Hyperglycemia in diabetes

Diabetes mellitus(hyperglycemia) is a widespread chronic and incurable metabolic disease whose course is normally without dramatic ups and downs. After a physician diagnoses the disease, the patient is adjusted with insulin or medication to counteract or regulate the effects of insulin deficiency on the body. In rare cases, diabetes mellitus can lead to medical emergencies. This occurs as soon as blood glucose levels deviate sharply from a normal level. If the blood glucose level drops below 50 mg/dl, this is called acute hypoglycemia. If, on the other hand, the value rises to over 250 mg/dl, hyperglycemia leads to an acute and also dangerous medical emergency.

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What happens during hyperglycemia?

When blood glucose levels are severely elevated (hyperglycemia), metabolic acidification of the blood and body occurs, known as diabetic ketoacidosis. A typical ketoacidosis is characterized by blood glucose levels that are (far) above 250 mg/dl. The body is massively lacking insulin and thus body cells cannot be supplied with nearly enough energy. In an "exceptional reaction", the body increasingly breaks down fat into fatty acids. These fatty acids cannot be completely broken down and can be detected in the urine and also in the blood.

What are the signs of hyperglycemia?

Such a serious process does not develop within minutes. The signs and symptoms of impending hyperglycemia (ketoacidosis) increase over time and are as follows:

  • Strong feeling of thirst
  • Increased urination
  • Loss of appetite
  • Nausea & vomiting
  • Clearly noticeable abdominal pain
  • Smell of acetone in the breath

The affected person has deepened breathing and feels tired as well as weak. Elevated blood glucose levels accompanied by malaise should always be treated by a physician. Vomiting sets off a medical emergency and requires calling 911 and immediate transport to a hospital emergency room.

What can first responders do?

First responders can ask the sick person to drink as much water as possible. Physical exertion should be avoided at all costs. With this in mind, refrain from having the sick person walk long distances or even up stairs. In the event of dizziness and the possible onset of clouding of consciousness, care should be taken to ensure that the patient does not fall asleep under any circumstances.

What happens in the hospital?

Depending on the severity of the emergency, a decision will be made at the hospital as to whether hospitalization is necessary or whether the patient can be treated as an outpatient. In any case, after such an incident, the attending physician must be notified of the incident so that medication or insulin can be readjusted for the diabetes, if necessary. Such a medical emergency is considered an exceptional situation and does not belong under any circumstances in the normal clinical picture of a diabetes disease. If the diabetes is well controlled with medication and the patient acts "sensibly", such an incident should not normally occur. The acute trigger of such a ketoacidosis can be an insufficient dose of insulin with simultaneous consumption of foods that are too sweet. This is an unfavorable combination of which every diabetes patient is usually aware. In the worst case, hyperglycemia can result in a diabetic coma, which requires hospitalization.

Prevent the emergency!

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As with all chronic diseases, you can prevent such emergencies by making those around you aware of your illness and symptoms. This does not mean that you have to "peddle" your illness. However, people who are close to the patient should know about such things. Depending on the situation, these people will then be able to react more correctly and more quickly in an emergency or will also be able to inject the insulin that is urgent in an emergency, provided they have permission to inject insulin.

For all (emergencies): Always have an emergency kit ready!

A small emergency kit with insulin syringes and an information card for first responders is also recommended for this emergency. If a person loses consciousness, you will not necessarily think of diabetes right away. But especially in the case of hyperglycemia, it will be necessary to keep the patient awake until the emergency services arrive. When in doubt, such information belongs on an information card, which should be carried so that first responders can find it quickly without difficulty. 

How likely is hyperglycemia?

Although such information certainly sounds dramatic, the active probability of hyperglycemia is relatively low with well-controlled medication. Even a diabetic coma is not in the spectrum of higher probability with prompt initial care. This would be quite different if the ill person is completely alone at the time of this emergency situation. With a little organizational talent, however, one will be able to set up a reliable rescue chain for such a case. In other words, by using a speed dial or some other agreed-upon signal, you can avoid being discovered by chance only two days later in the event of an emergency. A "do-not-report-at-a-determined-time" can also replace an active emergency call. Such scenarios can be easily coordinated among friends and family to encourage proper action by all involved while avoiding panic.

