Common Health Issues

Unexplained Hyperglycemia

• By Rich Health Editorial Team
• November 01, 2021

UNEXPLAINED HYPERGLYCEMIA SYMPTOMS

If you are monitoring your blood glucose, you will notice the first sign of hyperglycemia: a blood glucose reading of more than 250mg/dl. You may also notice one or more of the following symptoms: dry parched mouth, excessive thirst, warm dry skin with no sweating, frequent urination and sleepiness or confusion

 

What You Should Do When You Have Unexplained Hyperglycemia

If you have any symptoms of hyperglycemia, test your blood glucose at once. If it is over 250mg/dl, you may need to treat it right away. Talk to your doctor about what to do should your blood glucose rise above 250mg/dl. If you have any of the signs of diabetic ketoacidosis (vomiting, nausea, stomach pain, blurry vision, fever, weakness or difficulty breathing) you may require emergency treatment. You may need to take an extra dose of insulin if your blood glucose is too high, even if you do not show signs of diabetic ketoacidosis. 

 

However, if you are using an insulin pump and your pump is clogged, you may unable to deliver the extra insulin through the pump until you take care of the blockage. If the battery has run out or there is an obstruction in the insulin flow, an alarm will sound. If there is a kink in the line, straighten out the tubing to restore insulin flow. Check for clogs in the line and replace the tubing or infusion set if necessary. Also, check that there are no air bubbles in the line, that the battery is working, and the insulin syringe is not empty.

 

There may be times when blood glucose levels are high and there are no obvious problems with the pump. If this happens, other factors may be contributing. First, check your insulin. If it is not buffered, insulin may crystallize and clog or slow down the flow of liquid through the catheter. Use only buffered insulin preparations. Make sure your insulin has not expired and has not been exposed to extremes in temperature. Check that there are no clumps or floating particles in your insulin preparation. If you have used your vial of insulin for more than a month, replace it with a fresh vial.

If your insulin appears normal, check your insertion site. If the needle is near a scar or mole, move it to another site. Also, move it if is near your belt line or any other place where there is friction, or if the skin near the site is tender, red or swollen.

 

You should also check the infusion set. Make sure the needle is still intact and that insulin is not leaking around the infusion site. Make sure there is no blood or air in the line and that the line did not come loose from the pump. If the infusion set has been in place for more than 2 days, it may be time to change it. 

 

If everything else looks in order, check the pump itself. Make sure that the basal rate is set correctly and the battery has not run down. Check to see if the insulin cartridge has been placed correctly and still contains insulin. Also make sure that the pump is primed with insulin each time a fresh cartridge of insulin is put in. Another possibility is that your pump is just not working correctly. Follow the manufacturer’s instructions to see if there is a malfunction of your pump, and call the manufacturer if necessary.

 

INTENSIVE THERAPY FOR UNEXPLAINED HYPERGLYCEMIA

The Diabetes Control and Complications Trial (DCCT), a study begun in 1983, showed that you can greatly reduce the complications of diabetes by keeping your blood glucose levels under tight control. The study confirmed the suspicion that it is the excess glucose in the blood that leads to eye disease, cardiovascular disease, kidney disease and nerve disease. 

 

By monitoring frequently and taking three to four injection of insulin each day or using an insulin pump, you are more likely to keep your blood glucose levels closer to normal and delay or prevent diabetes complications. The DCCT was conducted using people with type 1 diabetes, but people with type 2 diabetes can also practice tight control through the use of diet, exercise and oral agents or with the use of insulin.

However, intensive therapy is not without its drawbacks. It requires a great deal of effort and motivation and should not be practiced by patients with cardiovascular disease, severe complications or a history of drug or alcohol abuse. It is not recommended for young children or the elderly, or anyone with a history of severe hypoglycemia. The chief problems for people adhering to a program of intensive therapy are an increased risk of hypoglycemia and greater tendency to gain weight. With proper attention and prevention, both problems can be minimized so that you can make intensive therapy work for you.

