Endocrinology-Diabetes Questions Type 1 Diabetes

What is the emergency treatment for hyperglycemia?

If my daughter goes into a hyperglycemic state, what should I do to help her? Should I take her to the emergency room, or is there a way for me to help her at home?

5 Answers

It depends on her baseline diagnosis. The best person to answer your question is her endocrinologist.
I must assume that your daughter has Diabetes Type 1. If this is the case and she develops hyperglycemia: Check her urine for ketones. If present then go to the DR. or ER as she is going into ketoacidosis & will need IV RX. If no ketones she can be treated at home. Treatment involves 2 things: 1) hydrate her with non-sugar containing fluids 2) give her supplemental insulin. How much you give depends on her body weight & previous doses. I would start with 0.1u/kilogram body weight every hour until her BS comes down to a normal or near normal level. The next step is to find out the cause of the hyperglycemia. Does she have an infection or did she miss a dose of insulin. etc.? If she is not diabetic & gets hyperglycemic she should see a Dr to see if she is developing diabetes or has another cause.
Hyperglycemia is a state of high blood glucose. Normal blood sugars are considered <100mg/dl fasting (no food for 8 hours), or blood glucose <200mg/dl 2 hour after heavy carbohydrate meal or 75 mg of glucose drink (glucola), or if a person has blood glucose over 200mg/dl with the symptoms of diabetes such as, excessive thirsty, frequent urination, weight loss, blurred vision, bed wetting chronic yeast infection, fatigue and headaches. Hyperglycemia could be due to diabetes or none diabetes. Hyperglycemia may be symptomatic or asymptomatic. In hyperglycemia due to diabetes, HA1c (>6.5% diabetes and between 5.7-6.4% prediabetes) is elevated most of the time. Symptoms of diabetes can be drastic or may evolve insidiously. In type 1 diabetes the symptoms of diabetes are drastic. They typically evolves within few week to few months. Type 2 diabetes may take many years to evolve. In fact some type 2 diabetic patients may present with chronic complications of diabetes during the diagnosis. There are many other forms of diabetes besides type 1 and type 2 diabetes. Maturity onset Diabetes of the young, gestational diabetes and diabetes due to other genetic abnormalities are examples.
When diabetes are treated properly the person should be able to control the blood sugars reasonably. Reasonable blood sugars are 70-140 mg/dl over 50% of the time. In most cases of diabetes expecting perfectly normal blood sugars is not realistic. check blood sugars at least 4 times a day (before each meal bed time and at night). Take medication properly. give correction for high blood sugars and adjust medications regularly. Work with your doctor and diabetes educators as a team. Manage low and high blood sugars appropriately. As you practice in daily management of diabetes you will be comfortable in handling extreme issue in diabetes such handling low and high blood sugars with little help from out side of your house. The only time you can think of going to ER is the child is sick and you can not hydrate her/him at home.
Some of the causes of none diabetic hyperglycemia could be stress, fever, illnesses, and medications. Chronic use of hyperglycemic medications can cause elevation in HA1c and therefore lead to diabetes. Once Offending medications are removed blood glucose she normalize.
Going back to your question, we need to know what your daughter has. How old is your daughter?. Does she have hyperglycemia due to diabetes?. Is she on medications?. Does she have other medical conditions?. Is she taking insulin?. When was she diagnosed?. Does she have type 1 diabetes or type 2 or other forms of diabetes?. Is she on insulin?. What kind of insulin regimen is she on?. Do you do carbohydrate counting?. do you correct high blood glucose with insulin?. How often do you check blood sugars?. Or does she only have intermittent hyperglycemia without any diagnosis?. Is there family history of diabetes?. Do you mean HYPOGLYCEMIA????. Or she has uncontrolled diabetes with episodic of hyperglycemic excursions?.
Lets assume the most likely scenario. Lets say your daughter has type 1 diabetes on insulin and she is having blood sugar excursions more often.
In this scenario; you should focus on the basics of diabetes management. You need to check her blood sugars at least 4 times daily without stressing her. With properly attention to blood sugars you should be able to control diabetes reasonably. You should focus on getting blood sugars between 70-140 mg/dl over 50% of the time. Do not expect perfectly normal blood sugars. that will not realistic. Do not check blood sugars every half hour unnecessarily. If she is eating and you gave her medication do not check blood sugar after 1/2 hr, it will be high. Unless you have a real concern or she is sick or she is experiencing low blood sugars it would be reasonable to check blood sugars after 2 hrs of her food. She need the appropriate amount of medication at the right time. Give correction insulin for high blood sugars and adjust medications on regular basis. I Work with your doctor and diabetes educators and nutritionist as a team. Manage low and high blood sugars appropriately. As you practice in daily management of diabetes you will be comfortable in handling extreme issue in diabetes such low and high blood sugars on your own at home. The only time you can think of going to ER is if the child is sick and you can not hydrate her/him at home. But is the child has low blood sugar and she can not take any thing by mouth due to vomiting, unconsciousness, stupor or seizures, do not go to ER call 911.
If her hyperglycemic episodes are not due to diabetes please call your doctor and have her proper evaluation and work up.
It is therefore important to discuss this with your doctor for more diabetes and nutritional education proper evaluation and workup.
Good Luck
Does she have diabetes? If so, check for ketones, if small you can increase water and give her regular insulin by the sliding scale you and endocrinologist have determined. If ketones are moderate or large you need to call the doctor about the need to be seen while you push low calorie fluids.
What you do when your daughter's blood sugar is high depends on how high it is, and how long it remains high. High blood sugars make one urinate a lot, and can lead to dehydration. The high blood sugars can make one urinate even when they are already dehydrated, so it can be quite dangerous. It's best to call the doctor's office and get their advise based on the reading. If your daughter is also vomiting (which happens quite often), she must go immediately to the ER.