• Hypoglycemia- low blood sugar

• Hyperglycemia- high blood sugar

• Ketoacidosis- a state of relative or absolute insulin deficiency

• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)- is a form of high blood sugar without the presence of ketone

Hypoglycemia- low blood sugar

It is possible for a person to be hypoglycemic even if they are doing all the right things to control their diabetes. It can be prevented though, by knowing the symptoms of hypoglycemia.

Symptoms:
Dizziness
Sweating
Shaking
Pale skin
Hungry
Headache
Mood swings
Seizures
Clumsiness
Confusion
Tingling feeling around the mouth

What to do in the case of hypoglycemia?

In extreme cases the fastest way to raise blood sugar levels is by consuming some form of simple sugar (glucose tablets, apple juice, candy). Then check blood sugar levels again about 15 minutes later. If the condition is not extreme then a slower digesting source of carbohydrates will help prevent a spike in the blood sugar (oatmeal, certain nutrition bars (Cliff Bars)). People with diabetes should always have something available to them in the case of an emergency.

If the condition is not promptly treated it can get much worse. A person can pass out or even go into seizures. If this happens a shot of glucagon can be administered. This will cause the body to release glucose into the blood. This should be done by someone with experience such as a trained professional or a trained friend or family member. Ask your doctor for more information.

If you are not able to administer treatment then the person should be taken to the nearest hospital or 9-1-1 should be called.

To avoid these problems blood sugar should be checked regularly and if signs and symptoms arise they should be treated immediately.

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Hyperglycemia- high blood sugar

Hyperglycemia is much more common than hypoglycemia in people with diabetes. It is also the cause for a large portion of the complications that arise from diabetes. This is the result of the body not producing enough insulin, not properly administering insulin, or the body not utilizing the insulin efficiently.

Signs and Symptoms:
High blood sugar levels
Increased thirst
Frequent urination
High levels of glucose in urine

What to do in the case of hyperglycemia?

Insulin injections are commonly used for diabetes and if hyperglycemia is occurring they should be adjusted by either dose or timing of injection. Exercise is also used to lower blood sugar levels. Before exercising for this purpose urine should be checked to be aware of possible ketones. Blood sugar levels of 240mg/dL or more is a sign of possible ketones in the blood. If ketones are visible then exercise should be avoided. Exercising with ketones present can actually raise blood sugar levels. Changes in the diet can also help prevent hyperglycemia.

What are ketones?

Ketones are substances produced when the body breaks down fat for energy. This occurs when there are insufficient carbohydrates in the diet so the body needs to use a different fuel source. It begins to break down fat for energy and ketones are produced. There are ketone tests that can be performed to see the level of ketones in the blood.

If there are ketones visible in the blood it should be treated immediately. Ketones will build up in the system because the body can’t eliminate them efficiently. This can lead to a build up of ketones and eventually to ketoacidosis or even a diabetic coma.

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Ketoacidosis- a state of relative or absolute insulin deficiency

Signs and symptoms of ketoacidosis:
A fruity scent on the breath
Shortness of breath
Nausea
Vomiting
Confusion
Extreme thirst or dry mouth
Frequent urination
Coma

This is most commonly seen in people with type 1 diabetes. When a person with diabetes is sick it is also advisable to check for ketone levels as they do increase. If ketones levels are high or if vomiting is occurring frequently then a health care provider should be notified immediately.

Ketoacidosis occurs for a few different reasons including:
Insufficient levels of insulin
Not getting enough food
An insulin reaction- an excessively low blood sugar level (usually lower than 50mg/dL)

In the event that ketoacidosis occurs it should be treated immediately. Call your health care provider for more information.

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Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)- is a form of high blood sugar without the presence of ketones

This most commonly occurs in older people with type 2 diabetes who retain enough pancreatic function to avoid ketones. The person’s blood sugar levels rise and the body tries to eliminate it through urine. The frequency of urination increases and the urine darkens.

Signs and symptoms of HHNS:
High blood sugar (over 600mg/dL)
Frequent urination
Excessive urination
Dark yellow urine
Excessive thirst
Confusion
Fatigue
Weakness
Sleepiness
Warm dry skin
Low blood pressure
High fever
Hallucinations
Coma
Seizures

In a case when frequent urination is occurring make sure to drink ample fluids to prevent dehydration.

Prevention of HHNS comes from frequently checking blood sugar levels and knowing the signs and symptoms. In the situation when HHNS occurs it should be treated immediately and 9-1-1 should be called. Call your health care provider for more information.

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