Hyperglycemia & Hypoglycemia

Hyperglycemia & Hypoglycemia

Hyperglycemia (High Blood Glucose)

Hyperglycemia is when there is more sugar in the blood than normal. It means the body may not be properly managing sugar in the body.

Hyperglycemia is often the first condition doctors look for when testing for diabetes. If a person’s level of Hyperglycemia is above normal and becomes worse over time, they are likely to develop Type II diabetes. Often people who have hyperglycemia but are not yet diabetic, are said to be “pre-diabetic.”

Hyperglycemia can be a serious problem if you don’t treat it, so it’s important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy.

When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

• Shortness of breath
• Breath that smells fruity
• Nausea and vomiting
• Very dry mouth

Talk to your doctor about how to handle this condition.

Hypoglycemia (Low Blood Glucose)

Hypoglycemia is a clinical syndrome that results from low blood sugar.  The term literally means “low sugar blood”  It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function (neuroglycopenia). The symptoms can vary from person to person, as can the severity. 

When the circulating level of blood glucose falls, the brain actually senses the drop. The brain then sends out messages that trigger a series of events, including changes in hormone and nervous system responses that are aimed at increasing blood glucose levels. Insulin secretion decreases and hormones that promote higher blood glucose levels, such as glucagon, cortisol, growth hormone, and epinephrine all increase. There is a store in the liver of glycogen that can be converted to glucose rapidly.

In addition to the biochemical processes that occur, the body starts to consciously alert the affected person that it needs food by causing the signs and symptoms of hypoglycemia.

The normal range of glucose in the bloodstream is from 70 to 100 mg/dL when the individual is fasting (that is not immediately after a meal). The body’s biochemical response to hypoglycemia usually starts when sugars are in the high/mid 70’s. At this point, the liver releases its stores and the hormones mentioned above start to activate. In many people, this process occurs without any clinical symptoms. The amount of insulin produced also declines in an attempt to prevent a further drop in glucose.

While there is some degree of variability among people, most will usually develop symptoms suggestive of hypoglycemia when blood glucose levels are lowered to the mid 60’s. The first set of symptoms are called adrenergic (or sympathetic) because they relate to the nervous system’s response to hypoglycemia. Patients may experience any of the following;

• nervousness,
• sweating,
• intense hunger,
• trembling,
• weakness,
• palpitations, and
• often have trouble speaking.

In most people, these symptoms are easily recognizable. The vast majority of individuals with diabetes only experience this degree of hypoglycemia if they are on medications or insulin. People (with diabetes or who have insulin resistance) with high circulating levels of insulin who fast, diet, or lower their carbohydrate intake drastically should also be cautioned. These individuals may also experience modest hypoglycemia.

People being treated for diabetes who experience hypoglycemia may not experience symptoms as easily as people without diabetes. This phenomenon has been referred to as hypoglycemic unawareness. This can be dangerous as blood sugars may approach extremely low levels before any symptoms are perceived.

Anyone who has experienced an episode of hypoglycemia describes a sense of urgency to eat and resolve the symptoms. And, that’s exactly the point of these symptoms. They act as warning signs to tell the body to consume more fuel. At this level, the brain still can access circulating blood glucose for fuel. The symptoms provide a person the opportunity to raise blood glucose levels before the brain is affected.

If a person does not or cannot respond by eating something to raise blood glucose, the levels of glucose continue to drop. Somewhere in the 50 mg/dl range, most patients progress to neuro-glyco-penic ranges (meaning that the brain is not getting enough glucose). At this point, symptoms progress to confusion, drowsiness, changes in behavior, coma, and seizure.