What Are the Signs of High and Low Blood Sugar?

One of the challenges of managing diabetes is maintaining consistent blood sugar (glucose) levels. Even with diligence, some situations can cause high blood sugar, or hyperglycemia, while others can bring on low blood sugar, or hypoglycemia.

After all, it’s not just carbohydrate intake that influences the amount of glucose coursing through your bloodstream when you have type 2 diabetes. Emotional stress and certain medications can increase your blood sugar levels, and a boost in activity can cause it to drop, says Megan O’Neill, CDCES, a medical science liaison for diabetes care at Abbott healthcare company in Monterey, California. Sometimes, people experience a spike in their blood sugar early in the morning due to the “dawn phenomenon,” a temporary surge of hormones that occurs as the body prepares to wake, according to the Cleveland Clinic.

“For people with diabetes, managing blood glucose levels is especially important,” O’Neill says. “Levels that are too low or high can result in complications that affect your kidneys, heart, and vision, reduce your quality of life, require expensive interventions, or even be fatal.”

RELATED: 5 Strategies to Help Avoid Diabetes Complications

The more prepared you are to spot the signs of both high and low levels, the better able you’ll be to quickly and easily bring them back within a desired range and stay healthy.

What’s the right range for you? The answer is slightly different for everyone, and your doctor can help you pinpoint yours. The American Diabetes Association (ADA) generally recommends trying to stay within these blood sugar targets:

• Between 80 and 130 milligrams per deciliter (mg/dL) before meals
• Less than 180 mg/dL two hours after meals

The first step to staying in these ranges, and course-correcting high and low blood sugar levels along the way, is to monitor your blood sugar levels with a glucose meter.

Clinical guidelines recommend that anyone taking insulin test their glucose at least four times per day and as many as 12 times per day. Those who are pregnant or have difficulty maintaining healthy blood sugar levels also need to test their blood sugar more often. Factors that increase the ideal testing frequency include the type of insulin, past levels of glucose control, and symptoms, O’Neill says. Some people with diabetes can benefit from continuous glucose monitoring, a device that allows you to get readings without finger pricks every five minutes, she says.

RELATED: 9 Signs Your Blood Sugar Is Out of Control

About High Blood Sugar (Hyperglycemia)

High glucose levels occur when the body doesn’t have enough insulin or can’t properly use the insulin it has to shuttle glucose from the bloodstream to the body’s muscles, organs, and tissues for fuel, O’Neill says. As a result, the amount of sugar in the blood builds up.

Hyperglycemia typically happens when you consume more carbohydrates or bigger portions of food than usual, if you don’t take enough insulin or other diabetes medication as prescribed, and if you decrease your levels of physical activity, she says. Heightened stress levels can also increase blood sugar levels. Non-diabetes-related medications that are known to raise blood sugar levels include steroids, beta blockers, birth control pills, and many mental health medications, she explains.

Signs of high blood sugar include frequent urination, fatigue, dry or itchy skin, feeling thirsty, more frequent infections, and eating more food but not gaining as much weight as usual, says Athena Philis-Tsimikas, MD, the corporate vice president for the Scripps Whittier Diabetes Institute in La Jolla, California.

High blood sugar levels can cause these symptoms through various mechanisms, according to the Mayo Clinic. For example, high blood sugar levels damage blood vessels and nerves throughout the body. They can also deprive organs of energy and can cause fluid to accumulate in the eyes. And in an attempt to get your blood sugar to a healthier level, your body will often increase urine output.

A blood sugar reading above 180 milligrams per deciliter (mg/dL) is considered above normal and can bring on these symptoms, although it’s possible to have high blood sugar without any symptoms, Dr. Philis-Tsimikas says.

A reading above 300 mg/dL can be dangerous, according to the University of Michigan, which recommends immediately informing your doctor if you have two or more readings of 300 mg/dL in a row. In severe cases, very high blood sugar levels (well above 300 mg/dL) can result in coma. If you experience mental confusion, nausea, or dizziness, proceed to the emergency room.

