What are the symptoms of hyperglycemia in diabetes. How is hyperglycemia diagnosed and treated. What causes high blood sugar in people with diabetes. How can hyperglycemia be prevented in diabetic patients.

Defining Hyperglycemia: The Silent Threat in Diabetes

Hyperglycemia, or high blood sugar, is a condition that primarily affects individuals with diabetes. It occurs when the body has too little insulin or when it can’t effectively use the insulin it produces. This results in elevated glucose levels in the bloodstream, which can lead to serious health complications if left unchecked.

The range for high blood sugar can vary depending on individual factors and the type of diabetes. Generally, blood glucose levels above 180 mg/dL (10 mmol/L) two hours after eating, or above 130 mg/dL (7.2 mmol/L) before a meal, are considered high for most people with diabetes.

Types of Diabetes and Their Relation to Hyperglycemia

• Type 1 Diabetes: The body doesn’t produce insulin
• Type 2 Diabetes: The body doesn’t use insulin effectively
• Gestational Diabetes: Occurs during pregnancy

Each type of diabetes can lead to hyperglycemia, but the underlying mechanisms and management strategies may differ.

Recognizing the Symptoms of Hyperglycemia

Identifying the signs of high blood sugar is crucial for effective diabetes management. Common symptoms of hyperglycemia include:

• Increased thirst and frequent urination
• Fatigue and weakness
• Blurred vision
• Headaches
• Difficulty concentrating
• Unintentional weight loss
• Slow-healing wounds

Is it possible to have hyperglycemia without noticeable symptoms? Yes, in some cases, especially in the early stages or with mild elevations in blood sugar, individuals may not experience obvious symptoms. This is why regular blood glucose monitoring is essential for people with diabetes.

Diagnostic Tests for Hyperglycemia and Diabetes

Accurate diagnosis of hyperglycemia and diabetes is crucial for proper management. Healthcare providers use several tests to assess blood glucose levels and diagnose diabetes:

A1C Test

The A1C test measures average blood sugar levels over the past 2-3 months. Results are interpreted as follows:

• Below 5.7%: Normal
• 5.7% to 6.4%: Prediabetes
• 6.5% or higher: Diabetes

Fasting Blood Sugar Test

This test measures blood glucose after an overnight fast:

• 99 mg/dL or lower: Normal
• 100 to 125 mg/dL: Prediabetes
• 126 mg/dL or higher: Diabetes

Glucose Tolerance Test

This test assesses how the body processes glucose:

• 140 mg/dL or lower at 2 hours: Normal
• 140 to 199 mg/dL at 2 hours: Prediabetes
• 200 mg/dL or higher at 2 hours: Diabetes

Random Blood Sugar Test

A blood sugar level of 200 mg/dL or higher, regardless of when the person last ate, can indicate diabetes.

How often should individuals with diabetes undergo these tests? The frequency of testing depends on the type of diabetes, current blood sugar control, and individual health factors. Generally, A1C tests are recommended every 3-6 months, while daily self-monitoring of blood glucose may be necessary for many patients.

Causes and Risk Factors for Hyperglycemia in Diabetes

Understanding the underlying causes of high blood sugar is essential for effective management. Several factors can contribute to hyperglycemia in people with diabetes:

1. Insufficient insulin: Either due to decreased production or ineffective use
2. Overeating or consuming high-carbohydrate foods
3. Lack of physical activity
4. Stress and illness
5. Certain medications, such as steroids
6. Hormonal changes, particularly during menstruation or pregnancy
7. Dehydration

Can stress really cause blood sugar to rise? Indeed, stress hormones like cortisol can increase blood glucose levels by promoting the release of stored glucose and reducing insulin sensitivity. This “stress hyperglycemia” can be particularly challenging for people with diabetes to manage.

