Hyperglycemia – StatPearls – NCBI Bookshelf

Continuing Education Activity

The term “hyperglycemia” is derived from the Greek hyper (high) + glykys (sweet/sugar) + haima (blood). Hyperglycemia is blood glucose greater than 125 mg/dL while fasting and greater than 180 mg/dL 2 hours postprandial. A patient has impaired glucose tolerance, or pre-diabetes, with a fasting plasma glucose of 100 mg/dL to 125 mg/dL. This activity reviews the pathophysiology of hyperglycemia, its presentation, complications and highlights the role of the interprofessional team in the evaluation and management of patients with this condition.

Objectives:

• Describe the causes of hyperglycemia.

• Review the history and physical exam findings expected in a patient with hyperglycemia.

• Summarize the treatment options for hyperglycemia.

• Explain modalities to improve care coordination among interprofessional team members in order to improve outcomes for patients affected by hyperglycemia.

Access free multiple choice questions on this topic.

Introduction

The term “hyperglycemia” is derived from the Greek hyper (high) + glykys (sweet/sugar) + haima (blood). Hyperglycemia is blood glucose greater than 125 mg/dL while fasting and greater than 180 mg/dL 2 hours postprandial. A patient has impaired glucose tolerance, or pre-diabetes, with a fasting plasma glucose of 100 mg/dL to 125 mg/dL. A patient is termed diabetic with a fasting blood glucose of greater than 125 mg/dL.[1][2]

When hyperglycemia is left untreated, it can lead to many serious life-threatening complications that include damage to the eye, kidneys, nerves, heart, and peripheral vascular system. Thus, it is vital to manage hyperglycemia effectively and efficiently to prevent complications of the disease and improve patient outcomes.

Etiology

Factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production. Glucose homeostasis is a balance between hepatic glucose production and peripheral glucose uptake and utilization. Insulin is the most important regulator of glucose homeostasis.[3][4]

Secondary Cause of Hyperglycemia

The secondary causes of hyperglycemia include the following:

• Destruction of the pancreas from chronic pancreatitis, hemochromatosis, pancreatic cancer, and cystic fibrosis

• Endocrine disorders that cause peripheral insulin resistance like Cushing syndrome, acromegaly, and pheochromocytoma

• Use of medications like glucocorticoids, phenytoin, and estrogens

• Gestational diabetes is known to occur in 4% of all pregnancies and is primarily due to decreased insulin sensitivity

• Total parental nutrition and dextrose infusion

• Reactive as seen postoperatively or in critically ill patients

Major Risk Factors for Hyperglycemia

• Weight more than 120% of the desired body weight

• Family history of type 2 diabetes

• Native Americans, Hispanics, Asian Americans, Pacific Islanders, or African Americans

• Presence of hyperlipidemia or hypertension

• History of gestational diabetes[5]

• Presence of polycystic ovarian syndrome

Epidemiology

The incidence of hyperglycemia has increased dramatically over the last two decades due to increased obesity, decreased activity level, and an aging population. The prevalence is equal between men and women. The countries with the greatest number of patients with diabetes included China, India, United States, Brazil, and Russia. Hyperglycemia is more prominent in low to medium-income households.

The latest data released by the Centers for Disease Control and Prevention indicate that there are nearly 30.5 million Americans with diabetes and nearly 84 million Americans with prediabetes. These numbers are set to increase significantly over the next decade.[6][7]

Pathophysiology

Hyperglycemia in a patient with type 1 diabetes is a result of genetic, environmental, and immunologic factors. These lead to the destruction of pancreatic beta cells and insulin deficiency. In a patient with type 2 diabetes, insulin resistance and abnormal insulin secretion lead to hyperglycemia.

According to recent studies, metabolic disturbances like type 2 diabetes mellitus increases the risk of cognitive decline and Alzheimer dementia. Alzheimer dementia is also a risk factor for diabetes type 2. Recent studies have indicated these diseases are connected both at clinical and molecular levels. Like peripheral insulin resistance leading to type 2 diabetes, brain insulin resistance is linked to neuronal dysfunction and cognitive impairment in Alzheimer dementia.[8]

History and Physical

Symptoms of severe hyperglycemia include polyuria, polydipsia, and weight loss. As the patient’s blood glucose increases, neurologic symptoms can develop. The patient may experience lethargy, focal neurologic deficits, or altered mental status. The patient can progress to a comatose state. Patients with diabetic ketoacidosis may present with nausea, vomiting, and abdominal pain in addition to the above symptoms. They also may have a fruity odor to their breath and have rapid shallow respirations, reflecting compensatory hyperventilation for the acidosis.