Ways to treat high blood sugar include:

• Take your medications as directed. Missing doses or taking insulin or other diabetes-managing medications at incorrect times can lead to large fluctuations in blood sugar levels up or down, O’Neill says. Apps such as Medisafe, which is free to download on the App Store and on Google Play, can help you stay on top of your medication regimen. The top-rated app allows you to plug your meds into your calendar and set reminders so you never miss a dose.
• Eat carbohydrates in moderation. The ADA recommends an individualized carb count for everyone with diabetes. Higher intakes can result in hyperglycemia and lower intakes in hypoglycemia. Count carbs by using an app such as the Carb Manager keto diet app, which is top rated and free to download on the App Store and Google Play. It’s not just for those on the ketogenic diet; with the free version, you can record food, track your carb and calorie intake, monitor weight loss, and log workouts.
• Exercise regularly with your doctor’s guidance. Exercise can lower blood sugar in the short term by using glucose for fuel. It can also help you manage your blood sugar over the long term by increasing insulin health, O’Neill says. Plenty of exercise apps and free online resources exist; work with your CDCES to come up with an individualized exercise plan.

RELATED: 10 Surprising Causes of Blood Sugar Swings

About Low Blood Sugar (Hypoglycemia)

Low blood sugar levels happen when there’s too little glucose left in the bloodstream to continue supplying fuel to your organs, muscles, and tissues. It most often occurs when you don’t eat enough food, especially carb-containing foods, given your blood-sugar-lowering medications and physical activity levels, O’Neill says. Levels can decrease gradually or suddenly.

When the amount of glucose in the bloodstream drops to too-low levels, the body reacts by releasing epinephrine, also called adrenaline or the “fight or flight” hormone. Epinephrine revs your heart rate and can cause sweating, shaking, anxiety, and irritability. If not enough glucose is able to reach the brain, the result may be difficulty concentrating, confused thinking, and slurred speech. In extreme cases, a lack of glucose within the brain can lead to seizures, coma, and even death, she says.

People with low glucose levels (lower than 70 mg/dL) can use the ADA’s “15-15 Rule,” which advises people consume 15 g of carbs, wait 15 minutes, and check their levels again. If the number is still low, repeat until reaching at least 70 mg/dL. It’s recommended that you check glucose with a traditional glucometer, not a continuous glucose monitor, given the lag time of the latter.

You can find 15 g of carbs in:

• 1 slice of bread
• 1 small piece of fresh fruit
• ? cup of yogurt
• ½ to 1 cup of juice, skim milk, or regular soda
• Three to four hard candies (such as Jolly Rancher or Werther’s Original)
• Glucose tablets (such as ReliOn and TRUEplus) as indicated on the label
• Glucose gel (such as Glutose 15 and Insta-Glucose) as indicated on the label

Once your glucose levels are back to normal, the ADA suggests going ahead and eating your next scheduled meal or snack, which will help prevent levels from dropping again.

But if your symptoms don’t stop, call your doctor or seek medical attention. If you experience more than two blood sugar readings below 70 mg/dL in a week, notify your doctor and go over your treatment plan.

RELATED: 10 Warning Signs of Low Blood Sugar

A Few Final Notes on Keeping Blood Sugar Stable

Taking an active, intentional approach to your blood sugar levels is crucial to your quality of life and overall health, O’Neill says. Avoiding too-high or too-low blood sugar levels will help you avoid adverse symptoms and health complications, and staying within your target range can enable you to feel your best and do whatever you want to do in life, she says.

Test your blood sugar regularly, listen to your body, and don’t ever hesitate to reach out to your doctor.

Additional reporting by Karen Appold.

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How to Lower Blood Sugar Quickly in an Emergency: Tips and More

The quickest way to lower your blood sugar is to take fast-acting insulin. Exercising is another fast, effective way. However, in severe cases, you should go to the hospital.

High blood sugar levels are known as hyperglycemia or high blood glucose. This can result in diabetic ketoacidosis (DKA), when insulin levels are low. it is a medical emergency. DKA typically occurs in type 1 diabetes.

