Diabetes in Children: Preventing High Blood Sugar

High blood sugar

High blood sugar means that the level of sugar (glucose) in your child's blood is above a target range. Your child may feel tired and thirsty when his or her blood sugar is well above a target range. But some people adjust to elevated levels of sugar in their blood and may not have obvious symptoms of high blood sugar until their blood sugar levels are very high.

• If your child's blood sugar level is between 80 milligrams per deciliter (mg/dL) and 200 mg/dL, he or she most likely won't have symptoms. If symptoms are present, they will likely be mild, such as fatigue or thirst.
• With a blood sugar level between 200 mg/dL and 240 mg/dL, your child may have mild symptoms such as increased thirst and urinating more often than usual. Some people don't notice any symptoms when their blood sugar level is in this range.
• A blood sugar level above 240 mg/dL usually causes moderate to severe symptoms. Your child may feel weak and drowsy, have blurred vision, and lose his or her appetite and develop nausea, vomiting, and rapid breathing. If blood sugar continues to rise, your child may become confused and go into a coma.

Symptoms of high blood sugar usually develop gradually over a period of hours to days. But it can also develop quickly (in just a few hours) if you eat a large meal or miss an insulin dose. Unless you and your child fail to notice the symptoms, you usually have time to get early treatment. An emergency occurs when high blood sugar levels lead to severe dehydration and interfere with the chemical processes of the body (metabolism).

What causes high blood sugar?

High blood sugar develops when there is too little insulin or when your child's body fails to respond properly to the insulin in the bloodstream. High blood sugar emergencies often develop because of an infection or surgery, which increase the need for insulin.

Blood sugar levels can rise above a target range when your child:

• Skips a dose of medicine for diabetes or a dose of insulin, if he or she takes insulin.
• Eats too much.
• Does not get enough physical activity.
• Is under emotional stress.
• Is sick, such as with the flu or an infection.

Your child sometimes may have very high blood sugar levels in the morning before breakfast. This may be due to the dawn phenomenon or the Somogyi effect.

Continue to Why?

Blood sugar levels that are somewhat above a target range may cause symptoms, such as increased thirst and more frequent urination. If early high blood sugar is not treated, it may rise to a very high level, which can be life-threatening. Over time, high blood sugar can also increase the risk for complications, such as problems with your nerves, eyes, or kidneys.

When your child's blood sugar level rises above 200 mg/dL, his or her kidneys will eliminate some of the extra sugar through the urine. Along with sugar, the kidneys release large amounts of fluid, which causes increased urination.

If your child's blood sugar level continues to rise and liquids that are lost aren't replaced, your child can become dehydrated. Dehydration can lead to a high blood sugar emergency. Both of the following high blood sugar emergencies can become life-threatening:

• Your child is at risk for a high blood sugar emergency called a hyperosmolar state. A hyperosmolar state can develop if your child's blood sugar levels are consistently very high, such as above 600 mg/dL, and he or she becomes dehydrated. It is easy to overlook early symptoms of a hyperosmolar state. A hyperosmolar state is more common in people who have type 2 diabetes than in people who have type 1 diabetes.
• Your child may also develop a condition called diabetic ketoacidosis (DKA) from high blood sugar. Diabetic ketoacidosis can occur if your child's blood sugar levels are consistently high, such as above 240 mg/dL, and he or she becomes dehydrated. In ketoacidosis, your child's body burns protein and fat for energy, causing acids and ketones to build up in his or her blood. These ketones can be partially released into the urine. If ketoacidosis develops, your child needs emergency care immediately to keep the condition from getting worse. DKA is more common with type 1 diabetes.

Often, a high blood sugar emergency can develop because of stress to your body, such as an infection or surgery, which increases the need for insulin.

Continue to How?

The best ways to prevent a high blood sugar (hyperglycemia) emergency are to check blood sugar levels often, be prepared for emergencies, treat high blood sugar promptly, treat infections right away, and make sure your child gets plenty of sugar-free liquids.

Treat infections early

Untreated infections, such as urinary tract infections and skin infections, can increase your child's risk of a high blood sugar emergency.

Be prepared

• Know the symptoms of high blood sugar. Post them in a place where you and your child can see them often, such as on your refrigerator door. Add any symptoms your child has had that are not on the list. Make sure other people know the symptoms and what to do in an emergency.
• Check your child's blood sugar at home often, especially when your child is sick or not following his or her normal routine. Testing your child's blood sugar at home will help you know when it is high, even if your child doesn't notice symptoms.
• Teach others involved in your child's care how to check blood sugar. Keep instructions for using the blood sugar meter with the meter so someone else could test your child's blood sugar if needed.
• Have your child wear medical identification, such as a medical alert bracelet, at all times. This is very important in case your child is too sick or injured to speak. See the Where to Go From Here section to find where you can get medical identification.
• Have ketone test strips on hand. Test for ketones if his or her blood sugar level is above 240 mg/dL. If the results of the ketone test show that your child has a moderate to large amount of ketones, call your doctor for advice.
• Develop a plan. Usually people who take insulin need to take extra fast-acting insulin when their blood sugar levels are high. Talk with your child's doctor about how much the child needs to take, depending on his or her blood sugar level (sliding scale).
• Give your child's medicines as prescribed. Don't skip the medicines for diabetes or insulin injections without first talking with your doctor.

Treat high blood sugar early

The best way to prevent high blood sugar emergencies is to treat high blood sugar as soon as your child has symptoms or when his or her blood sugar is significantly above the target range (200 mg/dL or higher).

• Follow the steps for dealing with high blood sugar. Post the steps in a convenient place at home. Make sure other people know what to do if your child is unable to treat high blood sugar.
• Keep a record. Write down your child's symptoms and how you treated them, and take the record with you when you visit your child's doctor. Use the blood sugar record(What is a PDF document?).
• Let your child's doctor know if your child is having high blood sugar problems. The medicine for diabetes may need to be adjusted or changed. If your child is taking insulin, the dose may need to be increased.

Offer plenty of liquids

If your child's blood sugar levels are above his or her target range, offer extra liquids to replace the fluids lost through the kidneys. Water and sugar-free drinks are best. Avoid caffeinated drinks, regular soda pop, fruit juice, and other liquids that contain a lot of sugar.

Continue to Where?

Now that you have read this information, you are ready to start preventing high blood sugar emergencies.

Talk with your child's doctor

If you have not talked with your child's doctor about a target blood sugar range and how to deal with high blood sugar levels, do so. Treating high blood sugar early can prevent an emergency and also prevent damage to your child's eyes, kidneys, heart, blood vessels, and nerves.

Medical identification jewelry can be purchased at most pharmacies. Talk with your doctor or contact the local American Diabetes Association about other places to purchase medical identification in your area.

If you would like more information about diabetes, the following resources are available:

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