Managing Hyperglycemia: Treatment Strategies and Lifestyle Changes

Effective management of hyperglycemia involves a multifaceted approach, combining medical interventions with lifestyle modifications:

Medication Management

• Insulin therapy: Adjusting doses or switching to different types of insulin
• Oral medications: Drugs that improve insulin sensitivity or reduce glucose production
• Injectable medications: GLP-1 receptor agonists or amylin analogs

Lifestyle Modifications

• Dietary changes: Focusing on balanced, portion-controlled meals
• Regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise per week
• Stress management: Techniques like meditation, yoga, or counseling
• Adequate hydration: Drinking plenty of water to help flush out excess glucose

How quickly can lifestyle changes impact blood sugar levels? Some people may see improvements in their blood glucose readings within days of implementing dietary changes and increasing physical activity. However, sustainable long-term management requires consistent effort and may take weeks or months to show significant improvements in overall glycemic control.

Preventing Hyperglycemia: Proactive Measures for Diabetes Management

Prevention is key in managing hyperglycemia and reducing the risk of complications. Here are some proactive steps individuals with diabetes can take:

1. Regular blood glucose monitoring
2. Adhering to prescribed medication regimens
3. Following a diabetes-friendly meal plan
4. Engaging in regular physical activity
5. Managing stress effectively
6. Getting adequate sleep
7. Attending regular check-ups with healthcare providers

Is it possible to completely prevent hyperglycemia in diabetes? While it may not be possible to prevent all instances of high blood sugar, especially in type 1 diabetes, consistent management and lifestyle choices can significantly reduce the frequency and severity of hyperglycemic episodes.

Complications of Chronic Hyperglycemia: Understanding the Long-term Risks

Persistent high blood sugar levels can lead to serious health complications over time. These may include:

• Cardiovascular disease
• Kidney damage (nephropathy)
• Nerve damage (neuropathy)
• Eye damage (retinopathy)
• Foot problems, including increased risk of amputation
• Skin and mouth conditions
• Increased susceptibility to infections

How long does it take for these complications to develop? The timeline for developing complications varies among individuals and depends on factors such as blood sugar control, overall health, and genetic predisposition. Some complications may begin to develop within a few years of poorly controlled diabetes, while others may take decades to manifest.

Emerging Technologies and Treatments for Hyperglycemia Management

The field of diabetes care is continuously evolving, with new technologies and treatments offering improved methods for managing hyperglycemia:

Continuous Glucose Monitoring (CGM) Systems

These devices provide real-time glucose readings, allowing for more precise management and early detection of hyperglycemic trends.

Artificial Pancreas Systems

Also known as closed-loop systems, these combine CGM with insulin pumps to automatically adjust insulin delivery based on blood glucose levels.

Smart Insulin

This developing technology aims to create insulin that activates only when blood glucose levels are elevated, potentially reducing the risk of hypoglycemia.

Gene Therapy

Researchers are exploring ways to modify genes to improve insulin production or sensitivity, particularly for type 1 diabetes.

How accessible are these new technologies to the average patient? While some advanced technologies like CGM systems are becoming more widely available, others, such as artificial pancreas systems, may still be limited in availability or covered by insurance. As research progresses and technologies improve, it’s likely that more patients will gain access to these innovative management tools.

Understanding and managing hyperglycemia is crucial for individuals living with diabetes. By recognizing symptoms, adhering to treatment plans, and making informed lifestyle choices, people with diabetes can significantly reduce their risk of complications and improve their quality of life. Regular communication with healthcare providers and staying informed about new developments in diabetes care can further enhance management strategies and outcomes.

Diabetes Tests | CDC

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You’ll need to get your blood sugar tested to find out for sure if you have prediabetes or type 1, type 2, or gestational diabetes. Testing is simple, and results are usually available quickly.

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

Your doctor will have you take one or more of the following blood tests to confirm the diagnosis:

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

Result*	A1C Test	Fasting Blood Sugar Test	Glucose Tolerance Test	Random Blood Sugar Test
Diabetes	6.5% or above	126 mg/dL or above	200 mg/dL or above	200 mg/dL or above
Prediabetes	5. 7 – 6.4%	100 – 125 mg/dL	140 – 199 mg/dL	N/A
Normal	Below 5.7%	99 mg/dL or below	140 mg/dL or below	N/A

*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Source: American Diabetes Association

If your doctor thinks you have type 1 diabetes, your blood may also tested for autoantibodies (substances that indicate your body is attacking itself) that are often present in type 1 diabetes but not in type 2 diabetes. You may have your urine tested for ketones (produced when your body burns fat for energy), which also indicate type 1 diabetes instead of type 2 diabetes.

