Troubleshooting for causes of hyperglycemia
It’s important to consider all potential causes of high glucose levels before insulin doses are changed.
Check that the glucose level is trustworthy
Your patient’s diet is high in sugar and carbohydrate
Your patient eats a lot of red meat
Poor insulin injection technique
Incorrect storage of insulin or issues with the insulin pump
Hypoglycemic events causing rebound hyperglycemia
Poor sleep quality
Stress or sickness
Gastroparesis or constipation
Not taking the insulin doses as prescribed
Insulin doses are not right
Eating snacks between meals is not well matched by insulin doses given with meals.
The result is glucose levels that rise higher and higher throughout the day:
Eating large serves of carbohydrate is difficult to match with sufficient insulin - natural or injected.
Insufficient insulin at meals lead to high glucose levels that rise all day:
Steroids cause insulin resistance and a typical pattern of hyperglycaemia after lunch and dinner.
Glucose levels can also go low in the early hours of the morning:
Protein raises the glucose, but more slowly than carbohydrate.
The dose of rapid-insulin needs to last longer:
Improving your patient’s insulin injection technique
Getting the injection technique right makes a significant difference to how well glucose levels are controlled. Make sure your patient receives good education about injection technique, and this is reviewed regularly (See How to Inject Insulin).
Glucose levels can improve significantly by correcting the injection technique:
How to inject insulin: Instructions for patients