Blood Glucose Management
What Influences Blood Sugar Levels?
• There are three main things that influence your blood sugar:
– Nutrition – Exercise – Medication
What Influences Blood Sugar Levels?
NUTRITION
4Meal Plan
Purpose of a Meal Plan
• There are four purposes of a diabetes meal plan:
– Provide food in amounts and intervals in balance with medication to maintain blood glucose levels
– Achieve and maintain reasonable body weight – Provide nutritional needs
– Normalize blood fats to decrease cardiovascular risk
Exercise
Exercise
• Exercise is beneficial for people with and without diabetes
• Usually lowers blood glucose levels
• Can help you lose weight, lower blood pressure, improve cholesterol, and lower stress
• Resistance training with weights can help improve insulin resistance
Medication
Medication
• Includes insulin and oral medication
• Oral Medication
– Work in several different ways, some stimulate the pancreas to produce more insulin while others lower blood glucose by lowering the body’s ability to absorb carbohydrates
• Insulin
– Lowers blood glucose like the insulin made by the pancreas
Importance of Monitoring
• Gives you information so you know how well your meal plan, exercise, and medication is balanced
• If these are not balanced, helps your healthcare team to make the necessary adjustments
• Tells you if you are reaching your blood glucose goals
Recording Your Numbers
• Keep a log book or a diary of all your blood glucose numbers
• Include the date and time of your reading
• Also include information about when you eat and when you take your diabetes medications
• Most glucose meters can download your blood
glucose numbers, but this alone will not provide your healthcare team with the full picture
You Can Use Your Recorded Information To:
• Adjust your treatment plan
• Determine your usual pattern of blood glucose
• Determine if you may be experiencing short-term diabetes complications
• Determine how certain foods, activities, medications, and other factors affect your blood glucose levels
Blood Glucose Goals
Fasting/Pre-meal glucose 70-100mg/dL
Post-meal glucose
(2 hr. after start of meal) 90-140mg/dL
Bedtime glucose <120mg/dL
What Do My Numbers Mean?
• Normal Blood Glucose Level
– A normal blood glucose is between 70 and 100mg/dL when you are fasting and between 90 and 140mg/dL two hours after a meal
• Hypoglycemia
– Hypoglycemia means low blood glucose and usually occurs when the blood sugar falls below 70mg/dL
– Can be caused by too much insulin, not enough food, and/or too much exercise
Symptoms of Hypoglycemia
Shaking Fast Heartbeat Sweating Dizziness Anxious
Hunger Impaired Vision Weakness Headache Irritable
These materials were adapted from http://www.keepingwellwithdiabetes.com/ed_comp_hypergly.jsp.
Treatment of Hypoglycemia
• Test blood glucose
• If blood glucose is between 50 – 70mg/dL, eat 15 grams of carbohydrates
• If blood glucose is less than 50mg/dL, eat 30 grams of carbohydrates
• Wait 10 minutes and then retest blood glucose
• Eat snack if blood glucose level is still below 70mg/dL
• IF PERSON IS UNCONSCIOUS, GLUCAGON MAY BE NECESSARY OR CALL 911
Glucagon
• Naturally occurring hormone made in the pancreas
• A life-saving, injectable hormone that raises blood glucose level
• Treatment for severe hypoglycemia
• Can save a life
Information provided from ADA Pediatric Diabetes Resource 2005
1 mg of freeze-dried glucagon (Vial)
1 ml of water for reconstitution (Syringe)
Combine immediately before use
Information provided from ADA Pediatric Diabetes Resource 2005
Glucagon Kit
What Do My Numbers Mean?
• Hyperglycemia
– Hyperglycemia means high blood glucose
– Can usually be caused by illness, infection, emotional stress, overeating, weight gain, and/or not enough exercise
– Usually occurs when blood glucose goes higher than 180mg/dL
Symptoms of Hyperglycemia
These materials were adapted from http://www.keepingwellwithdiabetes.com/ed_comp_hypergly.jsp.
Hunger Dry Skin
Frequent Urination Extreme Thirst
Decreased Healing Drowsiness
Blurred Vision
Treatment of Hyperglycemia
• Treatment depends on what caused the episode
• Drink plenty of fluids
• Check blood glucose and urine ketones
• Check blood glucose and ketones at least every 4 hours until back to normal
• May need to take more insulin if Type 1
• Talk to healthcare professional if have moderate to large ketones
Checking Urine Ketones
• Dip a ketone test strip into a sample of urine, wait at least one minute
• Compare the test pad color to the color chart on the side of the ketone strips vial
• Record your results in your blood glucose testing diary or log book
• Follow the manufacturer’s recommendation for care and storage of your ketone strips
How Often Should I Test?
• Recommended to check at least 2-4 times daily especially if taking insulin
• Best to check prior to eating and then 2 hours after eating to determine if your meal plan is matched up to your medication
Other Times To Test
• Your blood glucose is more than 300 mg/dl
• You feel nauseated, are vomiting, or have abdominal pain
• You are sick (for example, with a cold or flu)
• You feel tired all the time
• You are thirsty or have a very dry mouth
• Your skin is flushed
• You have a hard time breathing your breath smells
"fruity"
• You feel confused or "in a fog"
Information taken from http://www.diabetes.org/type-1-diabetes/blood-glucose-checks.jsp
28.0
Average Weekly Test Frequency
By Medication Type
Avg. Insulin User
Avg. Oral Med User
3.5
Insulin User Goal
13.6
2X 2X
Oral Med User Goal
7.0
Slide provided by Roche Diagnostics.
Source: Consumer Tracking Study June 2004; ADA.. RDC MBR, 2004 YE.
National Testing Frequency
While test frequencies appear to be increasing, only 12% of people with diabetes meet recommended testing goals according
to the Journal of the American Medical Association.
Barriers That Cause People With Diabetes Not To Test
• Claim to value testing, but lack of follow- through
• Too busy/Forgetting (22%)
• Too expensive (having diabetes) (16%)
• Fingers hurt (10%)
• Don’t like testing in public (63%)
– Less than half take a meter wherever they go (46%)
Information provided from Roche Diagnostics Source: DC Influencer Study 2005 (n=82)
Ways to Overcome These Barriers
• Set a schedule to test everyday at certain times
• Reward yourself when you keep to your schedule
• Use alternate site testing if your fingers hurt
• If you don’t like testing in public, test when you stop to use the bathroom or have a second by yourself; the meters are very quick now that you could be done in less than 10 seconds
Summary
• Nutrition, Exercise and Medication can affect blood glucose levels
• Monitoring can help your doctor make the necessary changes
• Normal fasting blood glucose level is 70-100mg/dL
• Hypoglycemia is when a blood glucose level under 70mg/dL
• Hyperglycemia is when a blood glucose level is above 180mg/dL
