The Two Levels of Hyperglycemia and a Separate Definition for People With Diabetes

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The Two Levels of Hyperglycemia and a Separate Definition for People With Diabetes

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By Sysy Morales

Sysy Morales has lived with type 1 diabetes for 23 years. She also blogs at The Girls Guide to Diabetes, is a motivational speaker, and is a graduate of The Institute for Integrative Nutrition. Sysy lives in Virginia with her husband and 8 year old twins.

December 20th, 2017

A Steering Committee made up of representatives from the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange formed a decision-making group for the Type 1 Diabetes Outcomes Program.

Their goal was to develop a consensus on definitions for hypoglycemia, hyperglycemia, time in range, DKA, and patient reported outcomes and while their decisions were informed via input from researchers, industry, and people with diabetes they relied on published evidence, their own clinical expertise, and Advisory Committee feedback.

We recently wrote about their definitions for hypoglycemia, here.

Level 1 Hyperglycemia

Level 1 hyperglycemia is defined by this group as a blood glucose concentration of >180 mg/dL (10.0 mmol/L) but ≤250 mg/dL (13.9 mmol/L).

The committee wrote that “In clinical practice, measures of hyperglycemia differ based on time of day (e.g., pre- vs. postmeal). This program, however, focused on defining outcomes for use in product development that are universally applicable.”

They believe that based on glucose profiles and post meal blood glucose data in those with no diabetes tell us that at or over 140 mg/dL (7.8 mmol/L) is high blood sugar. However, since most people spend most of their day over that blood sugar level, they believe the guideline for measuring hyperglycemia should be different in those with diabetes.

Since the current guidelines for those with diabetes indicate that after meal blood sugar shouldn’t ever go over 180 mg/dL (10.0 mmol/L), the committee states that they would define high blood sugar starting at that point.

Changing Definitions to Keep Up With Patients?

It’s appropriate to clarify that this definition seems to be largely informed by the majority of patients with diabetes and not by what is deemed healthy in persons with no diabetes.

In other words, no matter what we call a blood sugar level of just under 180 mg/dL (10.0 mmol/L), the body will not discern between how hard it is to achieve a lower blood sugar and the damage that is known to be incurred through an elevated blood sugar.

The chronic and serious condition of type 2 diabetes is diagnosed with a fasting blood sugar of only 126 mg/dL (7 mmol/L) or higher on two separate tests, according to the Mayo Clinic. Some diabetes complications have been shown to occur with only slightly elevated blood sugar levels.

Is it a good idea to define high blood sugar differently for those with diabetes? Could this information be used by people with diabetes as a guide for their blood sugar goals? Would this be like the hypothetical example of telling an overweight person they’re not overweight if the definition of “overweight” has been changed due to a majority obese population?

Level 2 Hyperglycemia

Level 2 hyperglycemia is considered as “very elevated glucose as defined by a glucose concentration of >250 mg/dL (13.9 mmol/L).”

The committee states that over these levels, a patient’s risk for DKA is increased and the A1c levels associated with that glucose level are linked to a “high likelihood of complications”.

They write in their report that this definition “allows for the assessment of the ability of therapies and technologies to provide better glucose outcomes and to limit exposure to level 1 and level 2 hyperglycemic blood glucose values,” and that the definition is basically intended to apply to those with type 1 diabetes at any point of the day.

More Research Needed

The committee explains that we need more research in order to improve our understanding of how an individual high blood sugar vs sustained high blood sugar affects a person with diabetes over time.

They write that we could also use more research to improve our knowledge regarding to ties between high blood sugar and microvascular disease and other complications as well as ” the role of genetic factors and a patient’s ability to recognize when hyperglycemia is occurring”.

Go to their report to read more about their findings.

Read more about A1c, American Association of Clinical Endocrinologists (AACE), American Association of Diabetes Educators (AADE), American Diabetes Association (ADA), diabetes complications, Helmsley Charitable Trust, high blood glucose/sugar (hyperglycemia), JDRF, low blood glucose/sugar (hypoglycemia), T1D Exchange.

Last Updated: December 19th, 2017

Filed Under: Life with Diabetes, News, Type 1 Diabetes

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