High blood glucose levels (hyperglycaemia) for people with Type 1 diabetes

If you have Type 1 diabetes you will often develop high blood glucose levels. Managing your Type 1 diabetes is a lot to do with developing problem solving skills and learning to use them. Remember that if your body is producing its own insulin, it alters the amount all the time (actually minute by minute). When you have Type 1 diabetes you have to do this consciously by using your knowledge and making sensible choices.

Your diabetes nurse educator can help you learn the skills you need to do this. Some people prefer to get guidance on any of the choices they make. Everyone is different. If you are making choices you haven’t previously put into practice, get advice and support from your diabetes team while you make the changes.

The effects of high blood glucose levels are probably what first led you to visit the doctor when your diabetes was diagnosed.

Normally the human body keeps its blood glucose level very stable (between 4mmol/L - 7.5mmol/L). The body has various systems (regulated by hormones such as insulin and glucagon) for keeping the blood glucose level in this range. This doesn’t happen if you have Type 1 diabetes.

Treatment for high blood glucose levels

Try to work out why your glucose level is high. If it is high because you have eaten extra food you can take extra short acting insulin if you have been taught how to do this. Contact your specialist diabetes team for teaching on this.

Drinking extra unsweetened fluids will help your blood glucose to settle. It is not a good idea to exercise when your blood glucose is higher than 17mmol/L. If you are feeling unwell, or if there is no reason why your blood glucose is high, or if a high blood glucose of more than 17mmol/L is not settling, you should test your urine for ketones.

If you are testing your own blood glucose level regularly you will quickly see if your glucose is above the healthy range (4mmol/L - 8mmol/L).

It’s good to aim to have your blood glucose levels in this healthy range for 70 - 80% of the time. However everyone goes high sometimes. A high of up to 16 - 20mmol/L is usually manageable as long as it settles back down again within a day. If not test for ketones and get some medical help.

If your blood glucose is high and you are showing ketones you must act quickly in order to avoid developing DKA (diabetic ketoacidosis).

What is DKA and why does it happen?

Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body starts to break down fats to use for energy. We all break down fats for energy sometimes. Problems arise, however, if we break down a large amount of fat at any one time.

When your body breaks down fats, waste products called ketones are produced. Ketones are acids. Nail polish remover (acetone) is a type of ketone. Ketones can cause a great deal of damage in your body if there are high levels of them in your blood. Imagine having nail polish remover in your bloodstream.

Ketones

How will I know if I have ketones?

Ketones are very easy to test for. When your body is high in ketones it tries to get rid of them very quickly. It does this by pushing them out in your urine. Testing your urine for ketones will give you a clear indication of how high your blood ketones are.

What does having ketones mean?

You develop ketones if you are not having enough insulin. Your insulin needs will change in certain situations. When you are sick or injured your body becomes resistant to the action of insulin (your insulin can't work properly) and your body's need for energy increases. This is because your body needs extra energy to fight infection or heal from an injury. So having ketones means your body needs more insulin.

When should I test for ketones?

You should test for ketones either when your blood glucose is more than 17mmol/L OR if your blood glucose is climbing and you feel unwell, OR if you are injured and your ketone levels are increasing.

How do I test for ketones?

That depends on what sort of ketone testing strips you have. At the moment ketone testing that you do at home is always done on your urine.

At what level of ketones in my urine should I be concerned?

A trace to a small amount of ketones in your urine is usually okay. However if you are showing small amounts of ketones and you are unwell you should keep a careful eye on whether they are increasing or coming down. Get help if they continue to increase.

If you are showing a moderate or large amount of ketones in your urine you need to act quickly to bring them down. You should ALWAYS contact your doctor or diabetes nurse educator if you have a moderate or large amount of ketones in your urine. If you can't get immediate advice you should go to the nearest hospital. If your ketones are high and you are feeling unwell this trip to the hospital should be in an ambulance.

Other things you can do for yourself if your ketones are raised, but not too high, are:

• Drink water. If your ketone levels are small or moderate AND you are feeling well you need to start drinking a large amount (2-3 litres) of water
• Take more insulin. You should also take more short-acting insulin. If you have not been taught how to do this (and what dosages to take) you must get help and guidance on this from your diabetes team. Don't take extra insulin unless you know how to dose for sickness
• Test your blood and your urine. You should also test both your blood glucose and urine ketone levels every 1 - 2 hours until the ketones are cleared and your blood glucose levels are coming down

You should get help if:

• Your urine ketone levels are high
• Your urine ketone levels are not coming down once you have started treating yourself for ketones
• You are feeling very unwell (drowsy, rapid breathing, pain in your abdomen or nausea and vomiting)
• You are unable to look after yourself
• You don't know how much extra insulin to take
• You are unable to drink fluids
• You have a temperature or an obvious sickness that is not improving

Should I eat when I am sick?

Balancing your food and insulin levels when you are sick can be quite a challenge. If you are taking extra insulin you should start to provide your body with glucose from your food when your blood glucose level starts to come down less than 17mmol/L. If you have ketones OR if you are taking extra insulin, remember to test your blood glucose every hour until your levels start to improve and you are able to eat again in a normal way.

What if I can't take solid food?

If you can’t manage solid food take liquid food instead. You need to be providing your body with glucose every hour, eg:

• fruit juice or sweet lemonade (not diet lemonade)
• yoghurt
• milk
• sweetened jelly

And don’t forget to drink a large amount of water if at all possible.