Rahh!! Why is my BGL so High!

Living with diabetes is not only a roller coaster of often unpredictable Blood Glucose Levels, its also an emotional roller coaster ride. Often we hear those words of exasperation “why is my Blood Glucose Level so high!”

Lets explore some of the more common causes of Blood Glucose Levels above target.

Stay Calm & Measure Your BGL

What is the Target?

It is generally accepted that optimum Blood Glucose Level is on waking between 4 – 6 mmols, and 2 hours after meals between 4 – 8 mmols. (*this is ideally individualised in collaboration with your usual health care team*)

Hyperglycemia is defined by the World Health Organisation as:

• Blood glucose levels greater than 7.0 mmol/L
  (126 mg/dl) when fasting
• Blood glucose levels greater 11.0 mmol/L
  (200 mg/dl) 2 hours after meals

Even positive stress can elevate your Blood Glucose Level e.g. your football team winning the competition!

I remember when I first started working as a diabetes educator I had a phone call from a young man – lets call him Fred – living with type 1 diabetes. His Blood Glucose Level was about 40% higher than usual. Not high enough to put him at risk of DKA, but high enough to be concerned.

We talked on the phone for about 45 minutes, going through the usual checklist of causes of high Blood Glucose Level.

Carbohydrates: Eating meals and snacks that contain too many carbohydrates for the energy needs of that moment. Consulting with your dietitian about how much carbohydrates are correct for you is an essential part of your safe and effective diabetes self care plan.

Medication: Examples…. forgetting to take your medication; the prescribed dose is not being effective; the prescribed medication is not being effective – a change of medication is required; taking a dose of insulin and then a having change in plan where your level of activity is less than expected; or not giving sufficient insulin for your meal total carbs.

Stress: Both positive and negative emotions can play a role in causing hyperglycaemia. When the body is stressed chemicals (hormones, such as adrenaline ) are released in the body. One of the effects of adrenaline is to cause the liver to release glucose > elevated Blood Glucose Level

Less Physical Activity Than Usual: Very simply, if you think of glucose as your bodies main source of fuel….. if you are not using your muscles then the body is using less glucose. Example: If you have eaten your usual amount of carbs for dinner, but then go and sit down to watch tv instead of your usual evening walk, then the Blood Glucose Level is going to be higher than usual. Or on a weekend you don’t take your bike out for a ride but eat the same amount of carb as if you were going for a ride, then the Blood Glucose Level is going to be higher.

Infection, illness, or surgery: With illness, blood glucose levels can rise. This is a physical stress on your body. For people with type 1 diabetes this is a high risk time for DKA.

Other medications: Certain drugs, especially steroids, can affect blood glucose levels.

Fred and I could find nothing amongst the usual suspects. I advised him i would go and talk with my team – who were much more experienced than me – and see what they could suggest as possible reasons for Fred’s higher than usual Blood Glucose Levels.

I returned Fred’s pone call after consulting with my team. In the meantime Fred has found the answer: he had been away for 5 weeks to the Northern Territory. He had not stored his insulin nor his test strips correctly. He found some new insulin, some new test strips, and his ‘problem’ was solved.

Meter inaccuracy

A few years ago, the International Standards Organization (ISO), in conjunction with international regulatory authorities, health care providers, and device manufacturers in many countries, established a standard for evaluating the accuracy of blood glucose meters. Called ISO 15197, the standard calls for a minimum accuracy. Ninety five percent of all measured values should fall within:

• 20% of glucose values above 75 mg/dl (4.1 mmols)
• 15 mg of glucose values below 75 mg/dl (4.1 mmols)

Possible Solutions to Inaccuracy

Besides user error e.g lack of hand washing, using outdated strips etc other sources of error occur.

Insulin / Medication Storage

Check with your pharmacist as to how best store you medications.

In Fred’s case, it was more likely to be an error of strip storage than medication storage.

Your Experiences?

What things cause your Blood Glucose Level to rise? Please share your experiences below in the comments section. Its always helpful for others to get that first hand lived experience from people like you.

If you would like some individual guidance with your diabetes self care plan, please send us a request

Kind Regards

David

Diabetes Educator @ Diabetes Counselling Online

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