The physical examination can reveal signs of hypovolemia like hypotension, tachycardia, and dry mucous membranes.

Evaluation

When evaluating a patient for hyperglycemia, the focus should be on the patient’s cardiorespiratory status, mental status, and volume status. Bedside serum glucose can be obtained quickly. Testing includes serum electrolytes with the calculation of the anion gap, blood urea nitrogen and creatinine, and complete blood count. Urinalysis by dipstick assesses glucose and ketones in the urine. Arterial blood gas or venous blood gas may be necessary if serum bicarbonate is substantially reduced.[9]

Blood Glucose Determination

To determine if the patient has developed type 2 diabetes the patient needs to have the following outcomes on these tests:

• A fasting plasma glucose level of 126 mg/dL or higher

• A 2-hour plasma glucose level of 200 mg/dL or higher during a 75-g oral glucose tolerance test (OGTT)

• Random plasma glucose of 200 mg/dL or higher in the presence of symptoms of hyperglycemia

• A hemoglobin A1c level of 6.5% or higher

Treatment / Management

The treatment goals of hyperglycemia involve eliminating the symptoms related to hyperglycemia and reducing long-term complications. Glycemic control in patients with type 1 diabetes is achieved by a variable insulin regimen along with proper nutrition. Patients with type 2 diabetes are managed with diet and lifestyle changes as well as medications. Type 2 diabetes also may be managed on oral glucose-lowering agents. Patients with hyperglycemia need to be screened for complications including retinopathy, nephropathy, and cardiovascular disease.

Goals of Treatment

Treatment goals are to reduce the following complications associated with hyperglycemia:

• Kidney and eye disease by regulation of blood pressure and lowering hyperglycemia

• Ischemic heart disease, stroke, and peripheral vascular disease by control of hypertension, hyperlipidemia, and cessation of smoking

• Reduce the risk of metabolic syndrome and stroke by control of body weight and control of hyperglycemia

Patients who have hyperglycemia and are confirmed to have type 2 diabetes need to be referred to an endocrinologist. Unless there is a contraindication, the drug of choice to lower hyperglycemia is metformin. In addition, some patients may require insulin therapy in combination with other agents.

Prevention of Complications

To prevent complications of hyperglycemia, the following preventive approaches are recommended:

• Refer to an ophthalmologist for yearly eye exams

• Monitor hemoglobin A1c levels every 3-6 months

• Check urinary albumin levels every 12 months

• Examine the feet at each clinic visit

• Maintain the Blood pressure to less than 130/80 mmHg

• Initiate statin therapy if the patient has hyperlipidemia

Some patients are prone to greater glycemic variability of their blood sugars within a day and also variability for the same time on different days, thereby causing frequent episodes of hypoglycemia and hyperglycemia. These patients need close monitoring by an endocrinologist with a treatment plan intended to reduce both the risks or at least maintain one risk while reducing the other.

Differential Diagnosis

There are many conditions that can present with hyperglycemia. Differential diagnosis of hyperglycemia include:

• Diabetes mellitus type 1 and 2

• Stress-induced hyperglycemia

• Medications induced like steroids

• Acromegaly

• Cushing disease

• Iatrogenic (from intravenous fluids with dextrose and tube feeds)

Prognosis

The prognosis of individuals with hyperglycemia depends on how well the levels of blood glucose are controlled. Chronic hyperglycemia can cause severe life- and limb-threatening complications. Changes in lifestyle, regular physical exercise, and changes in diet are the keys to a better prognosis. Individuals who maintain euglycemia have a markedly better prognosis and an improved quality of life compared to individuals who remain hyperglycemic. Once the complications of hyperglycemia have developed, they are basically irreversible. Countless studies have shown that untreated hyperglycemia shortens lifespan and worsens the quality of life. Thus, an aggressive lowering of hyperglycemia must be initiated, and patients must be closely followed. Studies suggest that one should try to achieve an A1C level of less than 7%. However, controlling blood sugars too tightly can result in hypoglycemia which is not well tolerated by elderly individuals who already may have a pre-existing cardiovascular disease.[10]

Complications

Complications of untreated or uncontrolled hyperglycemia over a prolonged period of time include:

Microvascular Complications

• Retinopathy

• Nephropathy

• Neuropathy

Macrovascular Complications

• Coronary artery disease

• Cerebrovascular disease

• Peripheral vascular disease

Patients with diabetes are more prone to depression than those without diabetes. This is more so in newly diagnosed diabetics and young patients due to significant lifestyle changes that are needed. [11]

Postoperative and Rehabilitation Care

Hyperglycemia is common postoperatively. High blood sugars postoperatively are associated with higher perioperative complications so the target blood sugars should be kept around 140-180 mg/dL. Multiple teams take care of postoperative patients during their hospital stay, thereby needing a multidisciplinary team to create and follow protocols to treat hyperglycemia and decrease perioperative and postoperative complications.[12]

Consultations

Hyperglycemia can be managed by internists but if remains uncontrolled then consultation with endocrinology is needed. The management of diabetes and its complications requires a multi-disciplinary team. Following specialties are involved in the management of diabetes and its complications

• Endocrinologist

• Ophthalmologist

• Nephrologist

• Cardiologist

• General surgeon

• Vascular surgeon

Deterrence and Patient Education

Patients diagnosed with diabetes need comprehensive care in the first few months of the diagnosis as management can be overwhelming and time-consuming. Patients and family members need to be educated about testing blood sugar, taking medications especially insulin, going to their medical appointments, and lifestyle modifications which include diet and exercise. Patients need to be given information for diabetes classes.

Pearls and Other Issues

Patients with severe hyperglycemia should be assessed for clinical stability including mentation and hydration. Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute, severe disorders related to hyperglycemia.

Patients confirmed with type 2 diabetes are faced with a life-long challenge to maintain euglycemia. This is not an easy undertaking and is also prohibitively expensive. Patients must be educated that making changes in their lifestyle can markedly improve their prognosis.

Enhancing Healthcare Team Outcomes

Diabetes management is very complex and time-consuming. A newly diagnosed patient can easily become overwhelmed, leading to non-compliance with treatment which would further lead to irreversible complications. Patients and family members need to work closely with primary care providers, endocrinologists, dieticians, and diabetic educators to help achieve optimal therapeutic goals and prevent complications. Home health nursing services for disease management in the first few weeks have been shown to improve outcomes and should be utilized when available.[13]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Villegas-Valverde CC, Kokuina E, Breff-Fonseca MC. Strengthening National Health Priorities for Diabetes Prevention and Management. MEDICC Rev. 2018 Oct;20(4):5. [PubMed: 31242164]

2.

Hammer M, Storey S, Hershey DS, Brady VJ, Davis E, Mandolfo N, Bryant AL, Olausson J. Hyperglycemia and Cancer: A State-of-the-Science Review. Oncol Nurs Forum. 2019 Jul 01;46(4):459-472. [PubMed: 31225836]

3.

Yari Z, Behrouz V, Zand H, Pourvali K. New Insight into Diabetes Management: From Glycemic Index to Dietary Insulin Index. Curr Diabetes Rev. 2020;16(4):293-300. [PubMed: 31203801]

4.

Simon K, Wittmann I. Can blood glucose value really be referred to as a metabolic parameter? Rev Endocr Metab Disord. 2019 Jun;20(2):151-160. [PMC free article: PMC6556155] [PubMed: 31089886]

5.

Bashir M, Naem E, Taha F, Konje JC, Abou-Samra AB. Outcomes of type 1 diabetes mellitus in pregnancy; effect of excessive gestational weight gain and hyperglycaemia on fetal growth. Diabetes Metab Syndr. 2019 Jan-Feb;13(1):84-88. [PubMed: 30641818]

6.

Jacobsen JJ, Black MH, Li BH, Reynolds K, Lawrence JM. Race/ethnicity and measures of glycaemia in the year after diagnosis among youth with type 1 and type 2 diabetes mellitus. J Diabetes Complications. 2014 May-Jun;28(3):279-85. [PubMed: 24581944]

7.

Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, Knopman DS, Walker K, Burgard S, Mosley TH, Gottesman RF, Selvin E. The Association of Late-Life Diabetes Status and Hyperglycemia With Incident Mild Cognitive Impairment and Dementia: The ARIC Study. Diabetes Care. 2019 Jul;42(7):1248-1254. [PMC free article: PMC6609963] [PubMed: 31221696]

8.

Kubis-Kubiak AM, Rorbach-Dolata A, Piwowar A. Crucial players in Alzheimer’s disease and diabetes mellitus: Friends or foes? Mech Ageing Dev. 2019 Jul;181:7-21. [PubMed: 31085195]

9.