Tests for Gestational Diabetes

Gestational diabetes is diagnosed using blood tests. You’ll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes (due to having more risk factors), your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Glucose Screening Test

This measures your blood sugar at the time you’re tested. You’ll drink a liquid that contains glucose, and then 1 hour later your blood will be drawn to check your blood sugar level. A normal result is 140 mg/dL or lower. If your level is higher than 140 mg/dL, you’ll need to take a glucose tolerance test.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. Results can differ depending on the size of the glucose drink and how often your blood sugar is tested. Ask your doctor what your test results mean.

Prevent Type 2 Diabetes

If your test results show you have prediabetes, ask your doctor or nurse if the lifestyle change program offered through the CDC-led National Diabetes Prevention Program is available in your community. You can also search for an online or in-person program. Having prediabetes puts you at greater risk for developing type 2 diabetes, but participating in the program can lower your risk by as much as 58% (71% if you’re over age 60).

Diabetes Treatment Plan

If your test results show you have type 1, type 2, or gestational diabetes, talk with your doctor or nurse about a detailed treatment plan—including diabetes self-management education and support services—and specific steps you can take to be your healthiest.

Hyperglycemia in diabetes – Symptoms & causes

Overview

High blood sugar, also called hyperglycemia, affects people who have diabetes. Several factors can play a role in hyperglycemia in people with diabetes. They include food and physical activity, illness, and medications not related to diabetes. Skipping doses or not taking enough insulin or other medication to lower blood sugar also can lead to hyperglycemia.

It’s important to treat hyperglycemia. If it’s not treated, hyperglycemia can become severe and cause serious health problems that require emergency care, including a diabetic coma. Hyperglycemia that lasts, even if it’s not severe, can lead to health problems that affect the eyes, kidneys, nerves and heart.

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Symptoms

Hyperglycemia usually doesn’t cause symptoms until blood sugar (glucose) levels are high — above 180 to 200 milligrams per deciliter (mg/dL), or 10 to 11.1 millimoles per liter (mmol/L).

Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious symptoms may become. But some people who’ve had type 2 diabetes for a long time may not show any symptoms despite high blood sugar levels.

Early signs and symptoms

Recognizing early symptoms of hyperglycemia can help identify and treat it right away. Watch for:

• Frequent urination
• Increased thirst
• Blurred vision
• Feeling weak or unusually tired

Later signs and symptoms

If hyperglycemia isn’t treated, it can cause toxic acids, called ketones, to build up in the blood and urine. This condition is called ketoacidosis. Symptoms include:

• Fruity-smelling breath
• Dry mouth
• Abdominal pain
• Nausea and vomiting
• Shortness of breath
• Confusion
• Loss of consciousness

When to see a doctor

Seek immediate help from your care provider or call 911 if:

• You have ongoing diarrhea or vomiting, and you can’t keep any food or fluids down
• Your blood glucose levels stay above 240 milligrams per deciliter (mg/dL) (13.3 millimoles per liter (mmol/L)) and you have symptoms of ketones in your urine

Causes

During digestion, the body breaks down carbohydrates from foods — such as bread, rice and pasta — into sugar molecules. One of the sugar molecules is called glucose. It’s one of the body’s main energy sources. Glucose is absorbed and goes directly into your bloodstream after you eat, but it can’t enter the cells of most of the body’s tissues without the help of insulin. Insulin is a hormone made by the pancreas.

When the glucose level in the blood rises, the pancreas releases insulin. The insulin unlocks the cells so that glucose can enter. This provides the fuel the cells need to work properly. Extra glucose is stored in the liver and muscles.

This process lowers the amount of glucose in the bloodstream and prevents it from reaching dangerously high levels. As the blood sugar level returns to normal, so does the amount of insulin the pancreas makes.

