How Hyperglycemia Is Treated

The treatment of hyperglycemia depends on a variety of factors, including duration of and frequency of hyperglycemia and its severity, as well as the person's age, health, and cognitive function. For example, an elderly person with a complex health history and limited cognitive function should be treated much differently than a younger, generally healthy person who presents with newly diagnosed diabetes.

The American Diabetes Association (ADA) stresses the importance of individualized treatment plans for all people with diabetes. And, although they have an algorithm dedicated to helping physicians prescribe medication to help treat hyperglycemia, the individual person should always be put first.

In the event that you experience hyperglycemia, there are things you can do at home to treat it, too. But, depending on the extent of hyperglycemia, you may need to contact your healthcare provider for assistance in altering your treatment plan. In extreme cases such as a diabetic ketoacidosis (DKA) emergency, assistance is required.

Home Remedies and Lifestyle

Lifestyle management is a critical factor in treating hyperglycemia. In fact, all diabetes medications are meant to be used as an adjunct to diet and lifestyle changes. Should a person not change his or her lifestyle and rely on medication alone, eventually those medications will stop working and he will need to add more medications to get blood sugars under control.

The key to lifestyle modification is to get support and be consistent. Support in the form of education, specifically diabetes self-management education (DSME), will help. The ADA recommends that all people with diabetes receive DSME at diagnosis, annually for assessment of nutrition and emotional needs, when new complicating factors arise that influence self-management, and when transitions in care occur.

DSME can help you to make changes in your lifestyle. The following lifestyle changes can treat hyperglycemia: 

Diet

Carbohydrates impact blood sugars the most. Eating excessive amounts of carbohydrates, such as refined grains (white bread, rolls, bagels, cookies, rice, pasta, crackers, sweets), sugary foods, and sweetened beverages can increase the risk of hyperglycemia. Therefore, eating a controlled and modified carbohydrate diet rich in fiber can help.

There is no one perfect diet for diabetes. The ADA states that all individuals receive individualized medical nutrition therapy (MNT), preferably by a registered dietitian who is knowledgeable and skilled in diabetes-specific MNT. Studies have shown that MNT delivered by a dietitian is associated with A1C decreases of 0.3 to 1 percent for people with type 1 diabetes and 0.5 to 2 percent for those with type 2 diabetes.

Exercise

The ADA states that breaking up extended sedentary activity and avoiding extended periods of sitting may prevent type 2 diabetes for those at risk and may also aid in glycemic control for those with diabetes. That's because exercise can help reduce hyperglycemia by burning glucose. For example, going for a walk after a big meal can help burn excess sugar in the blood. Regular exercise is also important for weight control,which can reduce hyperglycemia and improve overall health.

There are occasions when you should avoid exercise when your blood sugar is high. If your blood sugar is above 240 mg/dL and you have ketones, you should avoid exercise. Exercising with ketones can raise your blood sugar even higher.

Before starting any exercise routine make sure you are cleared by a physician.

Weight Loss

Weight loss is beneficial for reducing blood sugars because it improves insulin sensitivity. The ADA states, "there is strong and consistent evidence that modest, persistent weight loss can delay the progression from prediabetes to type 2 diabetes and is beneficial to the management of type 2 diabetes." Some studies suggest that losing weight by following a very low-calorie diet can actually put diabetes into remission, even for those people who have had diabetes for a minimum of six years. The key to weight loss though is keeping it off and receiving ongoing support.

It is important to note that weight-loss is most likely to lower hyperglycemia in the beginning stages of diabetes or prediabetes, when the body has preserved its insulin secretory capacity. A good place to start is by losing about five percent of your body weight. Typically the more weight you lose, the lower your blood sugars will be.

If you are taking medications while losing weight and notice that you are having low blood sugars, you will have to have your medications changed or discontinued.

Smoking Cessation

Smoking may have a role in hyperglycemia, particularly in the development of type 2 diabetes. Therefore, if you have prediabetes or at increased risk of diabetes, quitting smoking may help to prevent diabetes and hyperglycemia.

Blood Sugar Monitoring

Regular monitoring of blood sugar can help people with diabetes evaluate their response to therapy and manage high blood sugar.

There seems to be a correlation between blood sugar monitoring and lower A1C in patients with type 1 diabetes. Once you've established a pattern of high blood sugar, you can take action to treat and prevent it by testing your blood sugar and trending patterns. The sooner you are aware of your hyperglycemia, the sooner you can make changes.

Cinnamon

The jury is still out as to if and how cinnamon helps to lower blood sugar. Some studies say that two teaspoons per day may help to lower fasting blood sugar, while others do not.

As with most of diabetes care, this is probably specific to the individual. Either way, there is no harm in adding a sprinkle of cinnamon to your coffee, yogurt, oatmeal, or morning toast.

Apple Cider Vinegar

The juice from apples is used to make apple cider vinegar. A study published in the Journal of Functional Foods found that healthy individuals at risk for type 2 diabetes who ingested 8 ounces of Braggs Organic Apple Cider Vinegar Drink Sweet Stevia for 12 weeks saw a significant reduction in fasting blood sugar.

It is important to note that these people did not have diabetes and that the researchers found no significant difference in blood sugars two hours after a meal, nor in hemoglobin A1C. With that being said, the authors suggest that adding just one tablespoon twice daily may help to reduce fasting blood sugars. Toss some apple cider vinegar into your next salad or marinate your protein in it—a little goes a long way.

Prescriptions 

Insulin

Insulin is the hormone responsible for controlling blood sugar levels in the body. People who have type 1 diabetes do not produce their own insulin. Therefore, most people with type 1 diabetes should be treated with multiple daily injections of meal time (or prandial insulin) and basal insulin via injections or an insulin pump.