Shakya A, Chaudary SK, Garabadu D, Bhat HR, Kakoti BB, Ghosh SK. A Comprehensive Review on Preclinical Diabetic Models. Curr Diabetes Rev. 2020;16(2):104-116. [PubMed: 31074371]

10.

Elgebaly MM, Arreguin J, Storke N. Targets, Treatments, and Outcomes Updates in Diabetic Stroke. J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1413-1420. [PubMed: 30904470]

11.

Yayan EH, Zengin M, Erden Karabulut Y, Akıncı A. The relationship between the quality of life and depression levels of young people with type I diabetes. Perspect Psychiatr Care. 2019 Apr;55(2):291-299. [PubMed: 30614548]

12.

Duggan EW, Carlson K, Umpierrez GE. Perioperative Hyperglycemia Management: An Update. Anesthesiology. 2017 Mar;126(3):547-560. [PMC free article: PMC5309204] [PubMed: 28121636]

13.

Goswami G, Scheinberg N, Schechter CB, Ruocco V, Davis NJ. IMPACT OF MULTIDISCIPLINARY PROCESS IMPROVEMENT INTERVENTIONS ON GLUCOMETRICS IN A NONCRITICALLY ILL SETTING. Endocr Pract. 2019 Jul;25(7):689-697. [PubMed: 30865543]

Disclosure: MIchelle Mouri declares no relevant financial relationships with ineligible companies.

Disclosure: Madhu Badireddy declares no relevant financial relationships with ineligible companies.

The relationship between blood sugar level and GI

The blood sugar level regulation mechanism

When you eat rice, bread, or any other typical food high in carbohydrates, it is digested by the stomach and small intestine, where it is absorbed into the blood as glucose. Figure 1 shows how it is absorbed into the body.

Figure 1: Absorption of glucose

1. 1The sugar in food is absorbed into the blood as glucose.
2. 2The pancreas secretes insulin in reaction to the increase in glucose.
3. 3Because the glucose is absorbed into the liver, muscle, adipose (fat) tissue and other cells, the blood sugar level drops to the level it was before anything was eaten.
   This is the mechanism found in healthy people.

When glucose enters the bloodstream, insulin facilitates its uptake into the body’s cells. When an excess of glucose is ingested, insulin over secretion occurs. Insulin increases the biosynthesis of fat and suppresses its breakdown. Thus, it becomes easier for fat to accumulate in body tissues.

Blood sugar level will not drop if the sugar in the blood is not properly processed due to, for example, too little insulin being secreted, or resistance to the action of insulin. If blood sugar levels have not decreased several hours after eating on a regular basis, this indicates a susceptibility to diabetes. To avoid this and stay healthy, we should eat types of foods that will not cause a sudden, extreme rise in blood sugar levels.

What is BMI?

What is a healthy blood sugar level

• Fasting blood sugar level 99mg/dL (Japan Society of Ningen Dock)
• Postprandial blood sugar level (2 hours after eating) 7.8mmol/L (140mg/dL) (International Diabetes Federation)

Blood sugar level rises every time you eat

Chart: Meals and increases in blood sugar level

Your blood sugar level rises immediately after eating a meal or snack (Figure 2). In a healthy person, insulin then starts working, and the blood sugar level returns to the pre-meal level 2 hours after eating.
In untreated diabetes patients, the blood sugar level does not return to the pre-meal level of its own accord. Some people’s blood sugar level remains high two hours after eating, even though on an empty stomach it would be at a normal level. As a result, the risk of developing diabetes increases as insulin is not properly secreted, or does not work properly in the body.
In order to make sure insulin works properly, it is important not to overeat and to avoid becoming obese. Knowing which foods will not cause a sudden and extreme spike in blood sugar level and using this knowledge in your daily life will help you to prevent obesity and diabetes, and maintain good health.

What foods do not raise blood sugar level much?

High calorie foods may or may not cause the blood sugar level to rise

Many people think that all high-calorie foods raise blood sugar level, but this is not always the case.

In general, foods that cause blood sugar level to rise the most are those that are high in carbohydrates, which are quickly converted into energy, such as rice, bread, fruits and sugar.
Next are foods high in protein, such as meats, fish eggs, milk and dairy products, and oily foods.
However, even though carbohydrates affect blood sugar levels, if you don’t eat them your diet will be unbalanced and you won’t feel satisfied after your meal, which can lead to excessive consumption of foods rich in protein and fat.