Symptoms of DKA include:

• shortness of breath
• breath that smells fruity
• nausea and vomiting
• dry mouth

If you aren’t sure what to do, call your doctor for instructions on administering a dose of insulin and for advice about whether to go to the emergency room.

This article looks at ways to lower your blood sugar quickly when to go to the emergency room or see a doctor, and tips for managing high blood sugar.

When treated early, you can bring high blood sugar levels down and prevent complications, including DKA.

Some sources suggest that drinking water or eating a high protein snack can quickly lower your blood sugar levels, though there isn’t enough research to support this.

If you have high blood sugar and need to lower it fast, try the following methods:

Take your insulin as prescribed

High blood sugar occurs when your body has too little insulin, or your body can’t use insulin properly. Administering insulin can bring your blood sugar levels down.

Talk to your doctor about how much rapid-acting insulin you should administer when your blood sugar is high.

You may want to check your blood sugar a minimum of 30 minutes after taking insulin to make sure your blood sugar is going down and that it’s not dropping too low.

In these instances, you should not administer more correction insulin until at least 3 hours later to prevent insulin stacking and hypoglycemia.

Exercise

Exercise is a fast and effective way to lower your blood sugar levels. Exercise can lower your blood sugar for 24 hours or more. This is because it makes your body more sensitive to insulin.

Physical activity causes the body to demand glucose for energy. As a result, the cells deliver glucose to the muscles and blood sugar levels usually drop.

Importantly, if your blood sugar is above 240 mg/dl, you should check your urine for ketones. If ketones are present, do not exercise because this can make your blood sugar rise even higher.

While exercise is an effective way to lower your blood sugar throughout the day, some exercises — particularly short bursts of strenuous activity — can briefly increase blood sugar levels.

This is because strenuous activity activates the body’s stress response, causing a release of glucagon to power the muscles.

According to the University of Michigan, blood sugar levels of 300 mg/dL or more can be dangerous. They recommend calling a doctor if you have two readings in a row of 300 or more.

Call your doctor if you’re worried about any symptoms of high blood sugar. They can offer advice and reassurance.

See your doctor if you have consistently high blood sugar levels. Symptoms of this include:

• consistently high blood sugar readings
• frequent urination
• increased thirst
• high levels of sugar in urine

Ask your doctor how often to check your blood sugar and your ideal blood sugar levels.

High blood sugar can be very concerning because your body can start burning fat for energy instead of blood glucose.

This can cause DKA, which is a medical emergency and can be fatal if left untreated.

Symptoms that can indicate you should go to the emergency room include:

• ketones in your urine
• confusion
• nausea
• shortness of breath
• stomach pain
• vomiting
• fruit-scented breath

DKA is a serious complication of type 1 diabetes. It’s rare in people with type 2 diabetes, but can occur.

When to call 911

If you or someone around you is experiencing any of the above symptoms in relation to diabetes, call 911 or visit the nearest emergency room. Prompt treatment can enhance outcomes.

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Checking your blood sugar and then treating hyperglycemia early will help prevent any complications.

Health problems can arise when someone has high blood sugar regularly and without treatment.

Examples of complications include:

• nerve damage, called diabetic neuropathy, that may affect sensations in the feet and hands
• diabetic retinopathy, or damage to the blood vessels in the eyes that affects vision
• increased risks for kidney problems
• increased risks for heart problems

Taking steps to keep your blood sugar at target levels can help to minimize the likelihood that these complications will occur.

Find several tips for avoiding blood sugar spikes here.

Here are some general guidelines for blood sugar ranges:

Read more about blood sugar monitoring here.

Most people can manage their diabetes in a way that stops their blood sugar levels from ever getting too high. The following tips can help:

• following your treatment regimen
• eating a balanced diet
• regularly exercising
• reducing stress
• staying hydrated
• following a consistent sleep schedule
• maintaining a moderate weight

Administering insulin and exercising are two of the most common ways to get blood sugar levels down.

However, if someone has ketones in their urine or symptoms of excessively high blood sugar, they may need to go to the emergency room.