Diabetes drastically reduces insulin’s effects on the body. This may be because your pancreas is unable to produce insulin, as in type 1 diabetes. Or it may be because your body is resistant to the effects of insulin, or it doesn’t make enough insulin to keep a normal glucose level, as in type 2 diabetes.

In people who have diabetes, glucose tends to build up in the bloodstream. This condition is called hyperglycemia. It may reach dangerously high levels if it is not treated properly. Insulin and other drugs are used to lower blood sugar levels.

Risk factors

Many factors can contribute to hyperglycemia, including:

• Not using enough insulin or other diabetes medication
• Not injecting insulin properly or using expired insulin
• Not following your diabetes eating plan
• Being inactive
• Having an illness or infection
• Using certain medications, such as steroids or immunosuppressants
• Being injured or having surgery
• Experiencing emotional stress, such as family problems or workplace issues

Illness or stress can trigger hyperglycemia. That’s because hormones your body makes to fight illness or stress can also cause blood sugar to rise. You may need to take extra diabetes medication to keep blood glucose in your target range during illness or stress.

Complications

Long-term complications

Keeping blood sugar in a healthy range can help prevent many diabetes-related complications. Long-term complications of hyperglycemia that isn’t treated include:

• Cardiovascular disease
• Nerve damage (neuropathy)
• Kidney damage (diabetic nephropathy) or kidney failure
• Damage to the blood vessels of the retina (diabetic retinopathy) that could lead to blindness
• Feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations and, in some severe cases, amputation
• Bone and joint problems
• Teeth and gum infections

Emergency complications

If blood sugar rises very high or if high blood sugar levels are not treated, it can lead to two serious conditions.

• Diabetic ketoacidosis. This condition develops when you don’t have enough insulin in your body. When this happens, glucose can’t enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy.

  When fat is broken down for energy in the body, it produces toxic acids called ketones. Ketones accumulate in the blood and eventually spill into the urine. If it isn’t treated, diabetic ketoacidosis can lead to a diabetic coma that can be life-threatening.

• Hyperosmolar hyperglycemic state. This condition occurs when the body makes insulin, but the insulin doesn’t work properly. Blood glucose levels may become very high — greater than 600 mg/dL (33.3 mmol/L) without ketoacidosis. If you develop this condition, your body can’t use either glucose or fat for energy.

  Glucose then goes into the urine, causing increased urination. If it isn’t treated, diabetic hyperosmolar hyperglycemic state can lead to life-threatening dehydration and coma. It’s very important to get medical care for it right away.

Prevention

To help keep your blood sugar within a healthy range:

• Follow your diabetes meal plan. If you take insulin or oral diabetes medication, be consistent about the amount and timing of your meals and snacks. 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 level several times a week or several times a day. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range. Note when your glucose readings are above or below your target range.
• Carefully follow your health care provider’s directions for how to take your medication.
• Adjust your medication if you change your physical activity. The adjustment depends on blood sugar test results and on the type and length of the activity. If you have questions about this, talk to your health care provider.

Topic 8. Compensation criteria for diabetes

In a person without diabetes, the fasting blood glucose level does not exceed 5.5 mmol / l in capillary blood, after eating – 7.8 mmol / l.

Ideally, a diabetic patient should aim for the same level of glycemia, allowing rises to 10 mmol/l at the peak of a meal. However, this is not always possible or necessary. Maintaining glucose levels close to normal is often associated with the risk of hypoglycemia. A diabetic patient receiving insulin therapy constantly balances the risk of complications due to high glycemia and the risk of hypoglycemia. And in some cases, this balance is shifted towards a higher level of glycemia. This is especially common in the elderly, for whom hypoglycemia is extremely dangerous.

Target glycemic levels are therefore individual!

The younger the patient, the less comorbidities he has, the closer to normal his glycemic control should be. But what is given to the young can be harmful to the elderly.

glycated hemoglobin ( HbA1c) is currently used as a criterion for diabetic compensation.

Glycated hemoglobin shows what was the compensation for the last 2-3 months. It must be determined at least 2 times a year.

