High blood-glucose levels (hyperglycemia) can present with a wide variety of signs and symptoms and can affect the brain as significantly as low blood-glucose levels. When circulating blood glucose rises above a certain level, gradual changes that occur may be much more subtle than the more drastic changes witnessed with hypoglycemia. Emergencies due to high blood-glucose levels therefore have gradual onsets and require constant vigilance and monitoring.
High Blood-Glucose Levels
The ranges for blood-glucose levels for hyperglycemia have a greater degree of difference, depending on the source referenced. It is acceptable to note that any blood-glucose level that is high (after a recent large meal or sugar intake) may be noted to be greater than 150-170 mg/dL on a consistent basis, or if fasting, 90-130 mg/dL. Diabetics who have issues with high blood-glucose levels are often placed on insulin as their body is either unable to produce enough insulin or the receptors in the pancreas are just not responding to the insulin produced. Most professionals will instruct you that monitoring signs and symptoms along with ketones in the urine is the most efficient way to determine that you are dealing with a hyperglycemic emergency.
Polydipsia, Polyuria and Polyphagia
Some signs and symptoms to look for with a potential high blood-glucose emergency require the awareness that someone is a diabetic. Often it is the diabetic who can first detect these changes. It is important to stay aware of the three "polys." The first is polyphagia, a frequent, excessive hunger that is only increased by eating. Next is polydipsia, a frequent, excessive thirst that often leads diabetics to drink sugary soft drinks, thinking that they need sugar, which only worsens the situation by increasing an already elevated blood-glucose level. Polyuria is the excessive, almost constant need to urinate. As blood-glucose levels rise, the desire to eat and drink increases which can increase the blood-glucose levels even higher. This high blood sugar is recognized by the body, and it attempts to rid itself of the glucose by increasing urination.
Other Signs and Symptoms
Other neurological symptoms can occur as glucose levels continue to rise. Changes in vision, unusual fatigue and dry mouth often occur prior to more severe signs and symptoms such as changes in mental status or level of consciousness. If not recognized and treated this will quickly progress to unconsciousness and a coma-like state of being. Respiratory patterns can also change with the most common later sign being Kussmaul's hyperventilation, an extremely deep, fast breathing that may occur for what seems to be no apparent reason, but it is also the body's way of attempting to correct the issues caused by the elevated blood sugar levels. An unusually sweet breath smell, often confused with the breath of someone who has recently consumed an alcoholic beverage, can also occur. It is important to think through the situation and take into account that a blood-sugar-level emergency may be the cause.
A True Emergency
Although gradual in onset, potentially taking hours to days to become a true emergency, it is important to recognize these symptoms as early as possible, especially in patients who are known to be diabetics. It is this gradual onset that gives diabetics with high sugar level concerns the chance to recognize the onset sooner and address it more quickly. Unfortunately, the gradual onset can also be assumed to be coincidental by many patients, not recognizing that pattern until emergency care is needed.
Treatment and Outcome
Treatment of a true emergency should be given by professionals and may include administration of intravenous fluids, insulin and other medications and tests to regulate the blood-glucose levels in a controlled fashion. It is important to make every effort not to let glucose levels routinely remain elevated. The long term effects on the all the body systems, especially the pancreas and kidneys, from prolonged, untreated high blood-glucose levels can be devastating and life-limiting.
