Blood Sugar

When blood sugar levels rise above the standard range, it results in a condition known as hyperglycemia.[1] This condition can develop over several days or within a few hours, and it’s possible to have high blood sugar without being aware of it. For a healthy individual, the normal fasting blood glucose concentration in the morning is between 80 to 120 mg/dL (milligrams per deciliter). A fasting blood sugar level exceeding 130 mg/dL is classified as hyperglycemia. If the concentration surpasses 160 to 180 mg/dL, some glucose is excreted in the urine, a condition called glycosuria. Conversely, a blood sugar level below 70 mg/dL is termed hypoglycemia.[2] Hyperglycemia is one of the “three highs,” along with high blood pressure and high triglycerides.

Under normal circumstances, the body maintains a stable blood sugar level through two major regulatory systems: hormonal and neural, which balance the supply and demand of glucose. However, a combination of genetic factors (like a family history of diabetes) and environmental influences (such as an unhealthy diet and obesity) can disrupt these regulatory functions, leading to an increase in blood sugar levels.

Causes and Pathology

Several factors can contribute to high blood sugar:

• Insufficient medication: Inadequate dosage of insulin or oral hypoglycemic drugs.[3]

• Reduced physical activity: A significant decrease in exercise can prevent insulin from working effectively.[3]

• Dietary choices: Consuming too many sweets or sugary drinks.

• Obesity: Excessive body fat can contribute to insulin resistance.[4]

• Stress: Emotional or mental pressure can elevate blood sugar.[3]

• Rebound hyperglycemia: A spike in blood sugar following an episode of hypoglycemia, known as the Somogyi effect.

• Alcohol consumption: Drinking alcohol can lead to both low and high blood sugar.

• Certain medications: Drugs like prednisone and dexamethasone, as well as some cough syrups, can cause blood sugar to rise.[3]

• Illness or emergencies: During sickness or other stressful situations, the usual dosage of insulin or oral medication may not be sufficient.[3]

Clinical Symptoms

Elevated blood sugar leads to increased glucose in the urine, which can cause osmotic diuresis, resulting in frequent urination (polyuria). The significant loss of water and increased blood sugar raise the osmotic pressure of the blood, stimulating the thirst center in the hypothalamus and leading to excessive thirst and drinking (polydipsia). Due to a relative or absolute lack of insulin, the body cannot effectively use glucose for energy, leading to the breakdown of protein and fat, which causes fatigue and weight loss. To compensate for the lost sugar and maintain bodily functions, there is an increased need for food (polyphagia). These symptoms are collectively known as the “three polys and one less”: polydipsia, polyphagia, polyuria, and weight loss.

Other signs of high blood sugar can include:

• Dry skin and dehydration.

• Nausea, vomiting, and abdominal discomfort.[3]

• Loss of appetite.[5]

• Rapid heartbeat and slow, deep breathing.[5]

• A positive urine test for sugar.

It’s important to note that some individuals with type 2 diabetes may not exhibit the classic “three polys and one less” symptoms. This can be due to an increased renal threshold for glucose.

Emergency First Aid for Coma

• Hypoglycemic Coma: This occurs when a diabetic patient has taken too much insulin or has not eaten after their injection, causing their blood sugar to drop dangerously low. The effective emergency response is to give the person something sugary to eat or drink.[6][7]

• Hyperglycemic Coma: This can happen if a diabetic patient has not taken enough medication or has another illness, causing a sharp rise in blood sugar. In this case, giving sugar would be harmful.[8]

First Aid for a Diabetic Emergency:
If someone with diabetes loses consciousness, call for emergency medical help immediately.[9][10]

• Ensure their airway is clear by turning them on their side to prevent choking.[7][9][10]

• Do not give them anything to eat or drink.[9][10]

• Loosen any tight clothing.[8]

• If you are unsure whether the person has high or low blood sugar, it is generally advised to give them sugar, as this can be life-saving in cases of hypoglycemia and is unlikely to cause significant harm in cases of hyperglycemia.[8]

Relationship Between High Blood Lipids and High Blood Sugar

Many people with diabetes also have high levels of lipids in their blood (hyperlipidemia), which is why these two conditions are often referred to as “sister diseases.”[11] It is estimated that about 40% of individuals with diabetes experience lipid metabolism disorders. High triglyceride levels are strongly associated with poor blood glucose management.[12]