Blood sugar levels – targets and recommendations

Understanding blood glucose levels is a key skill in diabetes self-management. In this article, we look at target blood sugar ranges for people without diabetes and for adults and children with type 1 and type 2 diabetes.

If you are self-monitoring with a glucometer, you need to understand what the numbers (blood sugar readings) are saying.

Recommended blood sugar levels are subject to individual interpretation, so you should discuss your target blood sugar ranges with your doctor.

The following ranges are guidelines provided by the National Institute for Clinical Excellence (NICE), but each person’s target range should be agreed upon by their physician or diabetes advisor.

Recommended Blood Glucose Levels

The NICE recommended blood glucose levels are listed below for adults with type 1 diabetes, type 2 diabetes, and children with type 1 diabetes.

In addition, the target group of the International Diabetes Federation for people without diabetes is indicated.

The table gives general recommendations. The individual goal set by your doctor is the one you should aim for.

Normal and diabetic blood sugar levels

For most healthy people, normal blood sugar levels look like this:

• 4.0 to 5.4 mmol/l during fasting.
• up to 7.8 mmol/l 2 hours after eating.

For people with diabetes, blood sugar levels are as follows:

• Before meals : 4 to 7 mmol/l for people with type 1 or type 2 diabetes.
• After a meal : up to 9 mmol/l for people with type 1 diabetes and less than 8.5 mmol/l for people with type 2 diabetes.

Blood sugar level in the diagnosis of diabetes

The following table lists the criteria for diagnosing diabetes and prediabetes.

A blood sample for a random plasma glucose test can be taken at any time. It does not require such planning and is therefore used in the diagnosis of type 1 diabetes when time is of the essence.

Fasting plasma glucose test

Fasting plasma glucose test is taken after at least eight hours of fasting and is therefore usually taken in the morning. The NICE guidelines consider a fasting plasma glucose result of 5.5 to 6.9 mmol/L, because someone has a higher risk of developing type 2 diabetes, especially when accompanied by other risk factors for developing type 2 diabetes.

Glucose Tolerance Test (OGTT)

An oral glucose tolerance test involves first taking a fasting blood sample and then taking a very sweet drink containing 75 g of glucose.

After drinking this drink, you must remain still until another blood sample is taken 2 hours later.

HbA1c Test for Diabetes Diagnosis

The HbA1c test does not directly measure blood glucose, but the test result depends on how high or low the blood glucose is, typically lasting 2 to 3 months.

Indications for diabetes or pre-diabetes are given under the following conditions:

• Normal: below 42 mmol/mol (6.0%)
• Prediabetes: 42 to 47 mmol/mol (6.0 to 6.4%)
• Diabetes: 48 mm ol/mol (6.5% or more)

Diabetes mellitus

Diabetes is an endocrine disease, a complex of pathological conditions, which are based on the pathology of the synthesis and function of insulin, as well as impaired glucose metabolism. As a result, the patient develops persistent hyperglycemia – a high concentration of glucose in the blood.

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Pathology refers to chronic diseases. Gradually, in addition to carbohydrate pathology affects other types of metabolic processes – fat, protein, mineral. The clinical picture of diabetes is diverse, because it affects different organs and systems. The consequences of diabetes affect the condition of the skin, peripheral nerves, brain, kidneys, heart and blood vessels. Each of the violations entails appropriate consequences, and as a result, diabetes is a combination of several pathologies.

Laboratory diagnosis of diabetes is important for making a diagnosis, monitoring treatment, determining the degree and stage of the process. Various features of hyperglycemia are indicators for a particular therapeutic tactic.

How to recognize the disease?

Symptoms of diabetes develop depending on the stage of the process. The disease can gradually develop or debut in the form of an acute condition – coma. To organize the signs of diabetes, they are divided into two categories: basic and additional.

