Diabetes mellitus, or diabetes, is a disease affecting the regulation of blood glucose (sugar) levels.
An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.
With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes. Unfortunately, more than one in four people with diabetes don’t know they have it.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a major risk factor for eventually developing type 2 diabetes. The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
Having high blood sugar is hard on the body and can result in complications if left untreated.
There are times when high blood sugar can become a health emergency, and prompt medical treatment should be sought right away. Knowing how to identify high blood sugar and how to treat it can help keep people with diabetes healthy and safe.
Normal blood sugar for someone without diabetes ranges from 70-140 mg/dL. For people with diabetes, blood sugar goals can vary depending on the individual.
According to the American Diabetes Association (ADA), the goals for blood sugar are as follows:
The American Association of Clinical Endocrinologists (AADE) has more strict blood sugar goals as follows:
Any blood sugar above 200 mg/dL is considered very high, where blood sugars over 300 mg/dL may become dangerous. Some common symptoms of high blood sugar include:
- Increased thirst
- Frequent urination
- Nausea and vomiting
- Shortness of breath
- Stomach pain
- Fruity breath odor
- A very dry mouth
- A rapid heartbeat
How to lower blood sugar quickly emergency
It’s not always easy to quickly lower blood sugar, especially if the patient isn’t on insulin. People on insulin, especially those with type 1 diabetes, can administer fast- or rapid-acting insulin to correct high blood sugar.
However, this should only be done under the recommendation and guidance of a qualified health professional. Short- and rapid-acting insulins work quickly and can cause hypoglycemia (low blood sugar) if they are misused.
Injecting insulin to help correct high blood sugar is known as a correction bolus or correction factor. This amount is based on how that person tends to respond to insulin and their blood sugar goals.
If blood sugar is lowered too much after injecting insulin, it may result in hypoglycemia or low blood sugar. Low blood sugar is considered any reading below 70 mg/dL.
Symptoms of low blood sugar include:
- An irregular or fast heartbeat
- Pale skin
- Tingling or numbness of the lips, tongue, or cheek
In severe hypoglycemia, a glucagon injection may be needed to correct the low blood sugar. If hypoglycemia is over-corrected, it can lead to a rebound high blood sugar.
For people not on insulin, correcting a high blood sugar isn’t as straight-forward. Some things that can help to lower blood sugar include:
- Avoiding high-carbohydrate foods. Carbohydrates turn into glucose (sugar) when they are digested. This means that carbohydrates have the biggest impact on blood sugar levels than the other macronutrients (protein and fat). When blood sugars are high, eating carbohydrate-rich foods will likely worsen the high blood sugar.
- Foods rich in carbohydrates include starches like bread and potatoes, fruits, milk, yogurt, and refined/added sugar. Many foods include added sugars, which can worsen high blood sugar. Added sugar has many different names, including, Agave nectar, Beet sugar and Cane sugar to name but a few.
- When blood sugars are high, eating foods that don’t raise blood sugar very much (if at all) can help so that eating doesn’t worsen the high blood sugar. Protein- and fat-based foods, as well as non-starchy vegetables, are good choices to focus on when blood sugar is high. Examples of protein-rich foods include meat, eggs, cheese, unsweetened Greek yogurt, nuts, and seeds. Examples of non-starchy vegetables include broccoli, cauliflower, carrots, and leafy green vegetables, among many others.
- Staying hydrated by drinking plenty of water can help high blood sugar levels. Staying hydrated encourages regular urination, which can help eliminate some of the excess blood sugar. High blood sugar is dehydrating, so it’s essential for preventing dehydration as well.
- Exercising. Being physically active can help lower blood glucose. Muscles take up glucose for energy regardless of how much insulin is present, which is why it’s especially important for people with type 2 diabetes and insulin resistance. Blood sugar levels can stay lower for up to 24 hours after exercising, which makes regular exercise an important part of a long-term diabetes care plan.
- Blood sugar levels can actually increase during the beginning part of exercise, especially during activities like sprinting. Because of this, people with type 1 diabetes should test for ketones before starting to exercise when blood sugar levels are high. Ketones become present when insulin levels are so low that the body starts burning fatty acids for energy. Exercising with ketones present isn’t recommended since it can worsen hyperglycemia.
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When to go to the ER
When blood sugar levels are very high, it can sometimes require emergency medical attention. Such is the case for two conditions related to high blood sugar: diabetic ketoacidosis (DKA) and diabetic hyperglycemic hyperosmolar syndrome (HHS).
Diabetic ketoacidosis (DKA) affects people with type 1 diabetes and results from very high blood sugar and low insulin levels. Without enough insulin, sugar can’t get into the cells where it’s needed to use for energy. The liver will release more glucose to try to solve the problem, which further worsens high blood sugar.
Some risk factors for developing DKA include:
- Not taking insulin as prescribed or not taking insulin at all
- Type 1 diabetes that has not been diagnosed
- Stomach illness with a lot of vomiting
- Infections such as pneumonia, urinary tract infection, or sepsis
- Heart disease, such as heart attack
- Recent stroke
- Some medicine, such as steroids or antipsychotic drugs
- Recreational drug use, such as cocaine
- Blood clot to the lungs
- Significant illness or trauma
Symptoms of DKA include:
- Excessive thirst
- Frequent urination
- Nausea and vomiting
- Stomach pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
Knowing what level of blood sugar is dangerous is crucial. People should seek emergency medical care if blood sugar levels are above 300 mg/dL, there are ketones present in the urine, and the person’s healthcare provider can’t be reached, or any of the symptoms of DKA are present.
Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a condition when blood sugar is dangerously high and affects people with type 2 diabetes. Risk factors for HHS include:
- A stressful event such as infection, heart attack, stroke, or recent surgery
- Heart failure
- Impaired ability to detect thirst
- Limited access to water (especially in people with dementia or who are bedbound)
- Older age
- Poor kidney function
- Poor management of diabetes, not following the treatment plan as directed
- Stopping insulin or other medicines that lower glucose level
If the symptoms of HHS arise, emergency medical care is warranted. Symptoms of HHS include:
- Blood sugar level of 600 mg/dL or higher
- Excessive thirst
- Dry mouth
- Increased urination
- Warm, dry skin
- Drowsiness, confusion
- Vision loss
When to see a doctor
If blood sugar levels are consistently high, but it isn’t an emergency, it’s still a good idea to visit a healthcare provider. Consistently high blood sugar levels increase the risk of complications.
If a patient isn’t meeting their personal blood sugar goals, a visit with either their primary care provider or endocrinologist (diabetes specialist) is warranted. Medications and other aspects of the care plan can be adjusted, and tests can be done to find the cause of the increased blood sugar.
It’s important to speak with a healthcare provider if blood sugar levels suddenly change for no apparent reason. Blood sugars can increase due to illness and infection, so it’s a good idea to investigate these changes and not ignore them.
It’s also important for people without any known diabetes to seek medical attention if they experience high blood sugar symptoms. Millions of people have prediabetes and/or undiagnosed diabetes. There are many known risk factors for type 2 diabetes, including:
- Weight: People who are considered overweight or obese according to their body mass index (BMI).
- Age: people 45 and older are at increased risk.
- Family history of diabetes
- Race/ethnicity: diabetes tends to affect certain races more than others. At-risk races include African American, Alaska Native, Native American, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander.
- High blood pressure: if your blood pressure is higher than 120/80, you may be at increased risk.
- Altered lipid levels: low levels of HDL “good” cholesterol and high levels of LDL “bad” cholesterol are risk factors, as well as high triglycerides (blood fat).
- Pregnancy history: women with a history of gestational diabetes (GDM) or who gave birth to a baby 9 pounds or heavier are at increased risk.
- Physical activity: People who aren’t regularly active or who have a sedentary lifestyle are at increased risk.
- Smoking status: Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.
- Health history: those with a history of heart attack or stroke have a higher likelihood of developing type 2 diabetes.
- PCOS: Polycystic Ovarian Syndrome in women is a risk factor, as it usually is associated with insulin resistance.
- Acanthosis nigricans: dark, velvety patches of skin are a sign of insulin resistance and are a risk factor for developing diabetes. These patches of skin usually occur around the neck or armpits.
Complications of high blood sugar
When blood sugar levels are high, it damages the blood vessels supplying blood to the body. It’s similar to metal being corroded by rust – the longer metal is exposed to water, the more likely it is to rust.
Similarly, the longer a blood vessel is exposed to high blood sugar, the more likely it is to be damaged. When blood vessels are damaged by blood sugar, they can become more stiff and hard, and blood flow may be reduced.
The likelihood of complications increases with the length of time someone has diabetes. The best way to avoid complications is to keep blood sugar well-controlled. Some of the diabetes-related complications that can occur over time include:
- Heart (cardiovascular) disease: people with diabetes are two to four times more likely to die from cardiovascular disease than those without diabetes. People with diabetes are also more likely to have high blood pressure, which is another risk factor for heart disease. A heart attack is one potential complication of heart disease.
- Stroke: Diabetes increases the risk of stroke, as well as increases mortality when a stroke occurs.
- Kidney disease and failure: High blood sugar damages the kidneys and can lead to kidney disease. About one in four people with diabetes have kidney disease.
- Poor wound healing leading to amputations: High blood sugar inhibits proper wound healing. Diabetes is thought to be the leading cause of leg amputations worldwide.
- Neuropathy: Damage to the nerves, which can cause painful symptoms like numb and tingling legs and feet, as well as delayed stomach emptying from damage to the nerves of the stomach.
- Retinopathy and blindness: Damage to the nerves in the eyes is called retinopathy, which can lead to blindness if not treated.
High blood sugar levels aren’t healthy and can even become dangerous. High blood sugar damages the blood vessels and can lead to them becoming stiff and/or blocked.
Blood sugar should fall between 70-140 mg/dL, but blood sugar targets vary among individuals. A blood sugar over 200 mg/dL is considered very high, and levels over 300 mg/dL can warrant medical attention. In people with type 1 diabetes, very high blood sugar can lead to a dangerous condition called diabetic ketoacidosis (DKA). In people with type 2 diabetes, very high blood sugar can lead to hyperglycemic hyperosmolar syndrome (HHS). Both warrant immediate medical attention.
Blood sugar can be lowered through a combination of medication use as well as lifestyle habits such as avoiding carbohydrate- and sugar-rich foods and being physically active. Working with a healthcare provider to come up with a good diabetes care plan to manage glucose levels is the best way to avoid very high blood sugar.