When you have type 1 or type 2 diabetes, dangerous spikes in blood glucose (severe hyperglycemia) may mean you need to reduce blood sugar levels quickly. If you don't, you could be at risk for potentially life-threatening complications. Some key hyperglycemia symptoms include extreme thirst, frequent urination, and nausea.
Generally speaking, a blood glucose level of 180 milligrams per deciliter (mg/dL) is too high, but any blood glucose level (BGL) above your target range is cause for concern. Your healthcare provider should tell you what your upper limit is, as it may be different for different people.
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Take Insulin
The preferred—and quickest—method of lowering your glucose level is to take rapid-acting insulin such as Humalog, Novolog, or Apidra. If you have type 1 diabetes, you may be able to get a correction dose through your insulin pump, as well.
Slow-acting insulin, such as NPH, does not lower blood sugars quickly. It takes several hours to work. Therefore, it's not an appropriate treatment when you urgently need to bring down your BGL.
Insulin works by moving glucose from your blood into your cells. There, you either use it for fuel right away or your cells store it for later when you don't have enough ready energy to meet demands.
When the body doesn't have enough insulin (type 1 diabetes) or doesn't use it efficiently (type 2 diabetes), it can lead to short-term symptoms and complications, like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
Be sure you talk to your healthcare provider about how much rapid-acting insulin you should take to bring down dangerously high BGL.
Once you've had the shot, re-check your levels in 15-30 minutes to see whether they're coming down and how fast. Sometimes, levels will go too low and you'll end up with hypoglycemia (low blood sugar levels).
If your BGL doesn't drop right away or doesn't come down as fast as you'd like, resist the urge to take more insulin too soon; this could lead to hypoglycemia. Rapid-acting insulin may start working in 15 minutes, or it may take up to an hour.
A BGL of 240 mg/dL puts you at risk for DKA. Regular readings of 600 mg/dL or higher could lead to HHS. Both of these conditions can be fatal and require emergency medical treatment.
Intramuscular Injections
Injecting your insulin directly into a muscle can help your body absorb it more quickly. However, it's also more likely to lead to hypoglycemia, which may become severe. It can also cause a potentially fatal insulin overdose.
Talk to your healthcare team about whether intramuscular injections are a good idea during hyperglycemic episodes. They can also tell you where and how to give yourself this kind of injection.
Take Missed Medication
Many people with diabetes take prescription medications other than or along with insulin. These medications help keep your blood sugar within the normal range.
Missing a dose of these medications can make your BGL high. If you're surprised by a high reading, check to make sure you took your last dose. Keeping them in a daily pill sorter instead of a bottle makes this simple.
However, many diabetes drugs only work if they're taken before you eat. They won't help lower a dangerously high BGL. These include biguanides such as metformin and alpha-glucosidase inhibitors like acarbose and Glyset (miglitol).
Diabetes medications that can bring down your BGL quickly include:
- Meglitinides: Nateglinide and repaglinide
- Sulfonylureas: Diabinese (chlorpropamide), Amaryl (glimepiride), Glucatrol (glipizide), Glynase (glyburide)
Timing of a Makeup Dose
If you miss a dose of your diabetes medication, take it as soon as you remember. But don't double-up by taking your missed medication too closely to your next scheduled dose. This can cause dangerous side effects.
When in doubt, check the medication packaging for guidance, contact your healthcare provider, or talk to a pharmacist. If you miss several doses, contact your practitioner about the best course of action.
Treating the Lows of Hypoglycemia
- BGL between 55 mg/dL and 69 mg/dL: Eat 15 grams of carbohydrates and re-check BGL in 15 minutes.
- BGL below 55 mg/dL: Call 911. Inject Glucagon (glucagon hydrochloride) if available. If conscious, drink juice or a sugary soda, then eat carbohydrates with protein (e.g., cheese and crackers).
Exercise
Physical activity is the fastest way to lower your blood sugar without medication. Exercise lowers insulin resistance and helps your body convert glucose into energy.
During muscle contractions, your cells take glucose from your bloodstream and use it for energy. This lowers your blood sugar for 24 hours or more after you exercise.
Check Ketones Before Exercising
If your blood sugar is above 240 mg/dL, check your ketone levels and don't exercise if they're elevated. Exercise can increase ketone levels, which can raise blood sugars and put you at a greater risk of ketoacidosis.
Everyone responds differently to exercise, so there's no perfect formula for how much to exercise to lower your BGL. In general, though:
- You need to get your heart rate up.
- Longer durations of physical activity lower your blood sugar more than short durations.
It's a good idea to do regular blood sugar checks before and after working out. That way, you'll have an idea of how your body responds under normal circ*mstances; this can help guide your decisions the next time you have a dangerously high BGL.
Making a Type 2 Diabetes Exercise Plan
Drink Water
When you have an episode of severe hyperglycemia, water and other unsweetened fluids can help your kidneys flush out excess sugars through your urine. While it may not be as fast as rapid-acting insulin or exercise, it can help get you to a safe BGL.
Staying hydrated may help you prevent hyperglycemic episodes as well. Most people need about 4 to 6 cups of water each day. If you work out frequently or tend to sweat a lot, you may need more. If you take medications that cause fluid retention, you may need less.
Ask your healthcare provider about your daily water needs and about how much to drink if you have a spike in blood sugar.
Causes of Hyperglycemia in Diabetes
- Eating too many carbohydrates
- Not getting enough physical activity
- Illness or infection
- Taking a corticosteroid, like prednisone
- Skipping or not taking enough glucose-lowering medication
Watch Your Carbohydrates
Carbohydrates make your blood sugar rise. There aren't any foods you can eat that will reduce your blood sugar immediately. However, you can improve your body's ability to manage glucose over time by eating good sources of carbs, or low-glycemic index foods.
The glycemic index measures how different foods affect your blood sugar. High glycemic foods cause your blood sugar to rise quickly. Low glycemic foods have less impact on blood sugar.
Examples of low-glycemic index foods include:
- Oatmeal, steel-cut or rolled
- Legumes
- Apples
- Oranges
- Grapefruit
- Carrots
- Green vegetables
- Quinoa
- Milk and yogurt
When to See a Healthcare Provider
Contact your healthcare provider for guidance if you have:
- Consistently high blood sugar readings
- Frequent urination
- High levels of sugar in the urine (diagnosed using at-home glucose dipstick test)
- Increased thirst
They'll likely want you to make an appointment to go over treatment and lifestyle options for better managing your illness.
When to Go to the ER
Call 911 or get to an emergency room if you have:
- Hyperglycemia and elevated ketone levels
- Sustained very high blood sugar levels
- Symptoms of DKA or HHS
- Two blood sugar readings of 300 mg/dL or above
- Blood sugar readings above 180 mg/dL (or your target range) for more than a week
Summary
Any blood glucose level above your target range is too high. In general, 180 mg/dL is considered dangerously high and you should take steps to bring it down.
You can lower blood sugars quickly with rapid-acting insulin, taking missed doses of oral medications such as meglitinides or sulfonylureas, exercising, and drinking water. Watching your carbohydrates can help to prevent your blood sugars from rising too fast.
Get emergency medical attention for readings in the danger zone plus high ketone levels, sustained high BGL, or symptoms of DKA or HHS. Contact your healthcare provider if you have consistently high levels, increased thirst, or frequent urination.