Consider the main signs of diabetes:

• Polyuria. Frequent urination, increased fluid output. This is due to the fact that high glucose levels increase osmotic pressure, which affects the functioning of the renal glomeruli and tubules. Glucosuria develops – there is a lot of glucose in the urine, although normally it is not there at all. Patients note an increase in the nighttime urge to urinate.
• Polydipsia. In diabetes, there is intense thirst, which is not associated with physical exertion or weather conditions. If in the usual mode of life the patient notes a strong thirst and a frequent desire to drink water, it is worth considering taking a blood test for glucose. This clinical sign is associated with increased fluid loss.
• Polyphagy. A person constantly wants to eat. This hunger, like thirst, is not associated with environmental conditions or increased stress. The reason is that more nutrients are consumed and their metabolism in tissues is disrupted. Glucose is in the blood, but does not enter the cells. This affects the receptors, the body perceives the situation as a lack of glucose and increases appetite to replenish the supply.
• Slimming. Since glucose metabolism is disturbed, the catabolism of fats and proteins increases. This leads to a decrease in the volume and weight of the body. Weight loss occurs with increased appetite, which further enhances it.

This is a typical pattern for type 1 diabetes. In this case, the pathology can begin acutely, the symptoms develop quickly and the patient remembers the approximate time of onset of the disease.

Less specific, additional symptoms are common to all types of diabetes. They occur gradually, the patient cannot remember exactly how long they have been bothering him.

The following changes may occur:

• skin and mucous membranes constantly itch and itch;
• unpleasant dryness of the oral mucosa appears;
• muscle weakness is felt;
• persistent headache;
• frequent and prolonged inflammation of the skin, including purulent nature, which do not heal even during treatment;
• visual disturbances;
• the appearance of acetone in the urine.

There may be other general symptoms such as weakness and fatigue. It becomes difficult for a person to work or study, working capacity decreases, sleep is disturbed.

Modern diagnostic program for pathology

There are the following diagnostic methods for disorders of glucose metabolism:

• Determination of the level of glucose in the blood
• Glucose tolerance study
• Determination of glycated hemoglobin
• Urinalysis for the presence of acetone and glucose and determination of their level
• Determination of the level of insulin in the blood
• Analysis for C-peptide
• Analysis for Leptin
• Determination of antibodies to pancreatic beta cells (ICA, GAD, IAA, IA-2)

Let us consider in more detail these methods and their features

1) Determining the concentration of glucose in the blood shows how well insulin performs its functions, whether glucose is supplied to cells or is it in the blood. The normal concentration of glucose in the blood in humans is 3.3 -5.5 mmol / l. If the result is below the normal level, this is called hypoglycemia. It occurs in case of poisoning, functional disorders of the digestive tract, some diseases of the liver and pancreas, oncopathology, intoxication. High glucose levels – hyperglycemia. Characteristic for diabetes mellitus, chronic pathology of the liver, pancreas, hyperkalemia, hemorrhages in the brain tissue.

The technique is indicated for pathology of the liver, pancreas, obesity, to confirm or exclude diabetes, as well as to control its treatment.
Blood for analysis is collected in the morning, before meals and not earlier than 8 hours after the last meal. The patient should not be subjected to physical or emotional stress from the evening before the study.

2) Test for glucose tolerance. The study is indicated when the concentration of glucose in the blood does not go beyond the critical limits. If the measurement of glucose shows a result of 3.88 to 7 mmol / l, it is too early to speak of hyper- or hypoglycemia and the patient’s condition should be clarified. The test is also used for those who have risk factors for developing diabetes.
The study is carried out in the morning, before meals and not earlier than 8 hours after the last meal. The patient should be in a calm state, not subjected to physical exertion and stress. The test is not performed if the blood glucose level exceeds 7 mmol/L.
How is the test going? First, the level of glycemia is measured with a glucometer, after which blood is taken. Next, the patient is asked to drink 300 ml of water with 75 g of glucose dissolved in it. After 2 hours, blood is taken again. During this time, you can not drink and eat, smoke and exercise.
The test is deciphered as follows: a positive result is a blood glucose concentration of less than 7.8 mmol / l, from 7.8 to 11.0 – tolerance is considered impaired, if glycemia is above 11. 0 – a diagnosis of “Diabetes mellitus” is made.

