How Hyperglycemia Is Treated

The treatment of hyperglycemia depends on a variety of factors, including how long and how often you have attacks and how severe your hyperglycemia is. Your age, overall health, and cognitive function are also important.

The American Diabetes Association (ADA) stresses that each person with diabetes should have a personalized treatment plan. While the ADA offers an algorithm to help determine the right medication for certain situations, decisions should ultimately be made on an individual basis.

This article explains things you can do to treat hyperglycemia at home, medications that may be used, and signs that you might need to contact your healthcare provider.

Illustrated human body with arrows outlining common symptoms of hyperglycemia. Text on image reads: Hyperglycemia: Common Symptoms: fatigue; blurry vision; excessive thirst; fruity breath; increased hunger; nausea and vomiting; increased urination.
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Lifestyle

Lifestyle management is the most critical factor in treating hyperglycemia. The keys to lifestyle modification are to get support and be consistent.

Your healthcare provider will work with you on diabetes self-management education (DSME). DSME provides you with tools to help in vital areas, including:

  • Understanding how hyperglycemia affects your physical and mental health
  • Easting healthy
  • Being active
  • Monitoring your blood sugar
  • Coping with your condition

Diabetes medications are specifically used to support overall lifestyle changes. In fact, if you don't change your lifestyle and rely on medication alone, the medications will eventually stop being effective. You will then need to add more medications to get blood sugars under control.

The ADA recommends that all people with diabetes receive DSME at diagnosis and annually thereafter. DSME is also recommended when management targets aren't being met, when factors arise that get in the way of treatment, and when there's a change in care.

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 you manage blood sugar.

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 improved A1C, a test used to diagnose and monitor diabetes. MNT leads to A1C decreases of 0.3% to 1% for people with type 1 diabetes and 0.5% to 2% for those with type 2 diabetes.

Exercise

Breaking up extended sedentary activity and avoiding extended periods of sitting may prevent type 2 diabetes for those at risk. Exercise may also help you achieve glycemic control if you have 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 your healthcare provider.

Weight Loss

Weight loss is beneficial for reducing blood sugars because it improves insulin sensitivity.

According to the ADA, modest, persistent weight loss can delay the progression from prediabetes to type 2 diabetes, as well as be 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. That's true even for people who have had diabetes for a minimum of six years.

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 capacity to secrete insulin. A good place to start is by losing about 5% 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.

If you have prediabetes or are at increased risk of diabetes, quitting smoking may help to prevent diabetes and hyperglycemia.

Blood Sugar Monitoring

There seems to be a correlation between blood sugar monitoring and lower A1C in patients with type 1 diabetes.

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

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.

Prescriptions 

Healthcare providers agree that you need to change how you eat and elements of your lifestyle to ensure good control of blood sugar, but certain medications may be an important complement. And for some people, medication is essential for managing diabetes.

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 mealtime (or prandial) insulin and basal insulin. These are administered via needle 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 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 your healthcare provider so that you are not alarmed or misguided.

Pramlintide

Pramlintide is an injectable medication known by the brand name Symlin. This medication is approved for use in patients with type 1 diabetes and for those with type 2 diabetes who take insulin. It is used to delay gastric emptying and reduce blood sugar 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

A number of medications are approved to help manage blood glucose, including:

Metformin, a biguanide, is the most common first-line treatment for people newly diagnosed with type 2 diabetes. After three months, if the maximum tolerated dose doesn’t help achieve or maintain targeted A1C levels, a second medication can be added.

The ADA's algorithm to guide healthcare providers in prescribing medications to people with hyperglycemia takes several factors into account. These include age, sex, weight, health history, length of diagnosis, blood sugar level, lifestyle, education, etc.

In fact, the ADA recommends that a patient-centered approach be used to guide the choice of medications. Considerations include efficacy, hypoglycemia risk, impact on weight, potential side effects, cost, and patient preferences.

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 hyperglycemic hyperosmolar nonketotic syndrome (HHNS), 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 recommends bariatric surgery be advised as an option in screened surgical candidates with a body mass index (BMI) of ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans). Surgery is also advised for those with a BMI between 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who haven’t achieved durable weight loss and improvement to any other co-occurring conditions (including hyperglycemia) through non-surgical methods.

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age. 
Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

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 healthcare providers, such as their primary healthcare provider 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 as well.

Pancreas and Islet Cell Transplantation

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

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

Islet transplantation, in which pancreatic islet cells are transplanted into the liver, remains an experimental treatment. 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 healthcare provider about it.

Complementary and Alternative Medicine (CAM)

A plan to control hyperglycemia can include incorporating special supplements and psychological support.

Cinnamon

The research is not conclusive on how cinnamon helps to lower blood sugar. However, 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 or hemoglobin A1C two hours after a meal.

With that being said, the authors suggest that adding just one tablespoon twice daily may help 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.

Psychotherapy

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 reduce hyperglycemia.

If you experience diabetes distress (DD), receiving help will be critical in managing hyperglycemia and depression. DD is 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."

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.

Summary

Hyperglycemia treatment depends on the severity of your condition and the duration of high blood sugar. The most important step to managing your blood sugar is making lifestyle changes. These can include changes in diet and getting regular exercise, but your doctor will help develop a specific individualized plan for you.

Medication may be necessary in addition to these lifestyle changes. Injectable and oral medications are available. The right prescription depends on your specific needs and the type of diabetes you have. In some instances, surgery may be recommended to help reduce weight or better manage blood sugar.

Frequently Asked Questions

  • Can you control hyperglycemia with a special diet?

    Sometimes, yes. Working with your healthcare providers and/or a dietitian, you may be able to manage your sugar levels without medication if you create an individualized meal plan. This often involves tracking your carbohydrate intake and avoiding added sugars. Increasing your consumption of healthy, whole foods—especially non-starchy vegetables, legumes, and whole grains—can also help you regulate your blood sugar.

  • What type of treatment is needed for a hyperglycemic emergency?

    You should be treated at the hospital if you have symptoms of diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. You should receive IV fluids and electrolytes. Insulin therapy may also be needed.

  • What medications are used to manage hyperglycemia?

    Insulin injections are used to increase insulin levels in those who are hyperglycemic and don’t have enough to process glucose. There are several other classes of medications that may be used to boost insulin levels or lower blood sugar over time. You also need to follow a special diet that can help regulate blood sugar.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Barbie Cervoni MS, RD, CDCES, CDN
Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.