Approximate targets for glycemic control by age and disease are shown in the table. Under certain conditions, treatment goals may be less stringent

If glycemic hemoglobin was initially high at diagnosis of diabetes (this is especially common in type 2 diabetes), glycemic control should not be quickly brought to the target level, especially in older people, as well as in people with changes in the eye day. Insulin-independent organs (brain, blood vessels, retina) are accustomed to a high level of glycemia, and if they suddenly “cut their rations”, they may not endure this without damage. Glycated hemoglobin in this case should decrease gradually, by about 0.5% in 3 months.

To assess compensation for the last 2-3 weeks, an analysis for fructosamines is prescribed. The normal level of fructosamines is up to 280 µmol/L. At a level of up to 320 µmol / l, diabetes is considered compensated in the last 2-3 weeks, 320-370 – subcompensated, more than 370 – decompensated.

However, even if you have ideal HbA1c, but there are daily fluctuations in blood sugar of more than 5 mmol/l, this cannot in any way protect you from the development of complications.

Glycated hemoglobin is like the average temperature in a hospital. And if the target value of glycated hemoglobin is achieved due to frequent hypoglycemia, then this has a very bad effect on target organs.

Recently, TIR (time in range) has been used as the main indicator of diabetes compensation. TIR shows how many percent of the time a person had a blood glucose level within acceptable limits. There are also other indicators that reflect daily fluctuations in blood glucose levels. But all these indicators can only be determined by continuous monitoring of blood glucose.

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What is the best blood sugar range to guide the management of women with gestational diabetes mellitus (GDM) during pregnancy?

What is the problem (question)?

Almost a quarter of pregnant women develop gestational diabetes mellitus (GDM), depending on their ethnicity and the diagnostic criteria used. GDM is characterized by high blood sugar (hyperglycemia) during pregnancy and is associated with an increased risk of high blood pressure (hypertension) and protein in the urine during pregnancy (preeclampsia). These women are more likely to have a C-section delivery, develop type 2 diabetes, postpartum depression, and later cardiovascular disease. High blood sugar, which is associated with GDM, then often returns to normal after childbirth, but women with GDM are at risk of developing GDM again in subsequent pregnancies. Children of mothers diagnosed with GDM have an increased risk of high birth weight (greater than 4000 g), an increased risk of birth trauma due to their size, and the development of breathing difficulties after birth. These infants are also at risk of developing obesity and type 2 diabetes in the future.

Why is this important?

Women with GDM are monitored to control high blood sugar and reduce the risk of GDM to mother and child. The blood sugar level is monitored by measuring its concentration in the blood to ensure that it is maintained within a predetermined level or range. To test blood sugar levels in mothers, blood is usually taken from a finger, a drop of blood is placed on a test strip, which is then inserted into a small machine (glucometer) that reads blood sugar levels from the test strip. Glucose meter readings alert a pregnant woman to her current blood sugar levels and are used as a guide for her monitoring and treatment. For example, how many units of insulin a woman needs before meals. However, it is not clear at this time what to recommend to pregnant women with newly diagnosed GDM in terms of what blood sugar range to target and what levels require treatment.

What evidence did we find?

We searched for evidence up to 31 January 2016 and found one small randomized controlled trial (abstract only), of poor quality, in 180 women from Canada. This trial compared two blood sugar ranges, one more restrictive and one more relaxed, and reported very few health outcomes for pregnant women and their babies.

This trial did not provide any data for the main outcomes of this review. For women, these outcomes were related to the occurrence of high blood pressure and the appearance of protein in the urine during pregnancy, the development of type 2 diabetes. For children, these outcomes were mortality, increased birth weight, increased risk of birth injury due to the large size of the child, and disability.

In the tightly controlled group, more women were on insulin (but this result is based on very low quality evidence). There were no clear differences in the rate of delivery by caesarean section. Other secondary outcomes in women with GDM relevant to this review were not reported. Differences in the number of children born weighing over 4000g or small for gestational age were not reported. No other secondary outcomes in children relevant to this review were reported. No adverse events were reported in this study either.

What does this mean?

This review found that there is not yet sufficient evidence from randomized controlled trials to determine the best blood sugar range to improve the health of pregnant women with GDM and their children.