High or Low Blood Sugar: Recognizing the Signs and How to Manage

Madalyn McCaulley, PharmD Candidate Class of 2022
University of Hawaii at Hilo, Daniel K. Inouye College of Pharmacy

October 07, 2021

Hypoglycemia

Having blood sugar that’s too high or low is a problem many patients are unfamiliar with. This is an issue commonly seen in patients with diabetes. With the rise of diabetes, patients need to recognize the signs and understand what to do if their blood sugar is too high or low.

Hypoglycemia (low blood sugar)

Hypoglycemia is defined as a blood sugar drop in blood sugar, commonly < 70 mg/dL. There are several possible causes, which include the following:

  • Not eating enough
  • Postponing or skipping a meal or snack
  • Increasing exercise or physical activity without eating more or adjusting your medications
  • Drinking alcohol

However, the most common cause is a side effect of medications used to treat diabetes.

Signs and symptoms

  • sweating
  • feeling tired
  • dizziness
  • feeling hungry
  • tingling lips
  • feeling shaky or trembling.
  • a fast or pounding heartbeat (palpitations)
  • becoming easily irritated, tearful, anxious or moody

How to manage hypoglycemia

If blood sugar is less than 70 mg/dL

  • Use the 15 – 15 Rule
    • Ingest one of the following
      • 4 ounces (½ cup) of juice or regular soda
      • 1 tablespoon of sugar, honey, or syrup
      • Hard candies
      • 3-4 glucose tablets
      • 1 dose of glucose gel 
    • Wait 15 min then check blood sugar again
    • If still < 70 mg/dL repeat above step
    • If blood sugar is above 70 mg/dL, eat a meal to help maintain sugar level

Hyperglycemia (high blood sugar)

Hyperglycemia mainly affects patients with diabetes. It’s defined as a rise in blood sugar, which is typically determined by a fasting blood sugar level ≥ 126mg/dL or a random sugar level ≥ 200 mg/dL.

Some common causes of high blood sugar are:

  • Not using enough insulin or oral diabetes medication
  • Not injecting insulin properly or using expired insulin
  • Not following your diabetes eating plan
  • Being inactive
  • Having an illness or infection
  • Using certain medications, such as steroids

If symptoms are left untreated and blood sugar is allowed to increase, it could rise to life-threatening levels and cause Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic State (HHS). DKA is more common in patients with Type 1 diabetes, and HHS is more common in Type 2 diabetic patients.

Signs and symptoms

  • High Blood Sugar Levels
    • Frequent urination
    • Increased thirst
    • Fatigue/sleepy
    • Blurred vision
    • Dry skin
    • Increased hunger
  • Diabetic Ketoacidosis (DKA)
    • Fruity–smelling breath
    • Nausea and vomiting
    • Shortness of breath
    • Dry mouth
    • Weakness
    • Confusion
    • Abdominal Pain
  • Hyperosmolar hyperglycemic syndrome (HHS )
    • Weakness
    • Confusion

How to manage hyperglycemia

The best management for hyperglycemia is to keep your diabetes under control. Some ways to do this are:

  • Exercise regularly
  • Take your diabetes medication as directed
  • Follow a diabetic plate method
    • 25% - lean protein
    • 25% - whole grains or starchy vegetables
    • 50% - non-starchy vegetable
  • Check your blood sugar regularly
    • Fasting: goal 80 – 130 mg/dL
    • Postprandial (after meals): goal less than 180 mg/dL
  • Adjust your insulin doses to control hyperglycemia

When to seek medical attention 

  • Your blood sugar is persistently greater than 240 mg/dL
  • You develop fruity-smelling breath
  • You have abdominal pain or vomiting
  • You are unable to lower your blood sugar level with medications
  • You experience confusion

If you are having trouble maintaining a stable blood sugar level, talk with your doctor to see what options are available for you.

References:

  1. Hypoglycemia in Adults – Approach to the Patient Without Diabetes. Accessed August 18, 2021. https://ww.dynamed.com/approach-to/hypoglycemia-in-adults-approach-to-the-patient-wthout-diabetes
  2. Hypoglycemia in Diabetes. Accessed August 18, 2021. https://www.dynamed.com/condition/hypoglycemia-in-diabetes
  3. Diabetes Mellitus Type 2 in Adults. Accessed 20, 2021. https://www.dynamed.com/condition/diabetes-mellitus-type-2-in-adults
  4. Diabetic Ketoacidosis (DKA) in Adults. Accessed August 22, 2021. https://www.dynamed.com/condition/diabetic-ketoacidosis-dka-in-adults
  5. Riddle MC, Barkris GB, Blonde L, et al. Standards of Medical Care in Diabetes – 2021. Diabetes Care. 2021; 44 (1): S1-S232.
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