Hyperglycaemia
Monday, 03 May 2010 20:31
Hyperglycaemia – (hyper) - happens when blood glucose levels rise too high. Some of the reasons “hypers” happen are:
missing an insulin dose or taking too little insulin
eating more sugary or starchy food than usual
over-treating a hypo
stress
being unwell with an infection.
The symptoms include:
increased thirst and urination headaches
lethargy/ lack of energy stomach pain.
Children will need to drink lots of sugar-free fluids and may need extra insulin & may have ketones when they pass urine. A special test with Keytone strips is used. The presence of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis.
Ketones are an acid remaining when the body burns its own fat.
When the body cannot get enough glucose from the blood to use as energy it will begin to burn fat. When the body is burning too much fat, it may cause ketones to become present in the bloodstream.
In people with Type 1 diabetes who are deficient in insulin (perhaps because they have forgotten to take their insulin injections, for example), ketones can be produced in large amounts. Ketones accumulate in the blood, altering the acidity (the pH level). They are removed from the body in the urine and via the lungs in the breath. They have a distinctive ‘pear-drop’ smell or nail varnish type odour, which you may notice on someone's breath when you are close to them. If ketones build up in sufficient quantities in the blood, the condition of diabetic ketoacidosis (DKA) develops , which is a medical emergency. Testing for ketones when the blood glucose is high, especially if the person with diabetes is unwell, is essential to identify DKA, or to prevent it developing further, by treatment with fluids and insulin.
Ketones can be detected in the urine by using a reagent strip Usually the testing strip consists of a white plastic strip with a coloured pad stuck to it. The pad is dipped briefly into a specimen of urine, and then examined after the recommended time (usually about 30 seconds) for a change in colour.
The intensity of the colour change depends on the amount of ketones in the urine. No colour change means there are no ketones in the urine, and is said to be a negative result.
A very strong colour change means that ketones are present in high quantities, and treatment to prevent DKA is required urgently.
Diabetic ketoacidosis (DKA)
In the short term, consistent high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA).This happens because there's not enough insulin to allow glucose to enter the cells where it can be used as energy.
Ketones are very harmful and the body will immediately try to get rid of them by excreting them in urine. Consequently, when ketones are present and blood glucose levels are rising, people often become increasingly thirsty as the body tries to flush them out. If the level of ketones in the body continues to rise, ketoacidosis develops (ketoacidosis means acidity of the blood, due to an excess of ketones in the body). Their harmful effect becomes more apparent, and nausea or vomiting may start. In addition, the skin may become dry, eyesight blurred and breathing deep and rapid.
Unfortunately, because of vomiting, the body becomes even more dehydrated and less efficient at flushing out the ketones, allowing levels to rise even faster. As the level of ketones rise, it may be possible to smell them on the breath - often described as smelling like pear drops or nail varnish. Eventually, if untreated, the level of ketones will continue to rise and, combined with high blood glucose levels, a coma will develop which can be fatal. However, at any of these intermediate stages, ketoacidosis can be treated and damage usually limited. Obviously, the sooner, the better.
The high-risk time for developing ketoacidosis is when a person is unwell, as part of the body's response to illness and infection is to release more glucose into the bloodstream, and to stop insulin from working properly. This happens even if the person loses their appetite or goes off food altogether.
During periods of illness, even if you are not eating, insulin is still needed and it is important never to stop taking your insulin. You should do more frequent blood glucose testing.