If you have type 2 diabetes, you're certainly familiar with hyperglycemia, or high blood sugar. Hyperglycemia occurs when the body doesn't have enough, or is unable to use, insulin (the hormone that metabolizes carbohydrates and regulates the amount of sugar in the blood).  Hyperglycemia is common in people with type 2 diabetes, and its symptoms include frequent urination and increased thirst.

Recently, experts released new hyperglycemia treatment guidelines for individuals with type 2 diabetes, and flexibility is key. "This position statement differs from previous ones by recommending individualized care for patients," explains Jacqueline Salas, MD, of the Naomi Berrie Diabetes Center at New York-Presbyterian Hospital/Columbia Medical Center. "It crystallizes the fact that not every patient with diabetes is like every other patient with diabetes."

One Size Does Not Fit All
The new guidelines are a joint project of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes. The recommendations, published in the ADA journal Diabetes Care, encourage treatment plans that ideally take into account a patient's age, weight, lifestyle, and other factors.

The guidelines are promoting the idea that "there is no one right way to treat hyperglycemia," according to Salas. For instance, she explains, "A younger patient may be instructed to aim for a hemoglobin A1C of 6.5." The A1C test measures what percentage of your hemoglobin—a protein in red blood cells—is glycated, or coated with sugar. An A1C of six equals a blood sugar level of about 126 mg/dl. This stands for milligrams per deciliter, or thousandths of a gram per tenths of a liter. But blood sugar levels in that range can result in episodes of hypoglycemia, or low blood sugar. While younger people may easily treat low blood sugar, in the elderly, hypoglycemia can lead to dizziness and falls that can have catastrophic effects. So for an older person, a hemoglobin A1C of 8 (or about183 mg/dl) might be acceptable, Salas says. "It's a matter of weighing the issues and talking to the patient and getting to know him," she explains.

Exercise and Adaptability
The new guidelines also encourage exercise: "As much physical activity as possible should be promoted daily, ideally aiming for at least 150 minutes per week of moderate activity including aerobic, resistance, and flexibility training." However, just as the new guidelines recognize a wider range of healthy hemoglobin A1C results, there's also an understanding that exercise recommendations are flexible, too, since on occasion, exercise can raise already high blood sugar levels. When blood sugar levels are above 240 mg/dl, the urine should be tested for ketones. Ketones are waste products manufactured when the body breaks down fat to use for energy, which happens when it is unable to use glucose. If ketones are present, exercise should be avoided-it could drive blood sugar levels even higher.

The Benefits of an Individualized Approach
The new emphasis on a patient-centered approach is excellent, says Spyros Mezitis, MD, of Lenox Hill Hospital in New York City. "We need to be looking at the whole patient, controlling her blood pressure, and talking about smoking cessation," he says. "You may be looking at a patient with heart disease or eye problems." And when patients have one of these conditions in addition to diabetes, he says, they may need to be treated more frequently.

When it comes to diabetes care, he explains, looking at the patient as an individual is crucial. "Everybody is not identical, and we have to go according to each patient's needs," Mezitis says.



Inzucchi, Silvio E. et al. "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach." Diabetes Care. 19 April 2012.

"American Diabetes Association and European Association for the Study of Diabetes Issue Joint Position Statement on Hyperglycemia Treatment." MSNBC.com. 19 April 2012.

American Diabetes Association. "Hyperglycemia (High blood glucose)." http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html

American Diabetes Association. "Estimated Average Glucose (eAG)." Web. 14 April 2013.  http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/estimated-average-glucose.html