 

Hypoglycemia

When you make the switch from traditional management of diabetes to intensive therapy, you are trying to keep your blood glucose levels as close to normal as possible. This means that your overall blood glucose levels are much lower than what you might be used to and you don’t have a lot of room for error. 

 

A skipped snack, a smaller-than-normal lunch, or an extra lap around the track might be enough to trigger an episode of hypoglycemia. While practicing tight control, you can expect more frequent episodes of all levels of hypoglycemia (mild, moderate and severe). You might also be more likely to experience hypoglycemia unawareness, a condition in which you are unable to detect the early warning signs of hypoglycemia.

 

Symptoms of Hypoglycemia

Symptoms of hypoglycemia include shakiness, nervousness, sweating, irritability, chills and clamminess, rapid heartbeat, dizziness, light-headedness, anxiety, blurred vision, nausea, tingling or numbness in the tongue, confusion, strange behavior and unconsciousness.

 

Hypoglycemia Risks

Anyone practicing tight control is at an increased risk of hypoglycemia. However, if you are male, an adolescent, have had diabetes for a long time, had a high glycated hemoglobin level before intensive therapy and a low glycated hemoglobin level during intensive therapy, and a history of severe hypoglycemia before intensive management, then you are at especially high risk of hypoglycemia while practicing tight control. Hypoglycemia unawareness is also increased for people on tight control.

 

What You Should Do When You Have Hypoglycemia

If you think you are having a hypoglycemic reaction, test your blood glucose right away. If it is below 60mg/dl, you may need to eat fast-acting carbohydrate snack. Talk to your doctor or health care professional about the level at which you should begin treatment. For some people, hypoglycemia should be treated at a higher blood glucose level. 

 

Others may not become hypoglycemic until the blood glucose level is lower than 60mg/dl. If you are unable to test, but you feel any of the symptoms, treat anyhow. For initial treatment of mild to moderate hypoglycemia, start with 10-15 grams of a fast-acting carbohydrate. Wait 15 minutes, then test and treat again, if necessary. If your hypoglycemia reaction is severe, you may become confused or even unconscious. If this occurs, someone else must take over. If you are unable to eat or drink anything, you may need a glucagon injection. Make sure those around you know the warning signs and know what to do should this situation arise.

 

Prevention of Hypoglycemia

If you decide to practice intensive therapy, it is very important to take steps to prevent hypoglycemia from occurring. The most important is to become aware of the symptoms you experience during hypoglycemia. Monitor your blood glucose when in doubt and know the threshold at which your symptoms first appear and when they may change. Be aware that the glucose levels at which symptoms first appear may change during intensive management, compared to what they were on traditional therapy.

 

Blood glucose monitoring is essential for anyone with diabetes, but if you are practicing intensive therapy it is even more important. You should monitor at least four times a day—before each meal or snack and at bedtime—and you might also consider monitoring 2 hours after each meal. This is especially important during and after a period of increased exercise. 

 

If your blood glucose level is low 2 hours after you eat (less than 100mg/dl), this will tell you that you need to be careful until your next meal. This information will help you to decide whether to increase or decrease any planned activity, whether you need to adjust your next insulin dose or whether you will need to eat a snack before your meal or increase your food intake in your next meal. Always monitor your blood glucose level before driving.

 

Also, pay close attention to exercise and physical activity. Even weekend household chores or moderate activity may be enough to trigger an episode of hypoglycemia. Vigorous exercise can trigger hypoglycemia up to 12 to 24 hours following the initial activity.

Finally, to prevent hypoglycemia from occurring frequently, try to figure out what went wrong when you do have an episode. Did you skip a snack or forget to monitor your blood glucose before exercising? Did you oversleep or eat a meal later than usual? Try to figure out what you did out of the ordinary or what signs you may have missed so that you don’t repeat any mistakes the next time.

