Troubleshooting Hyperglycemia

Everyone with diabetes should review this list of reasons for hyperglycemia. It can explain some, maybe many of those unexpected and frustrating high readings. If you're on an insulin pump, also read the extra 15 ways insulin pumps can cause hyperglycemia.

Stay safe.Read the disclaimer.See your doctor for all medical advice.This site isn't medical advice.

Causes of Hyperglycemia in Diabetes

1. Food related. This can be anything from:
   • eating more carbohydrate foods than normal;
   • not realizing certain foods contain carb, which is very common;
   • underestimating the carb in some foods;
   • doing "wild-ass guessing" (eg. I know it's carb, I'll just give some insulin. Not sure how much carb, not sure how much insulin - ahhh - I'll just give a unit or two);
   • not bothering to consider which foods are carb foods;
   • high glycemic index carbohydrate food: As an example, I always require more insulin when eating the same amount of carbohydrate from white bread than from say, my oatmeal. And yes, low glycemic index foods have been shown to lower blood sugar in both type 1 and type 2 diabetes. Again, everyone is different, so here is where the value of self glucose testing and record keeping comes into play.
   • using an insulin-to-carb ratio incorrectly;
   • using a ratio that you haven't verified that works or sticking to an old ratio that just doesn't work anymore (why or why are we so hesitant to change our old habit math?) or perhaps, if giving fast insulin with meals, talking to your educator to see if learning about carb counting and insulin-to-carb ratios is appropriate for managing your diabetes.
2. Giving meal insulin or meal medication after the meal
3. Forgotten medication or insulin
4. Not enough meal insulin or meal medication: Again, some of these reasons may relate to number one above.
5. Not giving a correction dose or enough of a correction dose: If your blood sugars are high before the meal and you give insulin just to cover the food, then chances are you will be high again later. Many people who take insulin with each meal need a "correction dose" or a "sensitivity factor". This is basically a formula you use to determine how much extra bolus insulin (eg. regular, rapid insulin) is needed to drop the blood sugars into target. Or, put a different way, how much one unit of fast insulin will drop your high blood sugar level. Talk with your diabetes educator if you would like to learn more.
6. Less physical activity than normal:Yes, bugger that it is, sometimes just missing one evening's walk can do it. Although, more commonly, it takes missing 2-3 day's worth to see a difference. But...not always. As an example, if I walk within 1/2 hr of breakfast then I need half my breakfast insulin. If I don't walk one day - I need my full dose, even if I've walked the day before. Everyone is different.
7. Technical or absorption problems with insulin delivery:
   • Not doing air shot with insulin pen. You could
   • Insulin at room temperature longer than 30 days (although most will find it still works fine into that second month but please, do take this into consideration as technically the insulin is shown to act well for only 30 days at room temperature or after the insulin vial has been punctured even if still refrigerated)
   • Injecting into scarred tissue or overused injection areas
   • Giving large boluses (doses) into one injection site (eg. 50 units or more. Usually, educators instruct clients to give these doses as 25 units given twice in two separated areas to allow for better absorption. See causes of hyperglycemia related to insulin pump use.
   • Lumps or clots in the insulin or what looks like large flakes of dandruff. This means part of the insulin has denatured from either heat or extreme cold and should not be used.
   • If cloudy insulin not mixed well prior drawing up and injecting. Although, this is more likely to cause a low early on followed by a high 12-16 hours later if too much fast insulin and not enough of the slowing suspension is given. Still, by the end of the vial, there may be too much concentrated slowing suspension resulting in erratic blood sugar levels.
8. Stress:Don't underestimate the effect of stress in causing high blood sugar levels.
9. Illness or infection:I am constantly amazed at how the body can produce such vast amounts of glucose even before the signs of the cold appear - like 2 days before. Alas, some people weather colds and illness without experiencing high blood sugar.
10. Ovulation or menstruation:Some women with diabetes mark their periods and times of ovulation on the calendar so they are better able to see if there is a pattern of how these affect blood glucose levels. Some women experience hyperglycemia during their period while others experience low sugars.
11. Pregnancy, second or third trimester: The placenta plays a very large role in increasing the resistance to insulin, and hence increasing blood sugar levels. It is very common and normal in pregnant women with diabetes to see increased insulin needs due to hyperglycemia in these parts of the pregnancy. All pregnant women with diabetes should follow closely with their diabetes team and specialists. Because of this insulin resistance caused by the placenta, women without diabetes are generally screened for gestational diabetes sometime around 24 weeks gestation or as advised by their physician (ask about screening if you are pregnant and don't already have diabetes ).
12. Certain medications and illicit drugs:For example steroids, prednisone, large doses niacin can contribute to hyperglycemia. Talk with your pharmacist to learn the effect of any of your medications or supplements on blood sugars. Street drugs could have varying effects and of course could kill. Marijuana increases appetite, eating and hence blood sugars. (Please, just say "NO!" )
13. Changes in diabetes: The body changes, so does diabetes. Although, usually these changes are gradual and don't result in a sudden bout of high blood sugar readings. If you have recently been diagnosed with type 1 diabetes, then the honeymoon (the period in which you still have enough beta cells as they haven't all been destroyed by your body) may be over. If you have type 2 diabetes, it could be that the beta cells are getting even more "tired" (called beta cell exhaustion), together with your liver making even more glucose than it should (especially overnight resulting in higher fasting readings) and the insulin being used poorly (insulin resistance).
14. Adolescence:Growth hormones, particularly those in teenage boys with diabetes, can greatly increase blood sugars and insulin needs. Of course, so can performance steroids (stay away from those lads!)

15. Certain medical conditions: If you already have diabetes, you don't really need to consider these reasons for hyperglycemia, as likely your physician already has. Diabetes can be caused secondary to some medical disorders. People often read these disorders and start thinking the worst, but honestly, the vast majority of people diagnosed with hyperglycemia do not have these medical disorders: hemochromatosis, pancreatitis, pancreatic tumor, and a large list of inborn genetic defects and disorders that are associated with diabetes.
16. Sometimes nothing makes sense! I would be remiss if I didn't point out what everyone with diabetes already knows...sometimes logic defies the odd high blood sugar reading because really, we know so little about what is going on in the body. Although, I sometimes believe that some of the specialists fail acknowledge this point enough. Perhaps it's because they devote their lives to helping, and the only way to do that is to find answers that make sense. Regardless, it is nice to know that two plus two does not always equal four. However, if hyperglycemia occurs on a regular basis then something needs to change (eg. medicine, insulin, activity) to help lower those glucose readings, even if you don't know what's causing them. Talk with your doctor to help you troubleshoot options for hyperglycemia. You can find many options for how to lower fasting readings and other times of the day to review with your doctor here at www.diabetes-blood-sugar-solutions.com/normal-range-blood-sugar-levels.html.