ow do you usually treat unexpected high blood sugar?
Wait and check again later?
Extra Humalog or Novolog insulin?
Extra Regular insulin?
Additional exercise?
Reduced food?
Extra fluids?
Call your diabetes team for advice?
Don't treat
it?
Other?
It isn’t always appropriate to automatically treat a high blood sugar with extra insulin as most of the responders to this poll indicate that they do. Unexpected high sugar levels can be caused by many things. So, unless you are certain of the cause, most diabetes educators advise waiting at least an hour to see if the value is going up or coming down.
If some sort of stress has caused the high, it is because counterregulatory hormones such as
epinephrine,
glucagon,
and cortisol are secreted during times of stress the liver to put additional glucose into the system. Once the stress goes away, the blood sugar will return to baseline in a relatively short period of time and may even drop lower if this occurs during an insulin peak time.
In warm weather or during strenuous exercise, the blood sugar may rise simply because of dehydration. Giving extra sugar-free fluids in this case will return it to baseline. A rule of thumb is about one-third of an ounce per kilogram of body weight per hour.
Exercising vigorously to try to bring a blood sugar down might actually be dangerous. Exercise should be avoided if the blood sugar is greater than 250 mg/dl [13.9 mmol/L] or if there are
ketones
in the urine. As previously mentioned, exercise causes the release of counterregulatory hormones and dehydration, which can make the blood sugar, go even higher.
An often-overlooked cause of hyperglycemia is
rebound hyperglycemia.
Many times a blood sugar can go low and be undetected because, once again, those counterregulatory hormones come into play to raise the blood sugar when it is low. Giving additional insulin in this instance can make things worse instead of better.
The bottom line: don’t react to every high blood sugar unless you are absolutely certain of the cause. The best approach is to wait it out for hour or so and always re-check. A good rule of thumb is not to give extra insulin unless:
- You are absolutely certain of the cause (overeating, for example).
- The blood sugar has been over 240 mg/dl [13.3 mmol/L] for two or more readings about an hour apart.
- The blood sugar is elevated and there are ketones in the urine.
One last point: If you find that you are having to "chase" high sugar levels with extra insulin frequently, you’ll never find a correct insulin dose. Remember that the insulin affecting the current reading was given in the previous dose. If the highs are always happening at the same time of day or resulting from certain meal, use those blood glucose numbers to make permanent changes in doses. This will prevent the hyperglycemia and result in improved overall control.
