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Care During Chemotherapy and Beyond

Hyperglycemia (High Blood Sugar)



What is hyperglycemia?

Hyperglycemia may be described as an excess of sugar (glucose) in the blood. Your endocrine system regulates the amount of sugar that is stored and used for energy. It is important in brain cell function, and energy levels.

Since the sugar that you consume in your diet is either used or stored, certain conditions and disorders may cause you to have difficulty processing and storing blood glucose, resulting in hyperglycemia or hypoglycemia.

One hormone that is important to the normal storing and processing of sugar is insulin. Insulin is a hormone that is made in the pancreas that is responsible for maintaining "normal" blood sugar levels. If you have a problem with your pancreas, then you may have increased blood sugar levels.

Normal blood Glucose (sugar) levels are 60-110 mg/dL.  Normal values may vary from laboratory to laboratory. Levels higher than these might indicate hyperglycemia.

Causes of hyperglycemia may include:

  • Diabetes. About 90% of people with diabetes, have diabetes of adult onset (Diabetes type 2). You are more at risk for developing diabetes if you are older, extremely overweight (obese), if you have a family history of diabetes (parents, siblings), and if you are of African-American, Hispanic American, or Native-American heritage. People who have diabetes have an underproduction of the hormone, insulin, which lowers your blood sugar levels. If you have diabetes, you will have problems with elevated blood sugar levels.
  • If you develop diabetes type 2, and you are an adult, your healthcare provider may prescribe medications in a pill form, which allow your body to process insulin that is needed for maintaining "normal" blood glucose levels. It is likely that your pancreas is producing enough insulin, but your body is resistant to the insulin, and is unable to process this hormone effectively, thus resulting in hyperglycemia.
  • If you have diabetes and are hypoglycemic, your healthcare provider will also discuss with you a diet that may increase your blood sugar levels. You will need to follow a special diet, to maintain good blood sugar control.
  • Exercise is highly recommended, as it will help to lower blood sugar levels, and promote circulation of the blood throughout your body.
  • If you are not able to control your blood sugar levels with diet, exercise, and medications (in the pill form), your healthcare provider may prescribe insulin injections. You will be required to take your blood sugar levels at home, while your insulin requirements are being determined. Your healthcare provider will discuss this with you, and teach you how to best take care of yourself during this time.
  • Insulin cannot be taken by mouth because your stomach acid makes the insulin inactive (it will not work).
  • You may be taking corticosteroids, such as dexamethasone (Decadron®), or prednisone. These drugs will promote gluconeogenesis, or increased blood sugar levels in your blood. Many people who are on steroids for their disease, and develop high blood sugar levels (hyperglycemia), will return to normal after the medication has been finished.
  • You may be receiving Total Parenteral Nutrition (TPN), through your vein (IV). The TPN solution contains a very high concentration of glucose. Your body will often times be able to regulate your blood glucose levels, but in some cases, while you are on TPN, your blood sugar levels may be elevated.
  • You may have increased blood sugar levels if you have kidney or liver disease. You may also have an infection in your pancreas that controls blood insulin levels, thus resulting in hyperglycemia.
  • If you have an infection, your blood sugar may be briefly high, during the time that you are ill, resulting in a temporary hyperglycemia.
  • If you are pregnant, you may develop gestational diabetes. This means that you have diabetes while you are pregnant. This usually goes away after you deliver your baby.
  • Kidney failure, kidney disorders, and damage to your eyes, cardiovascular system, and other internal organs may result from long-term hyperglycemia. In addition, there are many other long-term complications of long-standing hyperglycemia, such as heart and blood circulation problems. This is why it is important to maintain good control over your disease.

How will I know if my hyperglycemia is related to diabetes?

