Hypoglycemia and Hyperglycemia

Hyperglycaemia

Hyperglycemia is elevated blood sugar above target or blood sugar 250 mg /dl or above on two separate tests at different times It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as a diabetic coma.

In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting your eyes, kidneys, nerves and heart.

Factors that contribute to hyperglycemia

• Not using enough insulin or oral 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 cortisone.
• Being injured or having surgery.
• Experiencing emotional stress.

Early signs and symptoms of hyperglycemia

Recognizing early symptoms of hyperglycemia can help you treat the condition promptly.

Frequent urination, Increased thirst, Blurred vision, Fatigue, Headache.

Later signs and symptoms of hyperglycemia needs urgent treatment at hospital

Nausea and vomiting, Shortness of breath, Dry mouth, Weakness, Abdominal pain, Confusion, Coma.

Tips to lower blood sugar

1. Regular exercise is often an effective way to control your blood sugar e.g. walking 30 minutes 5 days a week.
2. Follow your diabetes eating plan. It helps to eat less and avoid sugary beverages. If you're having trouble sticking to your meal plan, ask your doctor or dietitian for help.
3. You need to avoid high carbohydrate food like; bread (white and brown), potato, juices, dates, honey, rice, pasta and sweets.
4. Increase the intake of white meet (fish, tuna and chicken), vegetables and dairy products.
5. Drink plenty of liquids such as water and sugar free drinks throughout the day.
6. Check your blood sugar every 4 hours and write it in your log book to review it with your doctor.
7. If you forgot to take your diabetes pills take them once you remember.
8. If you are taking insulin, take your next recommended dose with fewer carbohydrate in your next meal, and if blood glucose still high 4 hours after the meal and after you have followed all the instructions you may take a correction dose of fast acting insulin according to your doctor’s instructions.
9. Always keep a list of medications and bring it on the follow-up appointment or in case of coming to emergency room

Come to emergency room in case if

1. If you are sick and cannot eat any food or drink any fluids.
2. Persistent diarrhea or vomiting.
3. your blood glucose levels are persistently above 250 mg/dL.

Follow up with the outpatient clinic (...............) within (..............) or if

1. Your blood glucose is more than 250 mg/dL even though you've taken your diabetes medication.
2. You have trouble keeping your blood glucose within the target range, and you are able to eat and drink without nausea or vomiting or diarrhea.

• Hypoglycemia is a condition in which the blood sugar (glucose) level is abnormally low (less than 70 mg/dL), and glucose is the main source of energy for your body.

Causes of hypoglycemia

1. Taking doses higher than prescribed of diabetes medications, such as insulin and oral medications that lower blood sugar levels.
2. Meals that are skipped or late.
3. Too much exercise or unplanned exercise.

Signs and symptoms of hypoglycemia

There may be no warning signs or you may:

1. Feel dizzy and hunger.
2. Confused and Nervous.
3. Fatigue, tiredness, and shaking.
4. Sweating and shaking.
5. Feel a fast heart beat.
6. Feel numb around the mouth or lips.
7. Feel moody or grumpy or not thinking clearly.
8. Have blurred vision.
9. Difficulty speaking.
10. Decreased level of consciousness and possible coma

Management of hypoglycemia

1. Check your blood sugar level immediately if you feel symptoms of low blood sugar. If it is 70 mg/dL or less, you should follow what is called the “Rule of 15".
2. Eat or drink 15 grams of fast-acting carbohydrate. Examples of this amount of fast-acting carbohydrate are (1⁄2 cup) of fruit juice or 1 tablespoon of sugar or 1 tablespoon of honey, 4 glucose tablets or 3 dates.
3. Check your blood sugar level 15 minutes later. If the blood sugar level is still low (less than 70 mg/dL), have another 15 grams of fast-acting carbohydrate.
4. When the level reaches to 100 mg/dL, eat a snack such as ( a small cup of milk or 1\2 slice of bread) that contains slow acting carbohydrates. This will help prevent another drop in blood sugar.
5. You should inform others (family members) that if you have low blood sugar , they should give you fast-acting carbohydrates if you are unable to get them by yourself.
6. Always carry a source of fast-acting carbohydrate. If you have symptoms of hypoglycemia and you do not have a blood glucose meter, have a source of fast-acting carbohydrate anyway. Avoid carbohydrate foods that are high in fat. The fat content may make it take longer to increase your blood sugar level.
7. Ask your healthcare provider if you should carry a glucagon kit. Glucagon is a medicine that is injected when you develop severe hypoglycemia and become unconscious.
8. Teach others (family members) how to help you if you have symptoms of hypoglycemia. Tell them about the symptoms. Ask them to give you a glucagon injection if you become unconscious or have a seizure due to hypoglycemia, and educate them on how to use the glucagon injection.
9. Ask them to take you to the hospital emergency department, because this is an emergency. Tell them never to try to make you swallow anything if you are in a coma or have a seizure.

Prevent of hypoglycemia

1. Eat your main meals and snacks regularly, and do not skip or delay any meal.
2. Always carry any sores of fast-acting carbohydrate like sugar, dates or glucose tablets
3. Check your blood sugar level as directed. Ask your doctor about the blood sugar levels you should have before and after meals, and when and how often you should check your blood sugar.
4. Record your blood sugar results and bring the record with you when you see your doctor, as this can help him adjust your medication, diet, or exercise schedule.
5. Check your blood sugar level before you work out. Exercise can decrease your blood sugar level.
6. If your blood sugar level is less than 100 mg/dL, have a carbohydrate snack. Examples are 1⁄2 banana, one cup of milk, or (1⁄2 cup) of juice.
7. If you will exercise for more than 1 hour, you may need to check your blood sugar level every 30 minutes also it is recommend to check your blood sugar level after exercise.
8. Take your diabetes medicine as directed. Do not take extra diabetes medicine without your doctor’s advice.
9. Tell other people who work or live with you that you have diabetes and how to treat low blood sugar.
10. You need to inform others when and how to use a glucagon kit, especially if you have type 1 diabetes (insulin-dependent diabetes mellitus).
11. Always remember to carry a card or wear a bracelet that says you have diabetes.
12. Talk with your doctor and dietitian before starting a weight loss diet.
13. Keep all your appointments and follow up regularly with your doctor, diabetes educator, and dietitian.
14. Always keep a list of your medications and bring it to your follow-up appointment or in case you go to the emergency room.

Come to the emergency room if

1. Having a seizure or being in a coma.
2. Blood sugar less than 50mg/dl and doesn't respond to treatment

Follow up with the outpatient clinic (...............) within (..............) or if

1. Frequent low blood sugar.
2. You need to adjust your medication or insulin doses.
3. You have questions about your condition.