Recognizing and managing severe hyperglycemia

Chau My Chi, MD, PhD

1. Definition: What is dangerously high blood sugar?

Hyperglycemia occurs when blood sugar levels exceed safe limits. This condition becomes dangerous when blood sugar rises excessively high (usually over 14 mmol/L or 250 mg/dL) accompanied by signs of severe toxicity or dehydration in the body.

If not treated promptly, the patient may fall into a coma or even die.

2. How to recognize: The “4 EXCESSES” rule and “EMERGENCY SIGNS“

To easily remember, observe the following symptoms:

Early recognition (4 EXCESSES):

• Excessive thirst: Drinking water constantly but still feeling a dry throat.
• Frequent urination: Urinating very often, especially at night.
• Excessive weight loss: Losing weight quickly despite eating normally.
• Excessive fatigue: Lethargic body, blurred vision, weak limbs.

EMERGENCY Signs (Need to go to the hospital immediately):

• Unusual breath odor: Smell of ripe fruit or nail polish (acetone).
• Digestive disorders: Abdominal pain, nausea, or vomiting.
• Cognitive disturbances: Drowsiness, confusion, delirium, or seizures.
• Rapid and deep breathing: Feeling short of breath even without strenuous activity.

3. Why is it dangerous? (Risks)

When blood sugar is too high, the body will experience acute complications:

1. Severe dehydration: Leading to cardiovascular collapse.
2. Diabetic Ketoacidosis (DKA): The blood becomes acidic due to burning fat instead of sugar.
3. Hyperosmolar Hyperglycemic State (HHS): Common in older adults, with a very high mortality rate.

 

4. How to handle: The “3 DOs” rule

When detecting a patient with signs of hyperglycemia, do the following immediately:

Step 1: Quick check

• Use a personal blood glucose meter (if available).
• If the result is > 14 mmol/L (250 mg/dL), high alertness is required.

Step 2: Rehydrate and use medication

• Drink plenty of filtered water: Helps the kidneys excrete excess sugar through urine (do not drink sugary drinks or fruit juices).
• Use prescribed medication: Take medication or inject Insulin at the exact dose prescribed by the doctor. Absolutely do not excessively increase the dose without guidance.

Step 3: Contact medical help

• If blood sugar does not decrease after 2 hours or if there are “Red flag signs” (vomiting, rapid breathing, drowsiness), call emergency services (115 in Vietnam) or take the patient to the nearest medical facility.

5. Preventive advice

• Eat right: Limit carbohydrates and sweets.
• Exercise right: Gentle physical activity for 30 minutes a day.
• Measure right: Check blood sugar regularly according to the doctor’s appointment.

References:

1. Guidelines of the Vietnam Ministry of Health

• Decision 3280/QD-BYT (2020): “Guidelines for diagnosis and treatment of type 2 diabetes”.
• Decision 5481/QD-BYT (2023): Latest update on the management and treatment of diabetes.

2. American Diabetes Association (ADA): Standards of Care in Diabetes (Updated 2024 – 2026)