Food containing three major nutrients

Carbohydrates do raise blood sugar levels quickly. However, recent studies have shown that even amongst foods that have the same amount of carbohydrates, there are two categories: those that cause a sudden rise in blood sugar levels and those that cause a more moderate rise, depending on the amount of dietary fiber contained.
Taking bread as an example, whole grain rye bread and pizza crusts are low GI foods, while French bread and bagels are high GI foods.

It is important to know which foods are low GI and which are high GI.

The University of Sydney has defined foods with a GI value of over 70 as “high GI foods,” foods with a GI value of between 56 and 69 as “mid-range GI foods,” and foods with a GI value of 55 or under as “low GI foods”, when using glucose as the reference food (where glucose = 100).

Because high GI foods cause a sudden spike in the blood sugar level, large amounts of insulin are secreted in order to process the sugar in the blood, causing a spike in insulin secretion to handle the sugar. When low GI foods are eaten, the sugar is gradually absorbed into the body so the blood sugar level rises gradually. Thus, an appropriate amount of insulin is secreted and sugar is promptly taken up by the tissues.

Thus, knowing which foods are low GI foods (causing moderate amounts of sugar to be absorbed) is very important to living a healthy life.
Making sure that carbohydrates, an essential type of nutrient, are absorbed by the body in moderate amounts is related to blood sugar levels, obesity, and of course a healthy diet.

GI of main food

Reference 1: Fitz-Henry, A. , In vitro and in vivo rates of carbohydrates digestion in Aboriginal bushfoods and contemporary Western Foods., in Human Nutrition Unit. 1982, University of Sydney: Australia.

Reference 2: Kentaro M, et al. Am J Clin Nutr 2006;83:1161-9.

Signs of high and low blood sugar levels

A person with diabetes may experience high blood sugar levels. Signs (symptoms) of high blood sugar include the following:

– thirst; skin,

– weight loss without cause,

– itching of the skin or mucous membranes.

It should be noted that these signs may not be present all together, and in addition, there are some additional ones, for example, pustular rashes on the skin. It often happens that the listed symptoms disturb the patient at the beginning of the disease, and then the body, as it were, “gets used” to living on the background of high sugar and these sensations disappear. Experience shows that many patients do not feel unwell even at a blood sugar level of 1416 mmol/l. Of course, a sharp increase in sugar levels compared to the “usual”, albeit already elevated, will again cause a deterioration in well-being in the form of the listed signs.

Diabetic coma. Acetone

A sharp deterioration in blood sugar levels is quite possible over many years of diabetes. The reasons for this may be different, for example, the cessation of insulin treatment, or the development of some other disease (pneumonia, acute appendicitis, heart attack, etc.). In this case, the blood sugar level can rise very strongly, in addition, a special substance appears in the body in large quantities – acetone , and all this together can lead to a serious condition with loss of consciousness – diabetic coma . Coma is life-threatening, but it never develops suddenly and imperceptibly, and therefore its development is quite possible to prevent. That is why a diabetic patient should be attentive to his condition, be able to properly control it and take the necessary measures in time. All this will be discussed in detail later.

Signs of low blood sugar
(hypoglycemia)

What are the symptoms of hypoglycemia?

Unlike hyperglycemia, which can be maintained in a patient with diabetes for a long time, hypoglycemia develops quickly, suddenly. Its typical symptoms are:

– sudden onset of severe weakness,

– sweat,

– trembling,

– anxiety, inability to concentrate,

– rapid heartbeat,

– hunger.

As with high blood sugar, not all symptoms necessarily develop together. In addition, some patients with hypoglycemia may regularly experience any peculiar sensations, for example, numbness or tingling in the nose, tongue or upper lip, etc. From the side, pallor of the skin may be noticeable. Finally, hypoglycemia may not manifest itself at all, and a reduced rate is detected only when measuring blood sugar levels.

The reverse situation – sensations of hypoglycemia at normal blood sugar levels may indicate that the body has adapted to increased sugar and its decrease to normal levels is perceived as hypoglycemia. This kind of sensational trickery doesn’t mean you have to keep living on high sugar levels; on the contrary, it is necessary to gradually achieve their reduction and then the body will again get used to the normal state.

Patients often report that they “feel” their sugar well, but these sensations can be deceiving.
This is easy to prove by comparing subjective feelings and blood sugar measurements; they very often do not coincide, to the surprise of patients. This applies to both hyper and hypoglycemia.

