Blood Sugar

The human body naturally has glucose, or sugar, in the blood. The right amount of blood sugar gives the body’s cells and organs energy. Some blood sugar is produced by the liver and muscles, but most blood sugars are obtained from the carbohydrate-laden food and drinks that people consume.

To maintain the normal range of blood sugar levels, the body needs insulin, which is a hormone that instructs the body’s cells to use up the glucose and store it. When insulin is not enough, or when it does not work properly, blood sugar builds up. High blood sugar can lead to health problems.

High blood sugar affects people who are diabetic. The technical term for high blood sugar is hyperglycemia. High blood sugar occurs when the body has too little insulin or when the body cannot use insulin properly. High blood sugar is a hallmark sign of both type 1 diabetes and type 2 diabetes, and prediabetes. 

Several factors contribute to high blood sugar in people with diabetes, such as food and physical activity choices, non-diabetes medications, illnesses, or skipping or not taking enough glucose-lowering medications. 

High blood sugar must be treated, because if left untreated, it can become severe and lead to serious complications that may require emergency care, such as diabetic coma, diabetic ketoacidosis, or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). In the long term, persistent high blood sugar, even if not severe, may lead to complications that affect your kidneys, eyes, heart, and nerves.

Causes of High Blood Sugar

During digestion, the body breaks down the carbohydrates it gets from foods such as bread, pasta, and rice, into various sugar molecules. One of the sugar molecules is glucose, which is the main source of energy source for the body. Immediately after eating, the bloodstream absorbs glucose, but cannot enter the cells of most of the tissues without the help of insulin - a hormone secreted by the pancreas.

When the glucose level in the blood rises, it signals the pancreas to release insulin. The insulin, in turn, unlocks your cells so that glucose can enter and provide the fuel your cells need to function properly. The extra glucose is stored in your liver and muscles in the form of glycogen. This lowers the level of blood sugar in the bloodstream, preventing it from getting to very high levels. When your blood sugar returns to a normal level. So will the secretion of insulin from the pancreas.

Diabetes drastically diminishes the effects of insulin on the body, either because your pancreas is not able to produce enough insulin, which is the case in type 2 diabetes, or because your body is resistant to the effects of insulin or does not produce enough insulin to maintain a normal glucose level, which is the case in type 2 diabetes. As a result, blood sugar tends to build up in your bloodstream, called hyperglycemia, and reach dangerously high levels if not treated properly. Insulin or other drugs are used to lower blood sugar levels.

Diagnosis and Treatment of High Blood Sugar

Your doctor shall set your target blood sugar range. For people who are diabetic, the following range of blood sugar levels are recommended before meals:

  • Between 80 and 120 mg/dL for people age 59 and younger who have no other underlying medical conditions.
  • Between 100 and 140 mg/dL for people age 60 and older, those with other medical conditions such as lung, heart, or kidney disease, or individuals who have a history of hypoglycemia or low blood sugar or those who cannot easily recognize the symptoms of hypoglycemia or low blood sugar levels.

For many diabetic people, the target blood sugar levels recommended by doctors are:

  • Between 80 and 130 mg/dL before meals
  • Less than 180 mg/dL two hours after meals

Your blood sugar range could differ, especially when you are pregnant or you have developed diabetes complications. Your blood sugar range goal may change as you get older, also. It most cases, it is a big challenge to keep your blood sugar on its normal range.

The symptoms of high blood sugar do not always manifest until your blood sugar level gets significantly high - typically in the range of 180 to 200 mg per deciliter  (mg/dL) or 10 to 11 millimoles per liter (mmol/L). Symptoms of high blood sugar develop slowly over several days or weeks. When the levels of your blood sugar remain high, you will get more serious symptoms. However, some individuals with type 2 diabetes for a long period may not manifest any symptoms even if they have high levels of blood sugar.

Early symptoms

Recognizing the early signs and symptoms of high blood sugar can help in treating the condition promptly. The following are the early signs and symptoms of high blood sugar:

  • Increased thirst
  • Frequent urination
  • Fatigue
  • Blurred vision
  • Headache

Later symptoms

  • Nausea and vomiting
  • Fruity-smelling breath
  • Dry mouth
  • Shortness of breath
  • Weakness
  • Confusion
  • Abdominal pain
  • Coma

Ongoing high blood sugar may cause:

  • Sores and cuts that heal slowly
  • Vaginal and skin infections
  • Worse vision
  • Stomach or intestinal conditions such as chronic constipation or diarrhea
  • Damage to the nerves which causes painful cold or insensitive feet, loss of hair on the lower extremities, or erectile dysfunction.
  • Damage to the eyes blood vessels, or kidneys.