3) Glycated hemoglobin is an indicator that distinguishes short-term hyperglycemia from a long-term pathological glucose metabolism. The principle of the study is based on the detection and measurement of the amount of hemoglobin that has irreversibly bound to glucose molecules. The technique allows you to evaluate the picture for the last 3 months, since that is how long an erythrocyte with altered hemoglobin remains in the blood. The score is important in predicting the complications of diabetes and making a diagnosis. Also, the analysis shows how good the treatment of the disease was over the past period and whether correction is needed.
The normal concentration of glycated hemoglobin is 4 to 5.9%. If the value exceeds 8% – correction of treatment tactics is urgently required.
Special preparation before the analysis is not required. The results do not depend on food intake, exercise and time of day. The study is indicated in the diagnosis of diabetes, to control the dynamics of the process.

4) Diabetic urine test includes acetone and glucose testing. An assessment of the daily amount of urine is used to determine the total glucosuria per day. Normally, there should be no glucose in the urine. Sometimes the analysis is divided into time intervals so that four servings of urine are obtained. This allows you to determine the daily fluctuations and find out their cause. Single urine collection is the standard procedure for determining or ruling out glucosuria. The assessment of the level of acetone occurs in a similar way and is performed simultaneously with the determination of glucose. Acetone is also normally absent in the urine, its appearance indicates pathology.
The technique is used to control the quality of treatment. It is also used for poor health, general health disorders, during illness.

5) Determination of the level of insulin is necessary for prolonged hyperglycemia. The hormone rises in response to a high concentration of glucose – this is natural and physiological. And the doctor manages to assess the features of glucose-insulin metabolism, thanks to this technique. Venous blood is used for analysis. It is advisable to combine this test with a glucose tolerance test.
The study is carried out on an empty stomach and after an 8-hour break after eating. Intense exercise should be avoided. The day before, you should stop eating food with a high sugar content. Do not smoke for 2 hours before the test.

6) Analysis for C-peptide is included in the diagnosis of diabetes, as it is a product of carbohydrate metabolism and shows its quality in the body. As a rule, the level of this substance corresponds to the concentration of insulin in the blood. Insulin resistance and pancreatic islet pathology are accompanied by a decrease in C-peptide. Normal indicator – 0.9-7.9. An elevated concentration indicates the presence of type 2 diabetes mellitus, reactions to glucose-lowering drugs may indicate the presence of insulinoma, antibodies to insulin, neuroendocrine processes and kidney problems.
Preparation for analysis involves the rejection of intense loads, exercise, stress. It is necessary to donate blood on an empty stomach, before giving up not only food, but also smoking.

7) Analysis for leptin is also part of the Comprehensive Diabetes Health Assessment Program. It is a hormone that regulates appetite and body weight. It is produced by adipocytes – fat cells. The norm is 1.1 – 27.6 ng / ml for men and 0.5-13.5 ng / ml for women.
Preparation for the analysis includes the refusal of food 8 hours before blood donation, a small amount of water is allowed. The patient should avoid stress and stress.
The study is indicated if the patient is suspected of having a deficiency of this hormone, impaired reproductive function, if it is necessary to differentiate diabetes or obesity, as well as with frequent thrombosis. The value may increase with increased food intake, diabetes, which does not depend on insulin levels, as well as obesity. A reduced result may accompany rapid weight loss, prolonged fasting, and a genetic deficiency of the hormone.

8) Pancreatic cell antibody test is used to diagnose autoimmune disorders of carbohydrate metabolism. This is an indicator of the destruction of gland cells, which has an autoimmune mechanism. It is used to correct therapy, differential diagnosis, determine the type of diabetes in complex cases and with an incomprehensible clinic.
Normally, antibodies to pancreatic cells and the body should not be. Their presence indicates a malfunction of the immune system.
The blood test is taken on an empty stomach, it is necessary to avoid physical and emotional stress before the examination. In addition to eating, you should stop smoking, you can drink a small amount of water without gas.
All analyzes must be carried out under appropriate conditions, with asepsis and antisepsis. The collected biological material must be properly stored and transported to the laboratory.