 

If, despite all your attempts at troubleshooting and preventing hypoglycemia, you still experience repeated episodes, you and your doctor may want to reevaluate your glycemic goals. Maybe you are shooting to keep your blood glucose level between 80 and 120mg/dl before meals and between 100 and 140mg/dl at bedtime. If you are attaining these goals but frequently developing hypoglycemia, then maybe you need to shoot for a slightly higher blood glucose level. Maybe a before-meal glucose level of between 100 and 160mg/dl, for example, will help you keep your blood glucose under control but prevent the frequent bouts of hypoglycemia. Talk to your doctor about which glycemic goals are suitable for you

 

WEIGHT GAIN

 Many people switch from a traditional program of diabetes management to intensive therapy experience weight gain. This tendency affects both men and women at any age equally. This may be a result of the tendency to eat more to prevent hypoglycemia. Or it could be due in small part to a more efficient metabolism. Whatever the reason, you may want to take steps to prevent excessive weight gain. This is especially true if you have type 2 diabetes or are already overweight. Excessive weight gain can contribute to further insulin resistance.

 

What You Should Do

Even before you begin an intensive management approach, talk to your doctor and nutritionist about changes in your meal plan. Your nutritionist should take a detailed nutritional history that takes into account your daily activities, what you have been eating, and what foods you like as a special treat every now and then. With this information, together you can devise a meal plan that is 200-400 calories per day less than what you have been eating. 

You will probably need to reduce between meal snacks. If you find that you need to take between-meal snacks regularly to prevent hypoglycemia, you may need to reduce your basal done of insulin instead of eating more snacks. Talk to your doctor about the best way to make these changes.

 

Instead of treating hypoglycemia with traditional snack items, such as juice or cheese and crackers, treat with pure glucose. If you eat foods that contain many non-glucose ingredient, your calorie intake will increase more than it needs to. These non-glucose ingredients can also slow the treatment of low blood glucose.

 

Make sure to make exercise a regular part of your daily routine. Talk to your health care team and consult an exercise physiologist to find an exercise program that is right for you. Your best bet is to find an activity you enjoy doing and that is convenient to do. Make it as much a part of your plan as eating and taking insulin. When you exercise more than usual, take less insulin instead of eating more. This may require extra blood testing to figure out the best way to correct an insulin dose for excess exercise.

 

Don’t be afraid to make adjustments in your meals. There may be times when you just don’t feel like eating as much or it isn’t convenient to eat as much as your plan calls for. At those times, reduce your calorie-intake and take less insulin. When you do this, make sure to test your blood glucose more frequently.

 

PANCREAS TRANSPLANTS

The first pancreas transplant was performed in 1966. Since then, thousands of pancreas transplants have been performed on people with type 1 diabetes. Patients who receive a new pancreas may be effectively cured of diabetes. They no longer need to take insulin and no longer need to test blood glucose levels or adhere to a stringent meal plan. You are probably wondering: if pancreas transplants are such a miracle cure, then why aren’t they done more often?

The major problem with pancreas transplant is that the cure can be worse than the disease. Any kind of surgery poses a risk to patients, and pancreas transplantation surgery is a major surgery. Once you receive a new pancreas, your body sees it as a foreign matter and will do anything in its power to destroy it. Therefore, any transplant patient must commit to a lifetime of immunosuppressant therapy. Immunosuppressant are drugs that suppress the immune system to prevent organ rejection. 

 

The immunosuppressant drugs you must take to prevent organ rejection can cause problems themselves. Cyclosporine, one of the most commonly used immunosuppressant drugs, can cause kidney damage, high blood pressure, nausea, hearing loss, acne, growth of body hair, and low white blood cell and platelet counts. Prednisone, a steroid drug usually given with cyclosporine, can upset the stomach and cause gastric and duodenal ulcers. It can also cause thinning of the bones, weight gain, cataracts, depression and other side effects. Imuran, another immunosuppressant, causes nausea, fatigue and fever.

 

In addition to the toxic effects of immunosuppressant drugs, patients who take immunosuppressant to prevent organ rejection must live with a suppressed immune system. That makes them less able to fight off a host of bacterial and viral infections. In a person with a suppressed immune system, even common pathogens can be life-threatening. A person on immunosuppressive drugs may also be more susceptible to cancer and other ailments. After all that, 50% of all transplanted pancreas are rejected by the patient’s immune system and fail within 1 year.

