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What is hyperglycemia?

High blood glucose (sugar) levels

Doctors diagnose diabetes on the basis of too-high levels of glucose in the blood. If you have diabetes, your blood glucose levels rise because of the foods you eat. Foods have little effect on blood glucose in people without diabetes. Normally, insulin, a hormone that is made in the pancreas, allows glucose to enter your body's cells and be used as fuel. Insulin is the main tool your body uses to lower your blood glucose level.

People with diabetes can have insulin deficiency - which means they make too little insulin - or insulin resistance, which means they don't respond well to insulin. In people with diabetes, insulin is not doing its job, so their body's glucose can't get into their cells and be used for energy. Instead, their unused glucose builds up in their blood and passes through the kidneys if the glucose level becomes high enough. The extra glucose causes frequent urination, which in turn leads to thirst. This is the body's way of making up for the fluid lost in urination.

What urine tests measure

High urine glucose levels give doctors a clue that something is wrong. But urine tests are not a good way to diagnose diabetes. Urine tests are not as accurate as blood tests. And the level of blood glucose needed to make glucose appear in the urine is different for each person. Your glucose level could be high, yet high levels of glucose may not appear in the urine. So in diagnosing diabetes, doctors measure glucose in the blood.

Urine tests are a very useful way to measure ketones, substances that build up when blood glucose is very high.

Blood tests

The goal of blood glucose tests is to find out whether you have an abnormal amount of glucose in your blood. There are two types of tests: screening tests and diagnostic tests. Screening tests are performed on people who have no symptoms of diabetes. On the other hand, diagnostic tests are done to confirm a diagnosis that is already suspected from the patient's symptoms.

Most doctors don't screen everyone for diabetes during regular checkups. The chance of finding the disease in most people is just too low. But screening tests are useful for people who may be at risk for developing diabetes.

For diagnostic tests, the doctor's office draws samples of blood from a vein and sends them to a laboratory for analysis. Different types of diagnostic tests are used to diagnose diabetes -- fasting plasma glucose, random plasma glucose, and oral glucose tolerance tests. When you get your test results, ask your doctor to explain them to you. Comparing your test results with those of family or friends may confuse or alarm you. You may not have had the same type of test, so your results could have a completely different meaning.

Fasting plasma glucose test

The fasting plasma glucose test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After you have fasted overnight (at least 8 hours), a single sample of your blood is drawn at the doctor's office and sent to the laboratory for analysis.

Normal fasting plasma glucose levels are less than 110 milligrams per deciliter (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.

Random plasma glucose test

Sometimes, random blood samples (if taken shortly after eating or drinking) may be used to test for diabetes when symptoms are present. A blood glucose level of 200 mg/dl or higher indicates diabetes, but it must be reconfirmed on another day with a fasting plasma glucose or an oral glucose test.

Oral glucose tolerance test

With the oral glucose tolerance test, you must fast overnight (at least 8 but not more than 16 hours) and go to your doctor's office or the laboratory in the morning. First, your fasting plasma glucose is tested. After this test, you receive 75 grams of glucose (100 grams for pregnant women). Usually, the glucose is in a sweet-tasting liquid that you drink. Blood samples are taken up to four times to measure your blood glucose.

For the test to give reliable results, you must be in good health (not have any other illnesses, not even a cold). Also, you should be normally active (for example, not lying down as an in-patient in a hospital) and taking no medicines that could affect your blood glucose. For 3 days before the test, you should have eaten a diet high in carbohydrates (150-200 grams per day). The morning of the test, you should not smoke or drink coffee.

The oral glucose tolerance test measures blood glucose levels several times over a period of 2-3 hours. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast.

People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT). People with IGT do not have diabetes. Each year, only 1-5% of people whose test results show IGT actually develop diabetes. And with retesting, as many as half of the people with IGT have normal oral glucose tolerance test results. Weight loss and exercise may help people with IGT return their glucose levels to normal.

If your values are abnormal, you will need to have another test - preferably the fasting plasma glucose test.

Glucose tolerance tests may lead to one of the following diagnoses.

Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl.

Impaired glucose tolerance: A person is said to have IGT when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl.

Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high.

Gestational diabetes: A woman has gestational diabetes when she has any two of the following: a fasting plasma glucose of more than 95 mg/dl, a 1-hour glucose level of 180 mg/dl or higher, a 2-hour glucose level of 155 mg/dl or higher, or a 3-hour glucose level of 140 mg/dl or higher.

In diagnosing your diabetes, your doctor needed test results. But test results are just part of the information that goes into the diagnosis of diabetes. Your doctor also took into account your physical examination, symptoms, and medical history to decide to test.

The blood test with a memory

When you've been diagnosed with diabetes, your doctor may order another type of blood test called an AIC test, or a glycated hemoglobin test. This test is easy to do during routine office visits and lets the doctor take a backward look at your diabetes control.

Hemoglobin is the protein in red blood cells that carries oxygen. Glycated hemoglobin forms when glucose in the blood attaches to the hemoglobin. Because blood cells stay in circulation for 2-3 months, the glycated hemoglobin level is a good measure of a person's average blood glucose level over the previous 2-3 months.

The test requires only one sample of blood, which can be taken at any time of the day, even right after a meal.

Although a high glycated hemoglobin level almost always means IGT or diabetes, people with IGT or diabetes can have normal levels. So this test is not used to diagnose diabetes. Doctors use it to monitor blood glucose control.

What is hypoglycemia? (low blood sugar)

Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood sugar is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes.

Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to control your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood sugar) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia.

What are the symptoms of hypoglycemia?

The symptoms of hypoglycemia include:

Shakiness.
Dizziness.
Sweating.
Hunger.
Headache.
Pale skin color.
Sudden moodiness or behavior changes, such as crying for no apparent reason.
Clumsy or jerky movements.
Seizure.
Difficulty paying attention, or confusion.
Tingling sensations around the mouth.
How do you know when your blood sugar is low?
Part of keeping diabetes in control is checking blood sugar often. Ask your doctor how often you should check and what your blood sugar levels should be. The results from checking your blood will tell you when your blood sugar is low and that you need to treat it.

You should check your blood sugar level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood sugar coming on. After you check and see that your blood sugar level is low, you should treat hypoglycemia quickly.

If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.

How do you treat hypoglycemia?

The quickest way to raise your blood sugar and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy.

Ask your health care professional or dietitian to list foods that you can use to treat low blood sugar. And then, be sure you always have at least one type of sugar with you.

Once you've checked your blood sugar and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again. If your blood sugar is still low and your symptoms of hypoglycemia don't go away, repeat the treatment. After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood sugar level up.

It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out. If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital.

Glucagon raises blood sugar. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it. You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it.

If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood sugar. If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help. It's a good idea to post emergency numbers by the telephone.

If you pass out from hypoglycemia, people should:

NOT inject insulin.
NOT give you food or fluids.
NOT put their hands in your mouth.
Inject glucagon.
Call for emergency help.

How do you prevent low blood sugar?

Good diabetes control is the best way we know to prevent hypoglycemia. The trick is to learn to recognize the symptoms of hypoglycemia. This way, you can treat hypoglycemia before it gets worse.

Hypoglycemia Unawareness

Some people have no symptoms of hypoglycemia. They may lose consciousness without ever knowing their blood sugar levels were dropping. This problem is called hypoglycemia unawareness.

Hypoglycemia unawareness tends to happen to people who have had diabetes for many years. Hypoglycemia unawareness does not happen to everyone. It is more likely in people who have neuropathy (nerve damage), people on tight glucose control, and people who take certain heart or high blood pressure medicines.

As the years go by, many people continue to have symptoms of hypoglycemia, but the symptoms change. In this case, someone may not recognize a reaction because it feels different.

These changes are good reason to check your blood sugar often, and to alert your friends and family to your symptoms of hypoglycemia. Treat low or dropping sugar levels even if you feel fine. And tell your team if your blood sugar ever drops below 50 mg/dl without any symptoms.