Diabetic Patients: Recognizing Warning Signs of Hypoglycemia and Hyperglycemia

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Many of the populations that you might work with as a healthcare professional will have patients with some form of diabetes. For CNAs, you’re a vital part in identifying when something might be wrong with diabetic patients and getting them the help they need. For LPNs and RNs, you’ll want to quickly identify warning signs of blood glucose levels that have gone too low or high out of normal range and how to treat the right condition the right way. 

If it’s been a while since you last cared for diabetic patients, or you need a refresher or a reference for quick facts, here are the basics of diabetes and how to identify early warning signs of hypoglycemia and hyperglycemia. 


Diabetes Overview

diabetes key facts graphic - Diabetes led to and estimated 1.6M deaths worldwide in 2016 and is the 7th leading cause of death worldwide

Insulin is a hormone that is important for making sure your cells get energy from blood glucose. Without that hormone, your blood glucose builds up in the blood with nowhere to go, and if there’s too much of it, it can cause lasting damage to many parts of your body.

On average, normal blood glucose levels are the following:

  • Before a meal, it should be between 80 to 130 mg/dl.
  • In the two hours after you start eating a meal, it should be less than 180 mg/dl.

Many people live relatively normal lives with diabetes. But if isn’t treated correctly, it can cause a lot of damage and even death. Some statistics on the damaging effects of diabetes include the following facts from the World Health Organization:

  • A 2016 estimate put diabetes as the direct cause of about 1.6 million deaths worldwide that year.
  • Also in 2016, diabetes was estimated to be the world’s seventh leading cause of death.
  • Between the year 2000 and 2016, the world saw a 5% increase in premature deaths directly caused by diabetes.
  • Besides death, diabetes can be a direct cause of other permanent health problems, like blindness, kidney failure, heart attacks, strokes, and amputations of feet or legs.

Types of Diabetes

Diabetes is a disease process where, due to certain reasons, the body can’t effectively manage blood glucose. Patients can have type 1 diabetes, type 2 diabetes, or gestational diabetes. Patients can also have prediabetes, which puts them at high risk of developing type 2 diabetes.

Type 1 Diabetes

A Type 1 Diabetes diagnosis can happen at any age.

In type 1 diabetes, a patient’s pancreas either doesn’t make any insulin at all, or the little it does make isn’t enough to maintain blood glucose levels. We still don’t know exactly what causes type 1 diabetes. It’s likely an autoimmune reaction, which means the patient’s body is attacking the cells inside the pancreas that make insulin. 

In terms of risk factors, family history is the most well-known. Most patients find out they have type 1 diabetes when they are young during childhood or as teenagers and young adults, while some won’t have symptoms until they are in adulthood. This type of diabetes is treated primarily with insulin in addition to healthy lifestyle habits.

Type 2 Diabetes

Lifestyle changes can help with managing Type 2 Diabetes, but some people may have to use medication.

Type 2 diabetes is the most common type of diabetes. Of all people diagnosed with diabetes, 90-95% of them will have this type. They range from any age, most commonly in adults. 

In type 2 diabetes, your body produces insulin, but it doesn’t use it effectively. Your body just can’t manage its blood glucose levels. People with type 2 diabetes can treat disease progression through healthy lifestyle habits. In people who don’t practice a healthy lifestyle, the illness is treated with medication. 

Gestational Diabetes

Pregnant people who don’t have diabetes can get gestational diabetes during pregnancy. Although patients generally recover from gestational diabetes after pregnancy, it increases their risk for type 2 diabetes. Gestational diabetes can also affect the baby, increasing the risk of health problems during pregnancy or later in life.


Hypoglycemia

Hypoglycemia is when a patient has critically low blood glucose. It can happen quickly, and when it does, you’ll need to treat it immediately to keep it from causing permanent damage. This condition can be caused by:

  • Taking too much insulin
  • Going too long without a snack or food by skipping or delaying meals
  • Not eating enough food
  • Exercising or being more physically active than normal
  • Sickness
  • Drinking too much alcohol compared to the amount of food you eat

Symptoms

Hypoglycemia Symptoms Graphic
Dizziness, trouble concentrating, and confusion are just a few symptoms of hypoglycemia.

Hypoglycemia symptoms can range from mild to severe.  Symptoms of mild to moderate hypoglycemia include the following:

  • Shakiness or jitteriness
  • Any unusual changes to behavior or personality
    • Anger, aggressiveness, or stubbornness
    • Nervousness, anxiety, irritability, or impatience
  • Unusual changes to mental state
    • Confusion or disorientation
    • Trouble concentrating
  • Dizziness or lightheadedness
  • Uncoordinated movements
  • Sweating, chills, or clamminess
  • Hunger
  • Headache
  • Nausea
  • Blurred vision
  • Weakness or fatigue
  • Fast or irregular pulse

Severe symptoms of low blood glucose can be life-threatening and are also more common in patients with type 1 diabetes. They include the following:

  • Jerky movements from seizures or convulsions
  • Unconsciousness
  • Inability to eat or drink

While it may be easiest to identify this condition when a patient is awake, some patients don’t show symptoms until they are asleep. Hypoglycemia symptoms can also happen when a patient is sleeping:

  • They might wake up crying out or having nightmares
  • They might sweat so much that their clothing or bed will be damp
  • They may feel like they didn’t get any sleep and feel tired, irritable, or confused after waking up.

