High blood glucose is also known by the medical term hyperglycemia. It is often an indication that a patient has the disease called diabetes mellitus. In diabetes mellitus, there is either a complete lack of insulin production -- this is called Type 1 diabetes -- or a resistance to the insulin that is produced -- this is known as Type 2 diabetes. In both cases, high blood sugar, and the complications of high blood sugar, will occur without treatment. Fortunately, there are several treatments for hyperglycemia.
Insulin
For all patients with Type 1 diabetes as well as some with Type 2, treatment of hyperglycemia requires insulin. Dr. David McCulloch, writing in the medical reference UpToDate, explains that in Type 1 diabetes, the pancreas cannot produce insulin. In contrast, patients with Type 2 diabetes may have become so resistant to their own insulin that they need extra "doses" in order to process food correctly. Patients who are dependent on insulin most often take insulin as an injection under the skin: this is known as a subcutaneous injection.
Some patients, however, may find that they achieve better control of the high blood sugar associated with diabetes when they use a pump, which is a continuous insulin delivery system. Pump users place a catheter under their skin; this catheter delivers insulin via a pump that can be programmed to automatically deliver the needed amounts of insulin, with no injections required. A significant potential side effect of insulin is hypoglycemia: if too much insulin is delivered, patients may experience symptoms associated with dangerously low blood sugar, including dizziness, confusion, rapid heart rate, and even loss of consciousness.
Diet and Exercise
Patients with Type 2 diabetes are said to have a condition called insulin resistance. This indicates that they are making insulin but they have become less sensitive to it; as a result, their blood sugar levels become abnormally elevated. One non-pharmacologic approach to this is to make changes in both diet and levels of activity. A diet that is lower in calories, combined with regular exercise, can result in weight loss, which may in turn improve insulin resistance. With greater insulin sensitivity, the body is better able to process food correctly -- sugar will be taken into the cells of the body rather than accumulate in the bloodstream. As pointed out in the consensus statement of the American Diabetes Association, however, the disadvantage of this approach to lowering blood glucose levels is that it is often difficult for patients to maintain a consistent diet and exercise regimen; without this consistency, sugar levels will come back up. UptoDate suggests that because of this, the majority of patients with Type 2 diabetes will need to take medication to control their blood sugar levels.
Oral Glucose-lowering Medications
For those patients with Type 2 diabetes who have tried lifestyle modifications with limited or no success, many types of glucose-lowering medications -- sometimes called oral hypoglycemic agents -- are available. Metformin is often the first choice of medication to use in trying to manage the high sugar levels of Type 2 diabetes. UptoDate reports that weight loss may occur as a desirable side effect of this medication. The common side effects of this medication include nausea and vomiting; hypoglycemia only rarely occurs.
Other medications include a class called the sulfonylureas; however, hypoglycemia is a common, potentially dangerous, side effect that may occur when taking this medication. Another class of medications, the thiazolidinediones, work by increasing insulin sensitivity; however, because of the possible risk of heart problems associated with some of these medications, they are frequently used only after other medications have been tried, or in combination with other glucose-lowering drugs.
References
- "UpToDate;" General Principles of Insulin Therapy in Diabetes Mellitus; D. McCulloch; May 2010
- "UpToDate;" Initial management of blood glucose in type 2 diabetes mellitus; D. McCulloch; June 2010
- "Diabetes Care;" Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy; D. Nathan et. al.; January 2009
