Ask Dr. Etingin: Signs of high blood sugar; Brain aneurysm

My 80-year-old mother, who has diabetes, has recently moved into my home so I can care for her. What signs of high blood sugar should I watch for?

Excessively high blood sugar (hyperglycemia) can be a medical emergency—if left untreated, it can result in a diabetic coma. Diabetes, a chronic condition of consistently elevated blood sugar levels, can damage the eyes, heart, nervous system, and kidneys.

Signs of hyperglycemia include increased thirst and urination, headaches, fatigue, blurred vision, and a “fruity” smell to the breath. Contact your mother’s doctor if she mentions any of these symptoms or if you notice them.

Adhering to the guidelines your mother has been given for controlling her diabetes is vital to ensure that she does not become hyperglycemic. This means that she needs to take her medications as prescribed, follow an eating plan that helps keep her blood sugar under control, and get sufficient exercise, as well as testing her blood sugar level as often as her doctor has recommended. In recent years, many new diabetes medications have been approved. Also, many people with diabetes have found that using one of the newer glucose monitors makes it easier to keep track of and control their blood sugar levels without needing finger sticks.

Another potentially dangerous risk associated with diabetes is an abnormally low blood sugar level (hypoglycemia). Symptoms include shakiness, heart palpitations, sweating, anxiety, dizziness, and confusion. If left untreated, hypoglycemia can cause fainting or a seizure. To bring blood sugar levels back up, she’ll need to consume some simple sugar. Glucose tablets, which are available without a prescription, are meant for such occasions. If you don’t have glucose tablets, a small glass of fruit juice, one tablespoon of sugar or honey, or a few pieces of hard candy will help bring her blood sugar into the normal range. Instances of hypoglycemia should also be reported to her doctor; if they occur frequently, a medication adjustment or change may be needed.

I had a brain scan because my doctor was trying to identify the cause of my chronic headaches, and the scan revealed a brain aneurysm. He said I don’t need treatment because the aneurysm is small and I don’t have risk factors that increase the possibility of rupture. What is an aneurysm and what will happen if it ruptures?

A brain aneurysm is a weak, bulging area in an artery in the brain. When blood from a burst or ruptured brain aneurysm leaks into the space between the brain itself and the thin tissues that cover the brain, it is called a hemorrhagic stroke or a “brain bleed.”

Symptoms of a ruptured brain aneurysm include sudden, severe headache, blurred or double vision, pain behind or above one eye, a stiff neck, sudden sensitivity to light, seizures, and a drooping eyelid. All of these symptoms require emergency medical treatment. A headache that lasts for days or weeks may be a symptom of a small leak from an aneurysm. Most people with an unruptured aneurysm experience no symptoms.

Risk factors such as smoking, older age, hypertension, and alcohol consumption affect the risk of rupture. The size, location, and shape of the aneurysm are factors that doctors consider when determining whether or not to treat an unruptured aneurysm.

Brain aneurysms are often detected during tests looking for other conditions, such as a cause of chronic headaches or other neurological symptoms; these tests include magnetic resonance angiography, computed tomography (CT) scan, and CT angiography. If an aneurysm is detected, imaging tests will be repeated regularly to see if the aneurysm grows or changes. If an aneurysm gets larger, it is more likely to rupture.

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