  • Your doctor or healthcare provider may order certain blood tests to determine if you are diabetic. As discussed, certain conditions may cause temporary increases in blood sugar levels, resulting in hyperglycemia. You may not be a "true" diabetic, and the blood sugars may return to normal after your illness, or treatment of your condition, is resolved. However, you may be treated as if you had diabetes, with frequent blood sugar monitoring, diet and exercise modifications, until your laboratory values return to normal. Normal blood sugar levels are between 60-110 mg/dL (normal values may vary from laboratory to laboratory).
  • If you have a fasting blood sugar level of between 110 and 125 mg/dl, you are diagnosed as having impaired glucose tolerance. This is a strong risk factor for developing diabetes. With good diet and exercise, you may slow the progression to diabetes type 2.
  • If you have a blood sugar of greater than 126 mg/dl, while fasting, you may be diagnosed with diabetes.
  • If you have any two blood sugar readings over 200mg/dl, you also may be diagnosed with diabetes.
  • You may have an oral glucose tolerance test (OGTT) to diagnose your condition. You will be required to drink a solution with a high concentration of glucose, and have your blood sugar checked 2 hours after it was ingested. This was the traditional method for diagnosing diabetes, but is done less often today.
  • A blood test, called Hemoglobin A1C (also called glycosolated hemoglobin), will measure your average blood sugar levels for 90 days. Your healthcare provider may order this on diagnosis, and every 3 months thereafter, if you have diabetes.

What are some signs and symptoms of hyperglycemia to look for?

  • Symptoms of hyperglycemia are the same as symptoms of diabetes type 2.
  • Symptoms include being overly or excessively thirsty. You may be urinating more often than usual.
  • You may be tired, and losing weight without trying.
  • You may develop yeast or fungal infections.
  • Late symptoms of prolonged, elevated blood sugar levels are blurred vision and possibly numbness in your fingers and toes.
  • Severely high levels of blood sugar may cause confusion or a coma.

Things you can do about hyperglycemia:

  • If you are experiencing high blood sugars from diabetes, an infection, or a pregnancy, your healthcare provider may instruct you on the use of pills, insulin, diet, exercise and blood sugar monitoring during this time. Follow all of your healthcare provider's instructions.
  • Try to exercise. Make a daily walk alone, or with a friend or family member a part of your routine. Even light walking or aerobic activity may help you to promote the flow of oxygen in your lungs and blood (oxygenation), lower your blood sugar levels, and help to prevent long-term complications of hyperglycemia. Also, consistent diet and exercise will help your healthcare provider determine your insulin or diabetic pill dosages, and help you to obtain better control of your disease.
  • Follow the recommended diet. A diabetic diet may be suggested even if you only have a short-term elevation in blood sugar due to an infection, or the use of steroids. The right diet can diminish symptoms.
  • You will most likely meet with a dietician if you are diagnosed with diabetes, either Type 2 or gestational, to help you determine a diet that is right for you. This will help you to gain control over your disease or condition that may be causing the high blood sugar levels.  Reading the labels on food is helpful to know what kinds of calories, fat and protein you are taking in to control your diet. Some general recommendations include:
  • Limit Carbohydrates - Carbohydrates, either simple (such as fruit and sugar) or complex, (such as pasta and cereals), have the greatest impact on blood sugar levels. Your diet should include around 50% carbohydrates. Avoid sugar, and instead, use artificial sweeteners, such as nutrasweet, aspartame, or saccharin.
  • Protein - your diet should consist of 15-20% protein. Long-term damage to your kidneys may be corrected by restricting protein - if you are diabetic.
  • Increase fresh vegetables and fiber intake - Up to 55 grams of fiber in your diet per day is recommended. Fiber and fresh vegetables help to decrease blood sugar levels, maintain regular bowel habits, and may prevent certain cancers.
  • There are many types of "good and bad" fats. The easiest thing to remember is to limit your intake of saturated fats and oils in your diet.
  • You will most likely be instructed on obtaining a blood sugar monitor especially if you have diabetes, and be asked by your healthcare provider to check your blood sugar levels at home. At first, you will be required to check your blood sugar levels up to 4 or more times a day, to make sure that the levels are in the normal range, without extremely high or low levels. Eventually, with diet, exercise, and the proper medication regimen, you may be able to check your blood sugar levels less often.
  • Although your blood sugar levels may run high, a sensible bedtime snack may help to prevent low blood sugar levels during the nighttime.
  • Alert your friends, family and close contacts about your condition. Tell them what to look for, including sweatiness, shakiness and confusion, which are serious symptoms of low blood sugar levels. Keep candy in your pocket in case your blood sugar gets too low, and instruct them to seek emergency assistance if they are unsure what to do.
  • Wear a "medic alert" bracelet, if you have diabetes, or a history of high or low blood sugars (hyperglycemia or hypoglycemia).
  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  These can cause severe interactions with oral medications, and affect blood sugar levels.
  • Remind your doctor or healthcare provider if you have a history of liver, kidney, or heart disease.
  • Keep yourself well hydrated. Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • Avoid alcohol. Certain forms of alcohol may cause you to have a severely high or low blood sugar level. High blood sugar levels may result if alcohol is mixed with "syrupy" drinks. Low blood sugars may result if you drink certain forms of "straight" liquor. If you are taking pills to control your hyperglycemia, alcohol use may cause life-threatening interaction.
  • If you have diabetes, it is important to inspect your feet daily. People with long-term high blood sugar levels may develop diabetic neuropathy, which has symptoms of decreased sensation and blood flow to your feet and toes. If you have neuropathy, you may be unable to notice if there has been any damage to your feet or toes. If you develop an infection, or a wound, you may not be able to heal as well.
  • Keep your feet clean and dry. Wear white cotton socks.
  • Inspect your feet and toes for cracks, hardened areas, or rashes.
  • Apply moisturizer daily, but not between the toes.
  • If you notice any wounds, or changes, follow up with a podiatrist or your healthcare provider.
  • If you have diabetes, you should see an ophthalmologist to have your eyes checked yearly. Any change in vision should be reported as soon as it is noticed
  • A most serious side effect and symptom of diabetes and long-term high blood sugar levels is kidney damage. Your urine may be checked periodically for protein (called, proteinuria). If there is damage to the kidneys, you will have protein in your urine. If your kidney damage is noticed early, and there is only a low level of protein in your urine, your healthcare provider may help you to prevent further damage by discussing diet, exercise and medications. Strict blood sugar control will help to prevent proteinuria.
  • A blood test, called Hemoglobin A1C, will measure your average blood sugar levels for 90 days. Your healthcare provider may order this, every 3 months if you have diabetes.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments.

Drugs that may be prescribed by your doctor:

If you are experiencing high blood sugar levels, you doctor or healthcare provider may prescribe:

  • Insulin - Insulin is a hormone that is naturally found in our bodies, that regulates blood glucose levels. Insulin may be given in the vein (IV), while you are in the hospital, or more commonly, under the skin (subcutaneous). If your blood sugar levels are not under good control, you may be ordered to take insulin alone, or in addition to an oral anti-diabetic agent. Insulin injections may be temporary, while you are first diagnosed, or they may need to be continued for a longer period of time. Your healthcare provider will determine this.
  • Oral anti-diabetic agents - There are many different kinds of medications that work by allowing your body to process insulin more effectively. These include metformin, glipizide, actos or avandia. Your healthcare provider will suggest one, which is right for you. Side effects of these medications may vary, but most include low blood sugar levels, weight loss, and improvement in your blood cholesterol levels. Some may cause slight nausea or loss of appetite, or diarrhea and bowel disturbances. It is important to follow your healthcare provider's recommendations for taking these pills.

When to call your doctor or health care provider

Call your doctor if you have the following symptoms:

  • Increased urinary frequency, painful urination, weight loss.
  • If you notice symptoms of low blood sugar, including shakiness, sweating, and tiredness.
  • If you develop signs of confusion.
  • Shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately -especially if you have started a new medication.
  • Feeling your heart beat rapidly, or experience palpitations.
  • Nausea that interferes with your ability to eat, and is unrelieved by prescribed medication.
  • Diarrhea (4-6 episodes in a 24-hour period), unrelieved with taking anti-diarrhea medication and diet modification.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.