[[0017]] The bane of a diabetics life... HYPERS/HIGHS

I have already written about hypoglycaemia over here so I felt it was time to write about the other end of the spectrum, hyperglycaemia (or highs as I will call them from here on out).

These are quite honestly the bane of mine (and I am sure other diabetics) life. Sometimes the highs cannot be helped, such as illness or stress, but other times, it doesn't matter how hard you try to keep your blood sugars stable, the highs just keep coming and coming and coming no matter what you do to try and stop them. Highs can also be deadly or just make you feel really sick and lethargic, amongst other things. I have actually suffered inadvertently with diabetic bulimia (diabulimia) due to constant high blood sugars, but that is a post for another date! 

Back to the post and what it is all about. Well, I will explain what hyperglycaemia is, symptoms of highs, how to treat highs and a couple of stories (alas, these will not be as funny as my hypo stories sadly, but they are poignant and bring the point home about how hard it can be to try and keep control of diabetes in an ever stressful world, or in my case, my not so ordinary world.

What is hyperglycaemia?

Hyperglycaemia is a result of too much glucose in the blood stream (check out the illustration above, those glucose molecules are definitely not making us feel very good). This can cause blood sugar readings to be very high, in my case, the highest I have achieved is 30mmol/L (be sure to check out my previous post about measuring blood glucose) but sugar levels can read higher than this, or in the case of my blood glucose metre, HI (which I think is about 35mmol/L but don't quote me on this). It is best to try and treat highs as quickly as possible, but this isn't as easy as treating a hypo... this can take longer to achieve and in my case, is not always successful.

The chart above shows just under a months amount of blood results... everything above the red line is out of range for me, or high. A lot of people have their highs set to 10mmol/L but mine is 15 due to the fact that I have struggled to keep control over the years so for the longest time, anything below 15 was decent enough for me. 

Looking at this, I realise how badly controlled my diabetes can be sometimes, especially towards lunch/afternoon. I'm still trying to figure out why I have the highs around that time of day, even when I have carb counted my breakfast and lunch, but that is a mystery for another day and not this post. 

How does hyperglycaemia happen?

Hyperglycaemia occurs due to a build up of glucose in the blood, which can simply be a result of an imbalance between the amount of insulin injected into the body and the amount of carbohydrate in food that has been eaten (although high levels of glucose can occur for other, not as common reasons).

The main causes of hyperglycaemia are:

• not enough insulin injected at meals
• not injecting before/after a meal or a sugary snack
• skipping meals
• illness
• non-diabetes related medications
• levels of physical activity
• stress/anxiety
• colder weather

As you can see, there are many factors that diabetics need to be in control of to help prevent highs from occurring. And it is vital that sugars are not high, as persistently high blood sugars can lead to diabetic complications later in life, such as:

• cardivascular disease/strokes/heart attacks
• diabetic peripheral neuropathy (nerve damage)
• diabetic retinopathy/diabetic maculopathy (damage to the small blood vessels in the eyes, leading to blindness)
• nephropathy (kidney damage/disease/failure)
• issues with the feet, such as infection, ulcers, blisters which can lead to amputation
• infection in the teeth and gums

What are the symptoms of hyperglycaemia? 

Hyperglycaemic symptoms I find, are not as obvious or noticeable as symptoms of hypoglycaemia. I have found that the symptoms of highs are subtle and only noticeable to myself... and the symptoms that I do get are very frustrating and certainly annoying to have. I have found that in a way, there are two stages to high blood sugar symptoms, the more common ones for when blood sugar levels are elevated for a shorted amount of time, then a second bunch for when blood sugars are raised for a longer period of time. 

Symptoms of short-term hyperglycaemia include:

• headaches
• dry mouth
• increased thirst
• urinating more often 
• feeling fatigued/lethargic 

Symptoms of long-term hyperglycaemis include:

• nausea/vomiting/making yourself vomit
• acetone/pear drop smell on the breath
• shortness of breath
• feeling weak
• sleeping a lot/falling asleep
• abdominal pains (in particular, around the kidney area)
• mental disturbance/confusion
• urine that smells sweeter than normal/pale coloured urine

Hyperglycaemia is a very serious problem, and the build up of glucose can result in diabetic ketoacidosis (DKA) in which toxic ketones build up in the blood stream. This can lead to hospitalisation but if left untreated, can become severe and result in coma or death. DKA is classed as a medical emergency and most people with diabetes do end up in hospital if DKA occurs.