Dangers of High Blood Sugar

While a single, brief episode of high blood sugar is not severely harmful, long-term hyperglycemia can lead to damage in various tissues and organs throughout the body, resulting in both acute and chronic complications.[4][13] These can include:

• Cardiovascular disease[14][15]

• Nerve damage (neuropathy)[4][14][16]

• Kidney damage (nephropathy)[4][14][15]

• Eye damage (retinopathy)[4][14]

• Increased susceptibility to infections and impaired wound healing[14]

• Diabetic ketoacidosis (DKA), a life-threatening condition where the body starts breaking down fat for energy, leading to a buildup of ketones.[4][13]

Benefits of Exercise Therapy for High Blood Sugar

• Helps control blood sugar: Exercise increases the uptake and use of glucose by the muscles, and after a workout, muscles and the liver take in more glucose to replenish their stores, further lowering blood sugar.[17][18]

• Improves lipid metabolism: Regular physical activity can increase the activity of lipoprotein lipase in muscles, speeding up the breakdown of fats.

• Aids in weight management: Exercise burns calories and can help reduce body weight.[18]

• Increases insulin sensitivity: Physical activity can enhance the body’s response to insulin, reducing insulin resistance.[18]

• Improves cardiovascular and respiratory function: Exercise enhances the body’s maximum oxygen uptake, benefiting the circulatory and respiratory systems.[18][19]

Prevention and Health Care

General Principles:

1. Do not stop taking medication without consulting a doctor.

2. Follow the dietary advice of healthcare providers and nutritionists.

3. Regularly monitor blood sugar levels.[2]

4. Try to avoid crowded public places to reduce the risk of infection.

5. If you experience nausea, vomiting, or fever, do not stop your medication and seek immediate medical attention.

6. Identify the cause of high blood sugar to prevent future occurrences.

7. Stay warm.

8. Drink plenty of water.[8]

9. Seek immediate medical attention if symptoms are severe.

Dietary Guidelines for High Blood Sugar:
The total calorie intake should be determined based on the individual’s nutritional status, weight, age, gender, and level of physical activity. The goal is to maintain a body weight slightly below or within the standard range. A balanced diet should include:

• Carbohydrates: These should make up about 60% of total calories. Coarse grains are recommended as they are digested more slowly.[20]

• Dietary fiber and vitamins: High-fiber foods can slow the absorption of carbohydrates, helping to balance blood sugar.[21] Fresh vegetables are a good source.

• Healthy fats: Limit cholesterol intake and avoid animal fats.[21]

• Protein: Soy products are a good source of high-quality protein and do not contain cholesterol.

Foods That May Help Lower Blood Sugar:

• Fruits: While fruits contain sugar, some, like berries and citrus fruits, have a lower glycemic index and are rich in fiber and beneficial plant compounds.[22]

• Vegetables: Non-starchy vegetables like leafy greens are high in fiber and nutrients.[23]

• Whole grains: Oats and other whole grains are high in soluble fiber.[24]

• Legumes: Beans and lentils are rich in fiber and protein, which can help regulate blood sugar.[22]

• Other beneficial foods: Garlic, pumpkin, nuts, and seeds may also help manage blood sugar levels.[22]

Dietary Precautions:

• Avoid sugary foods: This includes white sugar, brown sugar, candy, cakes, jams, ice cream, and sweet drinks.[23][25]

• Limit certain starchy vegetables: Foods like potatoes, yams, and taro should be consumed in moderation, and the intake of staple foods should be adjusted accordingly.

• Reduce saturated fats: Limit the use of pork lard, butter, and other animal fats.[21]

• Be mindful of high-cholesterol foods: Egg yolks and organ meats should be consumed sparingly.[21]

• Alcohol: It is best to avoid alcohol as it is high in calories and has little nutritional value.

Blood Sugar Self-Monitoring

Self-monitoring of blood glucose (SMBG) is a crucial part of managing diabetes.[26][27][28] Using a blood glucose meter at home allows individuals to:

• Accurately track their blood sugar levels.[29][30]

• Understand how diet, exercise, and medication affect their body.[27]

• Make timely adjustments to their treatment plan.[26]

When to Test:
It is often recommended to check blood sugar at various times throughout the day, including:

• Before meals

• Two hours after meals

• At bedtime

• Before and after exercise

• When feeling unwell[29]

Glycated Hemoglobin (HbA1c):
In addition to daily monitoring, it’s important to have regular HbA1c tests. This test reflects the average blood sugar level over the past two to three months and provides a better long-term picture of glucose control.[31]