Additionally, most individuals with type 1 diabetes should use rapid-acting insulin, as opposed to intermediate analogs. Women diagnosed with gestational diabetes may also need insulin to reduce the risk of hyperglycemia and keep blood sugars tightly controlled.

Sometimes, people with newly diagnosed diabetes who have severe hyperglycemia may be started on insulin therapy right away to reduce their blood sugars. Those people who've had type 2 diabetes for a prolonged period of time, especially those with frequent hyperglycemia, may need to start insulin therapy as well.

It is not unusual though to have someone with type 2 diabetes who is on insulin reduce or omit their insulin once their blood sugars normalize, particularly if they've lost weight. Each individual case is different and the goal of insulin treatment should be discussed with the healthcare provider so that you are not alarmed or misguided.

Pramlintide

This medication is approved for use in patients with type 1 diabetes. Its use is to delay gastric emptying and reduce blood sugars by reducing the secretion of glucagon. It can help people with type 1 diabetes lose weight (if they are overweight), as well as reduce blood sugars and lower insulin doses.

Oral Medications

The ADA has an algorithm to guide physicians in prescribing medications to people with hyperglycemia. This model takes into consideration the age, gender, weight, health history, length of diagnosis, blood sugar level, lifestyle, education, etc. of a person. In fact, the ADA states, "a patient-centered approach should be used to guide the choice of pharmacologic agents. Considerations include efficacy, hypoglycemia risk, impact on weight, potential side effects, cost, and patient preferences."

Typically, unless contraindicated, most people benefit from starting with Metformin. After initiation, the ADA states, "If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target after 3 months, add a second oral agent, a glucagon-like peptide 1 receptor agonist, or basal insulin."

Gestational Diabetes Mellitus

Hyperglycemia in pregnancy can result in a diagnosis of gestational diabetes. The first type of treatment is medical nutrition therapy, physical activity, and weight management depending on pre-pregnancy weight and blood sugar monitoring.

Lifestyle change, specifically diet and exercise, is an essential component and all women need to control blood sugar. However, if blood sugar cannot be controlled with lifestyle changes, insulin is the preferred medication as it does not cross the placenta to a measurable extent.

Other medications such as metformin and glyburide may be used, but both cross the placenta to the fetus, with metformin likely crossing to a greater extent than glyburide.

Emergency Situations

In the event that you've gone to the emergency room due to elevated blood sugar and you've been diagnosed with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state, you'll need to be monitored closely and should receive a careful clinical assessment.

Treatment will include resolution of hyperglycemia, correction of electrolyte imbalance and ketosis, and restoration of circulatory volume. Additionally, it will be important to correct any underlying cause of DKA, such as sepsis.

Depending on how complicated the situation is, people with DKA will be treated with intravenous or subcutaneous insulin and fluid management.

Surgeries

Surgery is not warranted for hyperglycemia unless there are other confounding factors such as morbid obesity in those with type 2 diabetes. Surgery may be an option for people with type 1 diabetes who are having multiple transplants or for those who have recurrent ketoacidosis or severe hypoglycemia despite intensive glycemic management.

Metabolic Surgery

Metabolic surgery, otherwise known as bariatric surgery, may be an option for the treatment of hyperglycemia in patients with type 2 diabetes who are obese. The ADA suggests that "metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates with BMI 40 kg/m2 (BMI 37.5 kg/m2 in Asian Americans), regardless of the level of glycemic control or complexity of glucose-lowering regimens, and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) when hyperglycemia is inadequately controlled despite lifestyle and optimal medical therapy."

The ADA also suggests that metabolic surgery be considered for adults with type 2 diabetes and BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m2 in Asian Americans) if hyperglycemia is inadequately controlled despite optimal medical control by either oral or injectable medications (including insulin).

Before considering surgery, people with type 2 diabetes should receive a comprehensive medical assessment and receive medical clearance from multiple doctors, such as their primary physician and cardiologist. Additionally, they must meet with a registered dietitian several times before and after surgery to make sure they are adhering to dietary guidelines.

Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery. An evaluation to assess the need for ongoing mental health services to help adjust to medical and psychological changes after surgery should be conducted.

Pancreas and Islet Cell Transplantation

Transplantation surgery requires lifelong immunosuppression which can complicate blood sugars, causing hyperglycemia. Because of the adverse effects, it is not something that is typically done in people with type 1 diabetes.

Instead, the ADA suggests that "pancreas transplantation should be reserved for patients with type 1 diabetes undergoing simultaneous renal transplantation, following renal transplantation, or for those with recurrent ketoacidosis or severe hypoglycemia despite intensive glycemic management."

Islet transplantation remains investigational. Autoislet transplantation may be considered for patients requiring total pancreatectomy for medically refractory chronic pancreatitis. If you think you're a candidate, learn more about the procedure and speak with your doctor about it.

Complementary Medicine (CAM)

If hyperglycemia is a result of an inability to take care of oneself due to psychological or social problems, psychotherapy may be used to treat the underlying problem, which can help to treat and reduce hyperglycemia.

If a person experiences diabetes distress (DD), defined as "significant negative psychological reactions related to emotional burdens and worries specific to an individual’s experience in having to manage a severe, complicated, and demanding chronic disease such as diabetes," receiving help will be critical in managing hyperglycemia and depression.

Know that help is available and there is no stigma associated with it. It can help you take better care of yourself and look and feel your best, so don't hesitate to reach out when needed.

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View Article Sources
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  • American Diabetes Association. Hyperglycemia (High Blood Glucose).
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