Treatment

Hypoglycemia treatment symptoms
Treat low blood sugar with a bit of fruit juice, glucose, or a patient’s medication before symptoms become severe.

Some patients with lifelong diabetes can recognize symptoms of low blood sugar before it gets severe. Many patients will have treatment options ready and available just in case. But as health care professionals, you should also be aware of the symptoms and how to help diabetic patients treat hypoglycemia.

The first step in treatment is to check the patient’s blood sugar. If it turns out the patient’s blood glucose is less than 70 mg/dl, you’ll need to treat them for hypoglycemia. 

The second step is treatment with either food or drink that equals 15 grams of carbohydrates. For quick reference, 15 grams equals any one of the following:

  • Four glucose tablets
  • One tube of glucose gel
  • ½ cup (four ounces) of fruit juice
  • ½ can (four ounces) of regular soda (avoid anything diet or reduced sugar)
  • Four pieces of hard candy
  • One tablespoon of sugar, honey, or corn syrup
  • Two tablespoons of raisins

After taking any one of the above sources of sugar, the third step is to wait 15 minutes. Then recheck the blood glucose levels. If it’s still below 70 mg/dl, repeat the previous steps by eating or drinking one of the above sources of carbohydrates and then waiting another 15 minutes to recheck. Repeat the steps as needed.

In addition to the 15 grams of carbohydrates, check to see when the patient’s next meal is scheduled. If it’s more than one hour until mealtime, have the patient eat a snack, like crackers or fruit.

If the patients are taking certain medications, particularly acarbose or miglitol, be aware that the best treatment for hypoglycemia is either the glucose tablets or the glucose gel. None of the other sources of carbohydrates will work well enough to restore blood glucose levels to normal.


Hyperglycemia

Hyperglycemia is when a patient’s blood glucose is above normal levels. Patients are at risk for high blood sugar levels in the following situations:

  • The patient is sick
  • They have a lot of stress
  • They ate more food than planned
  • They weren’t given enough insulin

Symptoms

Hyperglycemia symptoms graphics
Hyperglycemia symptoms can present as thirstiness, the urge to urinate frequently, or fatigue.

Symptoms of hyperglycemia include the following:

  • Tiredness
  • Thirst
  • Blurry vision
  • The urge to urinate a lot more often
  • Ketoacidosis

If a patient’s blood sugar is 240 mg/dl or higher, you should check their urine for ketones. If the ketone levels are high, they are at risk for diabetic ketoacidosis, which is a serious and life-threatening condition. See the section about diabetic ketoacidosis below.

Treatment

Checking a patient’s blood sugar levels is important, so you know when it increases or decreases.

For patients with high blood sugar that aren’t in the range for the risk of ketoacidosis, treating hyperglycemia is a combination of making sure medications are taken as prescribed, knowing how to determine how much insulin they need and when, and encouraging healthy lifestyle habits. 

Health care professionals can help patients to treat hyperglycemia with the following methods:

  • Encourage regular exercise. (Patients with ketones in their urine should not exercise, as it can make the problem worse.)
  • Help them to make sure they take any medications as instructed. 
  • Encourage them to follow a healthy diabetic diet and to not skip meals.
  • Check the patient’s blood sugar regularly as recommended by the doctor. If a patient is sick, check it more often.
  • Make sure the patient has had enough insulin as prescribed.
  • Educate patients if they have a new diabetes diagnosis on how best to manage the disease through healthy lifestyle choices.

Diabetic Ketoacidosis

Diabetic ketoacidosis graphics
Many symptoms of diabetic ketoacidosis seem similar to hyperglycemia, so it’s important to check a patient’s blood sugar, as directed by a doctor.

Ketoacidosis is a severe and deadly side effect of prolonged high blood glucose levels over 240 mg/dl. It happens if there’s not enough insulin to get blood glucose into the cells, so the liver tries to compensate by breaking down fat. A byproduct of that process is the ketones, which the body uses for energy. Too many ketones too fast can cause ketoacidosis. 

This complication is more common with patients who have type 1 diabetes compared to patients with type 2 diabetes. It tends to happen more commonly when diabetic patients are sick. Patients who are sick won’t eat or drink as much as normal, and that can cause their blood sugar levels to get out of control.

Symptoms

Symptoms for diabetic ketoacidosis include the following:

  • Fast and deep breathing
  • Dry skin and mouth
  • Flushed face
  • Frequent urination
  • Thirst that lasts for more than a day
  • Fruity-smelling breath
  • Headaches
  • Muscle stiffness or muscle aches
  • Nausea and vomiting
  • Stomach pain

Treatment

If a patient has ketones in their urine, get help immediately. If you aren’t in a hospital already, the patient will most likely need hospitalization. Depending on your facility’s policies and where you work, follow the chain of command to call a doctor or administrator.

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