Hypoglycemic coma

If blood sugar drops too much, this can lead to serious effects on the central nervous system. For example, a kind of numbness may develop when the patient is unable to take the necessary actions to treat hypoglycemia, or even complete loss of consciousness. The last one is called hypoglycemic coma . Any coma is very dangerous, so even slight sensations of hypoglycemia should be taken seriously and action should be taken immediately to treat it. Read more about the causes of hypoglycemia and the correct actions for hypoglycemia in the corresponding chapter.

Renal sugar threshold

Normal blood sugar does not appear in urine. In most diabetic patients, sugar appears in the urine only when its blood level exceeds 10 mmol / l. The fact is that the kidneys are an important regulator of the constancy of the internal environment for the body: they retain the necessary substances in the blood, remove unnecessary ones, and also rid the body of accumulated excesses of various substances. So, when sugar becomes too much, it begins to be excreted in the urine. However, this process cannot completely normalize blood sugar in a diabetic patient.

The level of blood sugar at which it begins to enter the urine is called the “renal threshold”. Rarely, but still it happens that the renal threshold is significantly lower or higher than 10 mmol / l. This may be important for a diabetic patient if they plan to self-measure their urine sugar.

DIABETES FOOT CARE

DIABETES AND CARDIOVASCULAR DISEASE

DIABETES AS A CHRONIC DISEASE

SELF-CONTROL IN DIABETES

HYPOGLYCEMIA

THE ROLE OF PHYSICAL ACTIVITY IN TYPE 2 DIABETES

5 signs of elevated blood glucose suffer a dangerous rise in blood glucose levels.

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Understanding how the body will signal high sugar levels.

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How is blood sugar regulated?

What causes high blood sugar? Elevated blood sugar (more precisely, blood glucose) occurs when glucose accumulates in the vascular bed. In a healthy body, the pancreas secretes insulin, which regulates blood glucose levels. Under its action, it enters cells and tissues for further use. Eating a ton of sugary foods isn’t enough to cause a blood sugar imbalance – your pancreas works hard to keep your blood glucose levels in a fairly small range.

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Disruption of this process results in hyperglycemia (increased glucose levels). In some cases, the pancreas simply does not produce enough insulin to equalize blood glucose levels. In other situations, high blood sugar may result from insulin resistance. Then the body will respond to this with even more insulin.

In this article, we have listed the five main signs that can be suspected of high blood sugar before laboratory tests. If you have these symptoms, it is recommended that you contact your doctor for advice.

Frequent urination

This is one of the most common signs of excessively high blood sugar. This is because if there is too much sugar in the blood, it affects the function of the kidneys. The kidneys are trying to get rid of excess sugar, and in doing so, they excrete water along with it in the form of urine.

Increased thirst

The downside of frequent urination associated with high blood sugar is dehydration, which can cause excessive thirst. Therefore, a constant desire to drink is another of the most common signs of too high blood glucose levels. Excessive thirst and dehydration are side effects of frequent urination caused by the kidneys trying to remove excess blood glucose in the urine.

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Unexplained fatigue

Fatigue is an insidious symptom that can have many causes. On the one hand, fatigue can occur as a result of regular lack of sleep, but it can also be a sign of more serious problems. This is why it is important to view the body as a whole, as it can help pinpoint the causes of fuzzy symptoms such as fatigue.

While normal episodes of fatigue are part of human life, chronic fatigue is a reason to consult a doctor. This is especially true if you are experiencing prolonged fatigue along with other symptoms related to blood sugar.

Poor wound healing

Slow healing wounds are another sign of chronic hyperglycemia. Elevated glucose levels can affect the elasticity and width of blood vessels. As a result, the free movement of blood throughout the body may be hindered, which impairs the functionality of the circulatory system. In particular, wounds or ulcers on the limbs can take a long time to heal. This, of course, is due to the fact that they are farthest from the heart that pumps blood, and therefore their circulation suffers the most.

Nerve tingling

Neuropathy is broadly defined as damage to nerve bundles that results in a sensation of tingling, numbness, or buzzing. These symptoms are most often felt in the hands and feet. However, they can also occur in the gastrointestinal and urinary tracts. Diabetic neuropathy is unfortunately common, but tingling nerves can be a sign of high blood sugar, even in those not diagnosed with diabetes.

If a person lives with elevated blood glucose levels for many years, it is likely that their nerves may be damaged as a result and not work properly. Neuropathy can be caused by complications unrelated to blood glucose levels, but it is extremely important to be aware of these sensations if you experience them in combination with other signs of high blood sugar.