for heart disease, get at least four hours a week of moderate-to-vigorous cardiovascular exercise or resistance exercises or both.

To lose weight or for maintenance:

For major weight loss or long-term maintenance, get at least seven hours a week of moderate-to-vigorous cardiovascular exercise.

Weight loss:

Even a small amount of weight loss can help improve insulin sensitivity. The invaluable benefits are improved fitness and reduction in overall mortality. The ultimate goal is to try to achieve a healthy BMI.

However, weight loss may be more difficult for people who already have type 2 diabetes, so focus on realistic goals and the priceless rewards of improved fitness and a better quality of life.

Lower stress:

Did you know chronic stress can raise your blood sugar levels, which also raise your insulin levels? Try to remove sources of stress or lean how to deal with them. Learn more about stress relievers that may work for you.

Two more tips:

• Get more sleep, limit alcohol to moderate amounts and stop smoking.
• Regularly check your blood sugar levels and keep records of your levels, diet, and exercise.

There are several risks and complications associated with hyperglycemia in diabetes.

Hyperglycemia can be a serious problem if not treated in time.

In untreated hyperglycemia, a condition called ketoacidosis could occur. Ketoacidosis develops when the body does not have enough insulin. Without insulin, the body isn't able to utilize the glucose for fuel, so the body starts to break down fats for energy.

Ketoacidosis is a life-threatening condition which needs immediate treatment. Symptoms include: shortness of breath, breath that smells fruity (such as pear drops), nausea and vomiting, and very dry mouth.

Chronic hyperglycemia (high blood sugar) injures the heart in patients without a history of heart disease or diabetes and is strongly associated with heart attacks and death in subjects with no coronary heart disease or history of heart failure, also results in diabetic nephropathy and diabetic neuropathy which have serious consequences for the organ system involved.