High blood sugar

Diabetes results in higher than normal levels of glucoseA simple sugar that is an important source of energy in the body. in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.. Sometimes, the glucoseA simple sugar that is an important source of energy in the body. level in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. may become very high. This may bring on the symptoms of diabetes suddenly. Such symptoms may include:[1]

  • Severe thirst
  • Dry mouth
  • Blurred vision
  • Drowsiness
  • A need to urinate often.

A number of things may bring about high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body., or hyperglycaemiaA high level of glucose in the blood., such as eating too much or not taking enough antidiabetic medication. It is important to get the right balance between food intake and medication. Being ill can also trigger hyperglycaemiaA high level of glucose in the blood.: infections are a frequent cause.[2,3]

Very high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. may take one of two forms, called diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. (seen more often with type 1 diabetes) and hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. (seen more often with type 2 diabetes).

Diabetic ketoacidosis

If a high level of glucoseA simple sugar that is an important source of energy in the body. in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. is not treated, a condition called diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. (sometimes abbreviated to DKA) may develop. This is more common in type 1 diabetes, although it is sometimes seen with type 2 diabetes as well.[4]

The breakdown of fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body., rather than glucoseA simple sugar that is an important source of energy in the body., for energy results in the production of ketonesA group of compounds that are produced by fat metabolism., acidic compounds that build up in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid..  This is where the term 'ketoacidosisHigh acidity of the blood and tissues combined with high levels of ketones in the blood. Ketones are produced during the breakdown of fat.' comes from. The ketonesA group of compounds that are produced by fat metabolism. may make your breath smell fruity, like pear drops or nail polish remover.[2,3]

Symptoms of ketoacidosisHigh acidity of the blood and tissues combined with high levels of ketones in the blood. Ketones are produced during the breakdown of fat., which usually develop rapidly over a period of days, include:[4,5]

  • A need to urinate often
  • Increased thirst
  • Weight loss
  • Lethargy, weakness
  • Loss of appetite
  • Increased breathing rate
  • Breath that smells fruity, like pears, or nail polish remover
  • Dehydration
  • Nausea and vomiting
  • Abdominal pain
  • Loss of consciousness.

A number of factors may bring on diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown.: these include being unwell - having an infectionInvasion by organisms that may be harmful, for example bacteria or parasites., for example - or taking the wrong dose of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels.. Having surgery can also bring on this condition, but it has been estimated that in around a quarter of cases no cause is found.[4,5]

It is important to recognise the symptoms of diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. as soon as possible so that it can be treated quickly.

Hyperosmolar hyperglycaemia

Also known as hyperglycaemic hyperosmolar non-ketotic coma, this is seen only in people with type 2 diabetes. It is thought that while insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. levels in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. are too low to stimulate the cells of the body to take up and use glucoseA simple sugar that is an important source of energy in the body., they are still high enough to prevent the fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. breakdown and accompanying ketone production seen in diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown..[3,5]

The factors that trigger the condition are similar to those underlying diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown.; often, an illness such as infectionInvasion by organisms that may be harmful, for example bacteria or parasites. is the trigger.[3]

The symptoms of hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. develop over a longer period than those of diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown., usually over a week or so. You may have signs of dehydrationWater deficiency in the body., feeling weak with a fast heart rate and low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure. A reduced level of concentration, and ultimately coma, is more common with hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. than with diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown..[3,5]

People with hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. are usually very dehydrated indeed and have a very high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. level. There is also an increased risk of developing bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots in the veins, called thromboembolism.[5]

Prevention and management

Many cases of both diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. and hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. can be prevented by ensuring you have good medical care and being aware of the symptoms and risks.

If you are taking insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., it is important to continue to take your medication properly, and to make sure that you see your doctor early if you have any additional illness.[3]

If you develop either of these conditions, diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. or hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes., you need to be admitted to hospital. You will need several tests, which may include bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. tests, an electrocardiogram, a chest X-ray, and urine, sputum or bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. cultures to check for infectionInvasion by organisms that may be harmful, for example bacteria or parasites..[3]

Treatment of diabetic ketoacidosisCondition mainly found in type 1 diabetes, in which high levels of ketones are present; these are acidic compounds produced by fat breakdown. and hyperosmolar hyperglycaemiaAlso known as hyperosmolar non-ketotic state - a state of having very high levels of glucose in the blood, most commonly associated with type 2 diabetes. involves:[2]

  • Intravenous fluids for hydration
  • Insulin to reduce glucoseA simple sugar that is an important source of energy in the body. levels
  • Correcting any electrolyteA solution containing ions (charged atoms such as sodium and potassium), or the ions themselves. imbalances, such as in potassium levels
  • Identifying and treating (if needed) any known underlying cause such as infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • Close monitoring.
References: 
  1. Boon NA, Colledge NR and Walker BR. Davidson's Principles and Practice of Medicine Churchill Livingstone Elsevier. 2006; 20th edition
  2. Hyperglycaemic crises in diabetes. American Diabetes Association. Diabetes Care. 2004;27:S94-102
  3. Hyperglycemic crises in adult patients with diabetes. Kitabchi AE, Umpierrez GE, Murphy MB et al. Diabetes Care. 2006;29:2739-48
  4. Diabetic ketoacidosisHigh acidity of the blood and tissues combined with high levels of ketones in the blood. Ketones are produced during the breakdown of fat. in type 1 and type 2 diabetes mellitusDisordered energy metabolism and high levels of glucose in the blood owing to a lack of insulin, or poor response of the body to insulin.. Newton CA and Raskin P. Arch Intern Med. 2004;164:1925-31
  5. Longmore M, Wilkinson I and Török E. Oxford Handbook of Clinical Medicine 2002; 5th edition.