If you have diabetes, it should be cause for concern any time your blood sugar is higher than usual. High blood sugar, also known as hyperglycemia, occurs when there is not enough insulin in the body needed to lower blood sugar or when your body is unable to use the insulin properly. Some typical causes of hyperglycemia include, eating more then planned, exercising less than usual, or any kind of stress on the body such as an illness or infection. Regardless of the cause, hyperglycemia, if left untreated can become a serious problem.
When hyperglycemia occurs, we want to take action, especially when blood sugar reaches over 200 mg/dl. Below are some general steps you can take that may help your lower blood sugar. Please note that your doctor or diabetes educator should always be contacted when your blood sugar consistently runs over 250 mg/dl for more than two days.
1. Monitor more frequently. When your blood sugar exceeds the glucose parameters established by you and your doctor, it is important to check your blood sugar more frequently until it reaches your target glucose range. Typically this means checking every two hours. This will help you treat and adjust your blood sugar right away to hopefully prevent it from getting worse. This also lets you know if your blood sugar is improving and if what you are doing to lower it is helping. It is recommended to check for ketones if your blood sugar is over 250 mg/dl. Ketones are checked in the urine and tell us whether or not your body is using fat for energy instead of glucose because there is not enough insulin available to allow glucose to be used as energy. Ketones are typically more common in those with Type 1 diabetes but can still occur if you have Type 2 especially if hyperglycemia is left untreated.
2. Treat/Identify illness or infection. Being sick or having an infection can cause an increase in glucose production in the body. The extra glucose comes from a rise in adrenergic hormones when ill. This is all part of the the body’s healing process. However with this increase in glucose, the demand for insulin goes up. For this reason it is important to continue to take your diabetes medications as prescribed even if your appetite decreases. You may even need to take more during an extended illness or infection period
3. Adjust meal/food intake. A general rule of thumb is that if you decrease a meal by 15 grams of carbohydrate, since carbohydrates typically affect blood sugar the most, your blood sugar will decrease by 30 mg/dl. 15 grams of carbohydrate is the amount of carbohydrate in one starch exchange, one fruit exchange, or one cup of skim milk. Therefore is your blood sugar is 200 mg/dl before a meal and you eliminate 2 starch exchanges, or 30 grams of carbohydrate, then this may help to get your blood sugar closer to at or around 140 mg/dl, otherwise closer to your target glucose range. It can at least prevent it from increasing even further. It is important to note however that this is just a general rule of thumb as each individual may respond differently.
You can also try focusing on carbohydrates that have a low glycemic index and replace your usual carbohydrates with them. Foods with a low glycemic index do not typically raise blood sugar as quickly or dramatically. Some examples of foods with a low glycemic index include brown rice, lentils, fruits, and vegetables. Testing your body’s response to different types of carbohydrates (low glycemic vs. high glycemic) is important to understand how different foods affect your blood sugar.
4. Get Active. Typically, for most people with Type 2 diabetes, simply just increasing your activity will have a favorable response on blood sugar. When your blood sugar is higher than normal, you may want to try going for a walk. Even just walking for 20-30 minutes a day may help improve your blood sugar numbers and overall diabetes control.
5. Adjust your medications. Before making an drastic changes in your medications, you may want to first try the above steps. If these measures do not work and your blood sugar remains high, increasing the dose of your oral medications or amount of insulin you take may be warranted. This however should always be discussed with your doctor first before making any drastic changes.
6. Stay hydrated. High blood sugar means the concentration of sugar in your blood is high. Staying hydrated through drinking plenty of sugar-free fluids may help dilute it.
By Alyssa Werner, RD, CDE, LD