 

Because the benefits of pancreas transplantation often do not outweigh the risks, pancreas transplants are not usually done alone. However, patients with type 1 diabetes who are having a kidney transplant are often given a pancreas transplant at the same time. Since they have to face the risks of surgery and immunosuppression anyhow, it makes sense to double the benefit: a new kidney and a new pancreas.

 

What You Should Do

If you are in line for a kidney transplant and think you might also want to consider a pancreas transplant at the same time, talk to your doctor. At most major hospitals that perform transplants, a double pancreas-kidney transplant is considered routine. The pancreas usually comes from a cadaver and the kidney from a live donor. In some cases, a kidney and half of a pancreas can be obtained from a living donor. Half of a pancreas is enough to supply the insulin you need. If pancreas transplants are not offered at your hospital, you might want to locate a medical center that will perform one.

Different medical centers will have different eligibility requirements for a pancreas-only or a pancreas-kidney transplant. In general, you must have type 1 diabetes and be between the ages of 18 and 60. Your health must be good enough to enable you withstand the stress of surgery and the immunosuppressant drug therapy that follows. You should be of sound mind and emotionally stable. Your chances of having a pancreas transplant are greatly enhanced if you have kidney failure and are undergoing a kidney transplant at the same time. In addition, be aware that organ transplants are costly. You must be able to cover your expenses or have insurance that will.

 

If you are seeking a pancreas-only transplant, the criteria will be more stringent. Today, only 5% of pancreas transplants are single transplants. Pancreas-only transplants are recommended only when you have a very difficult time managing your diabetes on standard therapy and continuing to do so threatens our health. For example, you might be eligible for a pancreas-only transplant if you have brittle diabetes. 

 

This means that you are unable to control your blood glucose levels through diet and insulin therapy, frequently experience wide swings in blood glucose levels, have had a severe episodes of ketoacidosis, hypoglycemia and infection and have hypoglycemia unawareness. You may also have to have two or more complications of diabetes, such as proliferative retinopathy, nephropathy or neuropathy. In addition, you should understand than pancreas-only transplants are still investigational and have a high risk of failure. 

 

You may also be eligible for a pancreas transplant sometime after you have had a kidney transplant, since you are already on immunosuppressant therapy. This type of procedure may require that you have an acceptable creatinine clearance and evidence that your life is threatened by progression in diabetes complications or brittle diabetes.

 

There are several conditions that may make your ineligible for a pancreas transplant, whether alone or in combination with a kidney transplant. If you have coronary artery disease, cancer, poor lung function, ongoing alcohol or drug abuse, or a history of not taking good care of your health—not taking your medication, for example—you may be ineligible for a pancreas transplant. Talk to your doctor about whether a pancreas transplant would be advisable for you.

 

Other ways to replace the insulin-producing cells of the pancreas are also being investigated, but none is ready for public use. Researchers are trying to develop ways to transplant the islet cells of the pancreas—the ones that produce insulin. But islet cells are attacked by the immune system more readily than a whole pancreas. For now, islet cell transplants remain in the realm of investigational treatments.

 

Researchers are also trying to develop an artificial pancreas. This would be no more than an insulin pump that would deliver insulin as the body needs it. Right now, the roadblock is developing the technology for sensing when the body needs insulin. This requires a glucose meter that would work internally and would automatically sense when blood glucose levels are too high or too low, to activate or deactivate the artificial pancreas, much as living pancreas does automatically. We are not there yet, but many scientists are working hard to solve this problem

 

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Unexplained hyperglycemia in continuous subcutaneous insulin infusion: evaluation and treatment by Stephen Ponder, Jay Skyler et al

 

 

• Pancreas transplantation by Patrick Dean, Mark Stegall et al

 

 

• Controlling diabetes: the need for intensive therapy and barriers in clinical management by Stuart Ross