The following can help you keep your blood sugar within the target range:

  • Follow your diabetes meal plan - You should be consistent about the amount and timing of your snacks if you are taking insulin or oral diabetes medication. The food you eat must be in balance with the insulin working in your body.
  • Monitor your blood sugar - Depending on your treatment plan, you may check and record your blood sugar levels several times a day or several times a week. Regular monitoring will ensure that the level of your blood sugar remains within the target range. Take note when your blood sugar readings are above or below your goal range.
  • Take your medication as prescribed by your healthcare provider - Take your diabetes medications exactly as directed by your doctor. Do not increase or decrease the dosage of your medication without your doctor telling you to do so.
  • Adjust your medication if you change your physical activity - The adjustment depends on the blood sugar test results and the type and length of the activity.

Hemoglobin A1C test

During an appointment, your doctor may conduct an A1C test, which indicates your average blood sugar level for the past two to three months. It works by measuring the blood sugar percentage attached to the oxygen-carrying protein in red blood cells.

A 7 percent A1C level or less may mean that your treatment plan works properly and that your level of blood sugar was within your target range consistently. If your A1C level is higher than 7 percent, your blood sugar, on average, was above the normal range. In this case, your doctor may recommend a change in your diabetes treatment plan.

For some individuals, especially older adults and those with certain medical conditions or those who cannot expect long life expectancy, it might be normal to have up to 8 percent A1C level.

How often you need the A1C test depends on the type of diabetes you have and how well you are managing your blood sugar. Most people with diabetes receive this test between two and four times a year.

Risks of Having High Blood Sugar

Many factors can contribute to high blood sugar level, including:

  • The amount of insulin or oral medications for diabetes is not enough
  • Improper injection of insulin or using expired insulin
  • Being inactive
  • Failure to follow a diabetes eating plan
  • Having an infection or other illnesses
  • The use of certain medications such as steroids
  • Getting injured or having surgery
  • Experiencing emotional stress, such as workplace challenges or family problems

Complications

High blood sugar could lead to complications.

Long-term complications:

Controlling your blood sugar will help prevent a lot of diabetes-related complications. Those complications can include:

  • Cardiovascular disease
  • Neuropathy or nerve damage
  • Kidney damage or kidney failure
  • Diabetic retinopathy or damage to the blood vessels of the retina, potentially leading to blindness
  • Cataract or clouding of the normally clear lens of your eyes
  • Problems in the feet due to the poor flow of blood or damaged nerves that may lead to ulcerations, serious skin infections, and in severe cases, amputation
  • Bone and joint problems
  • Teeth and gum infections

Emergency complications

If blood sugar remains high enough for a long period, it may lead to two serious conditions:

  • Diabetic ketoacidosis - It develops when you don’t have enough insulin in your body. When this condition occurs, glucose cannot enter your cells to give you energy. Your blood sugar level rises, and your body begins to break down fat for energy, producing ketones, which are toxic acids. Excess ketones will accumulate in the blood, eventually spilling over into the urine. If not properly addressed, the diabetic ketoacidosis may result in a diabetic coma, which is life-threatening.
  • Hyperglycemic hyperosmolar state - This condition occurs when people produce insulin, but it does not work properly. Blood sugar levels may become very high, at times greater than 600mg/dl. Because insulin is present but not working properly, the body cannot use either glucose or fat for energy. Glucose is then spilled into the urine, causing increased urination. If left untreated, the state of diabetic hyperglycemic hyperosmolar may lead to coma and dehydration, which are both life-threatening. Immediate medical attention is necessary.

When to Seek Medical Attention

If you experience tiredness, frequent urination, increased thirst, or weight loss, it is time to see a doctor as your symptoms could indicate diabetes or another health problem.

A routine check often involves blood sugar testing, even if you have no symptoms.

It is recommended that adults aged 40 to 70 who are overweight must be tested for diabetes. Those with a family history of diabetes or other risk factors may need earlier or more frequent tests.

Table of Medications

  • metformin
  • Januvia
  • Victoza
  • glipizide
  • glimepiride
  • Amaryl
  • Invokana
  • Actos
  • Levemir
  • Lantus

Sources

https://www.webmd.com/diabetes/guide/diabetes-hyperglycemia
https://www.medicalnewstoday.com/articles/313138.php
https://www.medicinenet.com/hyperglycemia/article.htm
https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hyperglycemia
https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

Tilly Whittaker

Our Senior Editorial Pharmacist brings positivity and light banter during meetings. She is a walking encyclopedia of knowledge and explanations. You will rarely need to open a book when she's around. Her almost eidetic memory makes her an invaluable member of the group.

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