How To Lower Blood Sugar Levels During An Emergency?

Hyperglycemia can be a life-threatening emergency. In these cases, the administration of fast-acting insulin will be key to avoid complications.

People living with type 1 or type 2 diabetes have difficulty controlling their blood sugar levels . And although it is possible that they go through long periods with their blood glucose levels high, an emergency could occur, with a sudden rise in values.

Hyperglycemia emergencies in diabetes are not always the same. Sometimes there are symptoms immediately and other times the signs appear progressively. The greatest risk is to develop a condition known as diabetic ketoacidosis.

Values considered normal for blood sugar range between 70 and 99 milligrams per deciliter of blood (mg/dL). After a meal, these values are expected to rise and then reduce to less than 140 mg/dL two hours after eating.

Why Can There Be Hyperglycemia?

Hyperglycemia is more common in people living with diabetes . A descriptive analysis conducted in 2017 in Valladolid, Spain, showed that hyperglycemic emergencies accounted for 72% of acute complications in these patients. The most frequent reasons for decompensation were poor control of the disease and the presence of an infection.

When a person with type 1 diabetes forgets a dose of insulin or takes it incorrectly at the scheduled time, the risk of an emergency increases, as explained in a review published in The British Medical Journal . The same thing also happens with forgetting to take oral hypoglycemic agents in type 2 diabetes, such as metformin.

Infections, on the other hand, cause an imbalance in disease control. The body fights microorganisms and consumes more energy, in addition to altering the use of the hormone insulin . Therefore, if there is no adjustment in medication doses, the patient is more susceptible to hyperglycemia.

In people without a diagnosis of diabetes, an emergency due to high blood sugar values is very rare. It could happen in a pregnant woman who is developing gestational diabetes and in situations of recreational drug abuse, such as cocaine .

What Are The Symptoms Of A High Blood Sugar Emergency?

A situation of acute hyperglycemia will cause some particular symptoms , different from the common signs of high blood sugar . In type 2 diabetes, signs appear slowly, over months or years. On the other hand, when blood sugar rises quickly, the following may appear:

Cold sweat
Blurry vision
Nausea and vomiting
Excessive thirst or polydipsia
Extreme weakness and fatigue

If the rise in blood glucose is high and diabetic ketoacidosis develops, then other more severe symptoms will appear, such as the following:

Abdominal pain: associated with nausea and vomiting.
Dehydration: the skin dries out quickly and thirst increases.
Breath with a fruity smell: due to the elevation of compounds inside the body, called ketone bodies.
Confusion and lethargy: weakness transforms into a reduction in cognitive alertness, which may cause fainting and loss of consciousness.
Rapid and deep breathing or Kussmaul breathing: the body tries to eliminate excess carbon dioxide and ketone bodies with a very high respiratory rate that becomes superficial and fails to oxygenate the cells correctly.

If hyperglycemia is not corrected, ketoacidosis could lead to diabetic coma . Prolonged lack of insulin will cause a significant increase in ketone bodies with acidification of the blood, which impedes the functioning of the organs.

In older adults with type 2 diabetes, a similar situation that may occur is the non-ketotic hyperglycemic hyperosmolar state , as explained in the Canadian Journal of Diabetes . Although it has symptoms similar to ketoacidosis, it occurs due to dehydration, without the ketone bodies increasing their concentration on their own.

What To Do If Blood Sugar Levels Rise Quickly

There are three emergency measures for high blood sugar: administer insulin, drink water and exercise . It is worth clarifying that they work in the context of hyperglycemia without serious symptoms. The presence of signs of ketoacidosis should lead to urgent medical consultation.

1. Administer insulin

The administration of rapid-acting insulin is the basic measure to take when there are high sugar levels, with obvious symptoms, in people living with type 1 or 2 diabetes. This is even more important when more than 250 mg/dL is recorded of glycemia .

The recommended insulin dose in these situations varies between 0.3 to 0.5 international units (IU) per kilogram of weight. However, you could change the recommendation for a particular feature.

There are various types of insulin on the market and the one that should be used in an emergency is fast-acting . The others will not have an effect in the acute context and will take hours to act.

After application, a new glucose self-monitoring measurement must be made 30 minutes later. In this way, it is certified that there is some type of decrease in values.

