【Major Points】

1. What is hyperglycemia? What are the symptoms?
2. What are the causes of hyperglycemia?
3. How can I take care of myself when I have hyperglycemia?

The blood sugar control target for adults with diabetes: fasting blood sugar is 80-130 mg/dl; blood sugar below 180 mg/dl two hours after meals. When blood sugar is greater than the control target, it is called hyperglycemia.

Hyperglycemia can evolve into a “hyperglycemic crisis” if not managed well, which may be life-threatening or cause chronic comorbidities that affect the quality of life.

What are the causes of hyperglycemia?

1. Failure of taking hypoglycemic drugs or injection of insulin according to the schedule.
2. Stopping the medication or reducing the dose of medication on their own.
3. Overeating.
4. Cold, infection, inflammation, surgical trauma, heart attack, or stroke.
5. Long-term or sudden stress that causes emotional instability, such as family disputes and academic problems.
6. Being unaware of the presence of diabetes or being aware of the presence of diabetes, but not receiving treatment.

1. Symptoms of eating more, drinking more, and urination more.
2. Vomiting, nausea, abdominal pain, anorexia, decreased appetite, and weight loss.
3. Weakness, fatigue, blurred vision, and headache.
4. Dehydrated and dry skin, and sunken eyes.
5.  Symptoms of “hyperglycemic crisis”:
   1. Symptoms of diabetic ketoacidosis: panting for breath; fruity-smelling breath.
   2. Symptoms of hyperglycemia hyperosmolar state: slow and deep breathing, confusion, and coma.

1. Monitor blood sugar:
   1. Follow the doctor's instructions to take hypoglycemic drugs or inject insulin, and do not stop the drug arbitrarily.
   2. Measure and record blood sugar at the frequency recommended by the physician.
   3. If blood sugar continues to rise after treatment, please seek medical attention as soon as possible.
2. Diet control: Follow the dietitian's dietary advice to control your diet.
3. Regular exercise:
   1. Develop the habit of regular exercise.
   2. Exercise is not recommended when the fasting blood sugar exceeds 250 mg/dl. When there is insufficient insulin in the body, exercise will cause the body to break down protein and fat to supply energy, which may lead to hyperglycemia and ketoacidosis.
4. Regular follow-up: Outpatient follow-up of glycosylated hemoglobin, renal function, and ophthalmological examination, as arranged by the physician.
5. Warning signs: If hyperglycemia does not cause nausea, vomiting, or coma, the patients may drink water to avoid dehydration. If the patients experience emergency symptoms, such as dehydration, shortness of breath, fever, or change of consciousness, they should seek medical attention immediately.

Reference

1. American Diabetes Association (2022). Diabetes care in the hospital: Standards of medical care in diabetes-2022. Diabetes Care, 45(1), S244-S253. https://doi.org/10.2337/dc22-S016
2. American Diabetes Association (2022). Standards of medical care in diabetes-2022 abridged for primary care providers. Diabetes Care, 40(1), 10-38. https://doi.org/10.2337/cd22-as01
3. Chen, F. Y. & Chen, H. H. (2018). Clinical introduction, diagnosis, treatment, and evolution of hyperglycemic hyperosmolar states. Journal of Clinical Medicine, 82(2), 469-472.  https://doi.org/10.6666/ClinMed.201808_82(2).0085
4. Ou, C. M., Shang, C. C., Liu, C. H., Chang, Y. J., Shih, K. C. & Hu, L. H. (2019). Nursing Care of Client with Endocrine Disorders. In K.Y. Wang, H.E. Liu, & R.C. Feng, Newly Edited Medical and Surgical Nursing (6th edition, pp. 13-102~13-107). Yeong Dah Book Company Ltd.
5. The Diabetes Association of the Republic of China (Taiwan) (2018). 2018 Guidelines for Clinical Care of Diabetes. The Diabetes Association of the Republic of China (Taiwan).