Ketones - why are they so deadly?

I shall do a proper big post about ketones and DKA in the future, but I figured a small section about them could help those who have friends or family members with diabetes as ketones can be spotted quite easily by other people.

Ketones occur when there is not enough insulin in the blood to convert glucose into energy, so the level of this sugar increases as the liver in turn, begins to turn fat into energy instead. This causes ketones to be formed in the blood which are toxic and require medical help immediately. Ketones lead to DKA, which occurs as ketones build-up to ever increasing toxic levels. 

A symptom of hyperglycaemia as mentioned above, is the unique smell of acetone/pear drops on the breath, which is often associated with ketones, as this smell tends to only be noticed when a diabetic's body has been in hyperglycaemia for a long period of time. IF YOU EVER SMELL KETONES AROUND SOMEONE WITH DIABETES, CHECK THEIR KETONES AND/OR CALL 999 IMMEDIATELY.  

How do you treat hyperglycaemia?

I personally find that highs are harder to treat than lows. I guess this is because it depends on why you are having the hyperglycaemic attack in the first place.

The easiest way to treat hyperglycaemia is by taking insulin, which as a starting point until diabetics have found their ratios, is a unit of insulin to reduce bloods by 3.0mmol/L. I also learnt in hospital, to drink a lot of water too, which can help flush glucose from the body (although this is not as effective as doing insulin, however it is best to do both of these at the same time).

But this only works if hyperglycaemia has occurred due to not doing enough insulin or physical activity; hyperglycaemia caused by illness and stress for example, can be more difficult to treat. 

One of the biggest problems that I have personally had in trying to control my blood sugars, is the result of stress on them. I have mentioned briefly in posts prior to this one, that stress has predominated my life from an early age and as I got older, I tended to brush my own health and mental health problems under the carpet to deal with everyone else's issues, and neglecting myself is the reason why I ignored my diabetes so much. I tended to inject when I could feel dry mouth and even then, I wasn't injecting to lower my blood sugars but just to get rid of the dry mouth. 

Stress causes high blood sugars due to the fight or flight response that is in-built within us from an early age. When put in a situation that causes stress, the body releases glucose from the glycogen (concentrated glucose) that is stored in the liver. In people without diabetes, the release of hormones that is a result of stress and deal with stress cause  this glucose to be released and the blood sugar rises, however insulin is also released but in type 1 diabetics, this does not occur. This can cause blood sugars to rise in those with diabetes and this kind of sugar I find, is difficult to medicate for. This also occurs when diabetics are struck with bugs and illnesses outside of their control... for example, when I had gastroenteritis last year, I was medicating but even though I was not eating food, my blood sugars remained consistently high, no matter how much insulin I did; it also turned out I had ketones when dealing with this illness, which was another reason I was admitted as well as the neuropathy. I have since learned that if I ever end up with an illness like gastroenteritis again, that I do need to go to hospital straight away and obviously, call 999. You live and you learn after all!!!

In these situations I find its best to do everything you can to beat the illness, such as drinking a lot of water to help flush the bad stuff out of the body and increasing medication. If you are lucky enough to be able to predict when an anxious moment is coming, then do a little extra insulin, but honestly, unless you are logging every little thing that causes you stress, it is hard to know when you will become anxious or stressed, especially if it is spontaneous. Can you believe it, but some people's blood sugars can go up due to anxiety caused by a scary film! 

That is it for now folks! I hope you enjoyed this post about hyperglycaemia and how to treat it as best you can. Needless to say, all diabetics are different and what is said here may work for some but not for others. All information provided is based on my own experiences, but please, get talking to everyone else out there and find out their stories too!!! I also hope you're looking forward to future posts hinted at in this post, such as DKA and diabulimia, cold weather with diabetes and more!

Also, a big thank you to all those of you who are still following and reading my posts but also a big thank you to a member of a diabetes group I recently joined, Taz Marie, who gave me the idea to write about highs and eventually DKA and a couple of other interesting posts/interviews coming in the future!!!