Diagonised Diabetics Type II, PPBS 656 ml/dl

by Mini Samraj
(India)




Question: My PPBS is 656 mg/dL. I am a 47-year-old woman. Does this mean type 2 diabetes?



Quick Answer



A post-meal blood sugar of 656 mg/dL is a medical emergency. It is far above the diabetes range and meets the glucose threshold used when evaluating for hyperosmolar hyperglycemic state (HHS). Please go to an emergency department now or call emergency services, especially if you feel weak, very thirsty, confused, drowsy, short of breath, nauseated, or unable to keep fluids down.


Do not wait for a fasting glucose, A1C, or another routine appointment before seeking care. This result strongly suggests diabetes or a hyperglycemic crisis, but the glucose number alone cannot determine whether the type is type 1, type 2, or another form.




What Should You Do Right Now?



  1. Arrange emergency medical evaluation immediately. Do not drive yourself if you are confused, drowsy, faint, very weak, or having vision problems.

  2. If this was a home-meter result, wash and dry your hands and repeat the test with a new strip while arranging care. Do not let the repeat test delay leaving.

  3. If ketone testing is available, check blood or urine ketones, but do not postpone emergency care while doing so.

  4. If you are fully awake, can swallow normally, are not vomiting, and have not been told to restrict fluids, sip plain water while help is being arranged.

  5. Bring your glucose meter, medicines, supplement list, and any recent laboratory results.




Do not: exercise to “burn off” the glucose, take herbs, double a diabetes tablet, borrow insulin, or take an extra insulin dose unless you already have a clinician-approved correction plan. Severe hyperglycemia may require intravenous fluids, electrolytes, insulin, and close monitoring.




Why 656 mg/dL Is Dangerous


A postprandial blood sugar of 656 mg/dL is about 36.4 mmol/L. At this level, the body can lose large amounts of water and electrolytes through frequent urination. Severe dehydration and rising blood concentration may lead to hyperosmolar hyperglycemic state. Diabetic ketoacidosis can also occur, including in some people who appear to have type 2 diabetes.



Emergency warning signs include:



  • Confusion, unusual drowsiness, fainting, or difficulty waking

  • Repeated vomiting, severe abdominal pain, or inability to drink

  • Rapid or deep breathing, shortness of breath, or fruity-smelling breath

  • Extreme thirst, very dry mouth, frequent urination, or little urine

  • Severe weakness, blurred vision, seizure, or loss of consciousness

  • Moderate or high ketones



Does This Confirm Type 2 Diabetes?


This reading is far above the diagnostic threshold for diabetes. A random plasma glucose of 200 mg/dL or higher with classic symptoms or a hyperglycemic crisis can establish diabetes without waiting for routine repeat testing.



However, the reading does not identify the diabetes type. Type 2 diabetes is common at age 47, but adults can also develop autoimmune type 1 diabetes, ketosis-prone diabetes, pancreatic diabetes, medicine-related diabetes, or another form. The hospital team may use the medical history, examination, ketones, electrolytes, kidney function, blood gases, A1C, and later—when appropriate—antibody or C-peptide testing to classify it.



What Tests May Be Done?


Urgent tests may include laboratory glucose, electrolytes, kidney function, blood or urine ketones, blood acidity, serum osmolality, urinalysis, and tests for triggers such as infection. A1C can help estimate how long glucose has been elevated, but it must not delay emergency treatment.



After the crisis is treated, the diabetes team can decide whether insulin, other glucose-lowering medicine, nutrition changes, monitoring, and diabetes education are needed. Do not try to treat a glucose of 656 mg/dL with dietary restriction alone.



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References




Answered by: Dr. Albana Greca Sejdini, MD, MMedSc

Medically reviewed by: Dr. Ruden Cakoni, MD, Endocrinologist

Last reviewed: July 2026


Medical disclaimer: Educational only—not personal medical advice. Diagnosis and treatment should come from a qualified clinician who knows the patient’s medical history.



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