Let's Talk About High Blood Sugar
Concerns over complications of hyperglycemia – high blood sugar – often take a backseat to fears around low blood sugar. Experts discuss the need for educating caregivers of children with type 1 diabetes about avoiding this dangerous condition.
While the dangers of hypoglycemia (low glucose levels) are often discussed, fears around the effects of hyperglycemia (high glucose levels) often take a backseat. That’s because high blood sugar is considered more of a long-term danger.
However, the reality is the health impacts of hyperglycemia can be devastating. For a person living with diabetes, hyperglycemia is sometimes defined as blood sugar levels of 180 mg/dL or higher. This can be dangerous over an extended period of time and lead to complications like kidney damage, heart problems, and cognitive decline.
At a scientific session around fear of hyperglycemia and its impacts at this year’s Advanced Technologies & Treatments for Diabetes conference in Berlin, Alon Liberman, a pediatric psychologist and researcher with Schneider Children’s Medical Center in Israel, discussed the need for more research around this underexplored topic. Liberman stressed that there just isn't enough literature on fear of hyperglycemia and the impact on both people living with diabetes as well as their loved ones.
“With one Google search, 35,000 articles for ‘fear of hypoglycemia’ appear,” Liberman said. “However, hyperglycemia can be more harmful and there are only 53 articles – and none of them deal with hyperglycemia in children and their parents. Why?”
Liberman cited the negative impacts of extended hyperglycemia in children and adolescents, which include but aren’t limited to adverse effects on memory, IQ, executive functioning, and learning. (He also noted that most children under 8 depend on parents for diabetes management and that the demands of caring for a young child with type 1 diabetes can impact the health of the entire family).
A study conducted by Dr. Nataša Bratina, a pediatric endocrinologist at University Children's Hospital, Ljubljana in Slovenia, as well as other researchers found that a parental fear of hypoglycemia is significantly associated with worse glycemic control in children with type 1. The study also suggested that parents of children with type 1 diabetes with greater levels of fear of hypoglycemia may lead to deliberate maintenance of higher glucose levels.
At the same scientific session, Bratina emphasized that education around hyperglycemia must be more intensive: While parents and children usually focus on information about hypoglycemia, they often skip over key parts of treating hyperglycemia, such as the use of pen injectors, types of insulin, continuous glucose monitors, and glucometers, which if lacking can potentially lead to hyperglycemia. To minimize fears surrounding the consequences of hyperglycemia, Bratina ultimately stressed the importance of discussing three goals at diagnosis: time in range (TIR), A1C, and average blood glucose – all indicators of diabetes management.
“There are goals set in the educational process, and all members of the team must follow these goals, [including] educators, dietitians, psychologists, and doctors,” Bratina said, adding a reminder that, in addition to schooling patients, it’s important to teach healthcare staff and loved ones, too. “While we work with children, we must never forget that we must share our knowledge with teachers and caregivers. They must be a part of this process as well.”