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Final tips

In conclusion, it is easy to remember: If the sick person is unwell with persistent fatigue or even vomiting after eating a generous dessert, the emergency call is mandatory. As with all peculiarities of chronic diseases, one can always ask the attending physician for clarification and advice. The physician is familiar with the patient and also the diabetes setting and will certainly be able to give warnings that are individual to the particular patient as well as their disease process. This concerns the correct amount of insulin as well as possible recommendations on the acceptable consumption of sweet foods. In most cases, patients are prepared for such events. For example, if an invitation to a birthday party is pending, no doctor will be annoyed if the patient inquires whether it is okay to eat this or that.

Many people who have special dietary requirements; such as vegans or those with lactose intolerance, make little cards to hand to the kitchen via the service staff when visiting a restaurant to politely request that they refrain from using various ingredients in the preparation of their dish. In the case of diabetes, such a small card could be accompanied by a request to refrain from "sweetening" the food. This would also make visits to special restaurants less likely to catapult blood glucose levels to dangerous levels in the short term. Blood sugar levels can be influenced very quickly - both positively and negatively. This plays a role in the selection of meals and ingredients in the case of diabetes. There is then also no reason to be ashamed if you ask your environment for consideration. No matter whether it is your own family or the kitchen staff of your favorite restaurant. People will certainly show more understanding for such a harmless request than for the hustle and bustle of a rescue mission with blue lights.

Typical signs of hyperglycemia include frequent, copious urination and a strong sense of thirst. Other symptoms include nausea, vomiting and abdominal pain, tiredness and weakness, low blood pressure and deep breathing with an acetone odor. Prolonged hyperglycemia can cause dry skin, vision problems, and loss of consciousness, including unconsciousness (diabetic coma). </p>

Acute hyperglycemia is treated clinically with the immediate administration of insulin. Blood glucose and urine acetone levels should be checked every two hours, and plenty of sugar-free fluids, preferably water, should be consumed. The patient should avoid exercise, rest, but not sleep. If levels remain elevated despite insulin administration, or if the condition worsens or symptoms increase, the emergency physician should be called. </p>

In sugar shock, central respiratory and circulatory disturbances, seizures, disorientation, and unconsciousness occur. Life-threatening sugar shock refers to hypoglycemic coma, which is the maximum expression of hypoglycemia. It manifests itself in the following symptoms: hot hunger, nausea, vomiting, nervousness, restlessness, sweating, accelerated pulse and respiration, tremors, hypertension, headache, gait unsteadiness, speech impediments, and seizures. </p>

A low blood glucose level, i.e. hypoglycemia, is more dangerous for the body than a high blood glucose level. In the event of hypoglycemia, the body reacts with typical stress symptoms that can develop into hypoglycemic coma, or sugar shock, and can have fatal consequences if left untreated. Hyperglycemia can also lead to life-threatening coma and requires immediate emergency medical attention. </p>

Sugar shock refers to hypoglycemic coma, the maximum expression of hypoglycemia. The sugar level in the blood is below 50mg/dl. Symptoms include central respiratory and circulatory failure, unconsciousness, and eventual death. </p>

High sugar levels above 250 mg/dl may indicate the onset of diabetic coma. If left untreated, it can lead to death. </p>

After a meal, it can happen that the sugar value is 200 mg/dl. It is important that the value goes back down to the normal range around 100 mg/dl in the next few hours. </p>

Anyone suffering from sugar shock is dependent on the help of others, as sugar shock involves disorientation, seizures, unconsciousness and symptoms of paralysis. Accompanying persons should immediately call 911, place the patient in the recovery position, and clean the mouth of food debris. With appropriate training, glucagon should be injected subcutaneously or intramuscularly into the thigh. After awakening, immediate help can be given with the administration of glucose. </p>

When blood glucose is elevated, there is a risk of diabetic ketoacidosis, a metabolic acidosis of the blood and body. If left untreated, it can lead to diabetic coma. Therefore, at the first sign of hyperglycemia, immediate action should be taken and blood and urine levels should be checked regularly. </p>

High blood glucose levels occur when the body produces no or too little insulin (type 1 diabetes) or the body's cells cannot respond to the hormone (type 2 diabetes).Despite blood glucose-regulating therapy, the following factors can cause hyperglycemia: Eating too much and too high in carbohydrates, stress, febrile infections, too little exercise, a defective insulin pump, or taking medication incorrectly. </p>

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