If there is no decrease in values, repeating the insulin dose is contraindicated. This could lead to severe hypoglycemia . Therefore, it would be better to contact the doctor or go to a hospital emergency department.

2. Drink water

One of the main reasons for the increased risk of hyperglycemia is dehydration . When you don’t drink enough water, some blood components, such as glucose, become more concentrated. In addition, the metabolism begins to break down fats, with the possibility of increasing ketone bodies.

Therefore, it is indicated to always drink water and, above all, when you begin to feel the signs of dehydration: dry mouth and dry skin. This will lead to greater urine production that can remove excess glucose from the blood.

It will not be an immediate method, but it is necessary. This action complements the insulin injection and, if hospitalization is later required, will facilitate the intravenous hydration process in the hospital.

3. Exercise

Exercise is a very effective means of reducing high blood sugar levels. For physical activity to have a metabolic effect, it must increase the heart rate and last over time, that is, be prolonged.

So, if self-monitoring is done and hyperglycemia is found, it will be advisable to correct it with insulin and go for a walk, for example. As long as the symptoms allow it and there is no dizziness or lethargy.

A reading of more than 250 mg/dL, with the risk of ketoacidosis, implies special care if we want to exercise. First you will have to perform a quick ketone test and, if they are elevated, then physical activity is contraindicated.

The method, like drinking water, is not quick. Again, it is worth emphasizing that it is a complement to insulin injection, so it cannot be considered a solitary strategy in the event of an emergency.

When To Seek Medical Attention?

Mild hyperglycemia, with values around 180 mg/dL and few symptoms, can be treated at home if rapid-acting insulin is available. Furthermore, it is assumed that a protocol to act in these cases has already been discussed with the treating doctor.

On the other hand, symptoms of ketoacidosis, the persistence of high blood glucose values despite measurements or confirmation of ketone bodies using a rapid test should lead to an emergency room. In these cases, the dose of rapid insulin can be applied and the alert system activated by calling 911 or the on-call telephone number of the nearest clinic.

In the hospital setting, the goal of treating hyperglycemic crises is to stabilize the patient and correct blood sugar . To do this, the following will be done:

Fluid replacement: intravenously to restore body fluids and prevent dehydration.
Electrolyte replacement: sodium and potassium will be included in the intravenous formula so that rehydration does not cause a dilution of these minerals and complications appear.
Intravenous insulin: intravenous insulin therapy is the specific measure to correct hyperglycemia in the hospital. Infusion of the hormone through a pump is the most efficient and safest system.

What Blood Sugar Values Should I Be Concerned About?

For the diagnosis of hyperglycemia, blood sugar must be above certain standardized values. This means exceeding 125 mg/dL if we are fasting, when we wake up in the morning, or exceeding 180 mg/dL after 2 hours of ingestion.

If blood glucose reaches 250 mg/dL at any time, there is a risk of ketoacidosis. Therefore, it is advisable to do a rapid urine ketone test, which you should have if you suffer from type 1 diabetes. A positive test would imply contacting an emergency service.

Finally, the persistence for a week of values greater than 180 mg/dL or very high readings in isolation, reaching 500 or 600 mg/dL, merit scheduling a consultation as soon as possible.

How To Prevent Hyperglycemia?

Avoiding high blood sugar spikes is possible with some lifestyle changes. All of them are part of diabetes treatment. Well, beyond medication, patients have to implement habits and ways of eating that contribute to their health.

There are different ways to control blood glucose , but in general terms, the following is recommended:

Exercise constantly.
Promote good sleep hygiene .
Drink natural drinks to reduce blood sugar .
Carry out regular self-monitoring , according to medical indications.
Reduce the intake of simple sugars and increase fiber consumption.
Consume foods to lower sugar , that is, with a low glycemic index.
Stay hydrated, preferably with water. You can also incorporate homemade smoothies .

Reducing the risk of hyperglycemia is key. High blood sugar is an emergency that, if it progresses, is life-threatening.

In addition, the persistence of high registers has long-term consequences on the nerves, arteries, heart, vision and kidneys. Therefore, medical advice is essential, both in emergencies and before they happen, to receive information on how to act.