Blood Sugar Log
Date Before Breakfast
(daily)
Before Lunch Before Dinner Bedtime
DIABETES MANAGEMENT (HEMOGLOBIN A1c)
Your Hemoglobin A1c is the blood test that tells your doctor how well you are managing your diabetes. It is usually drawn every 3 months.
High Blood Sugar Signs
• Thirst
• Hunger
• Dry Mouth Target Blood Sugar
Before meals: 70-130 mg/dL 2 hours after meals: 180 mg/dL or less
Bedtime: 150mg/dL Low Blood Sugar Signs
• Thirst
• Dizziness
• Blurred Vision
Plan for controlling my blood sugar:
Take my medicine/insulin as ordered
Exercise more often and/or longer
Work with the dietitian to make better food choices
See an eye doctor
(ophthalmologist) yearly
See a foot doctor (podiatrist) yearly
See a diabetes doctor (endocrinologist) regularly
See my primary doctor regularly
Diabetes Pattern Management
Part I: Diabetes Management Log (Food and Activity)
1. Write down everything you eat right away- don’t wait until the end of the day.
2. Include everything – meals, snacks, drinks.
3. Specify amount of food – be as accurate as possible.
4. If you know the carbohydrate (“carb”) content of the foods, mark it down.
5. Activity – indicate exercise and any unusual activity.
6. Other factors – stress, illness, injury Part II: Blood Sugar Log
1. Check your blood sugar every day before breakfast.
2. Also check before lunch, dinner and bed in a rotating pattern, for example:
Always check before breakfast AND…
Monday – before lunch
Tuesday – before dinner
Wednesday – before bed
Thursday – before lunch
Friday – before dinner
Saturday – before bed
Hemodialysis and Diabetes Frequently Asked Questions
1. Why have I started having such a change in my blood sugars since starting dialysis?
When the kidney function decreases, toxins in the body build up causing increased resistance to insulin in the body. Dialysis helps to remove some of these toxins and you may need less insulin as your blood is cleaned. Also, the toxins and dialysis can change the way you absorb oral medications, so you may need a lower dose or change in the type of medication used.
2. I was taught to use orange juice for my low blood sugar. Why can I not use orange juice now?
As kidney function decreases you are unable to excrete extra potassium and orange juice is high in potassium. So to treat low blood sugar without increasing your potassium level, try cranberry blends, apple juice, or grape juice. If you need to control fluids try using glucose tablets or regular hard candy to treat low blood sugar. If you have low blood sugar often, try carrying a tube of cake icing to use in emergencies.
3. I have always been told to use wheat bread. Why do I need to change to white bread products?
If your phosphorus remains under control or low, you may continue to use wheat bread. As kidney function decreases you excrete less phosphorus and it will begin to build up in your body. One way to help decrease your intake of phosphorus is by changing to white breads.
4. Why do I need to increase my protein? I was told to limit my protein foods.
Before you started dialysis, you needed to limit protein to try to save kidney function. Now you lose protein each time you have dialysis, so you need to increase your protein intake to allow fluid to be removed easier, help fight off any infections and heal if you have surgery or get any infection, even sometime as small as a cold. You should usually take in 80-100 grams of protein each day.
Check with your dietitian to see your individual needs.
5. I have treated my diabetes with metformin (Glucophage) for years. Why did
they stop this medication when it was still working fine?
Metformin is unchanged in the body and excreted by the kidneys. When your kidneys cannot work properly they do not clear the kidney and builds up in the body creating lactic acid which can cause your blood vessels in your stomach to break open and bleed. Depending on your overall dialysis clearance, diet control and weight you may not need medications or you may need to change to a different medicine.
6. What diabetic medications can I use to treat my diabetes?
Glipizide Safe at dosages of 2.5-10mg/day.
Do not use extended release.
Januvia Safe at dosages of 25mg/day.
Onglyza Safe at dosages of 2.5mg
Insulin Long lasting insulin and short acting insulin, as needed are best on dialysis.
Note: You should always check with your doctor before adjusting or changing medication.
Remember!
Take your blood sugar level as directed by your doctor. Treat sugar levels according to results. You may not always recognize when sugar levels are low.
You may need to change dose, type or even stop the medicine you use to treat your diabetes when you begin dialysis.
If you have weight changes (gain or lose), this may require changes in your oral medication or insulin dosage.
You still need to monitor your carbohydrate intake, but will need to adjust some foods in your diet because your kidneys cannot clean some minerals such as potassium and phosphorus from your body anymore.
You will need extra protein now that you have started dialysis.
When you have questions about your diet ask your dietitian for help.
Low Blood Sugar
If you take medicine for diabetes, your sugar may go too low. You might feel shaky, sweaty or dizzy. Food and drink will make you feel better, but you do not need very much to make your blood sugar go up. Many people eat and drink too much, and get high blood sugar later. If your blood sugar is less than 70, eat or drink one serving (15 grams) of carbs.
Here are some choices:
Half-cup regular soda – Ginger Ale, Seven-Up or Sprite. Do not drink diet soda.
One small piece of fruit
One half-cup of juice. Choose apple, cranberry or grape. Do not use orange juice!
Three glucose tablets
One tablespoon honey, sugar or corn syrup
After you eat or drink:
Wait 15 minutes. This is important!
Check your blood sugar.
If your blood sugar is still too low, have one more serving of food or drink.
If your sugar is coming up, you do not need to eat or drink more unless you are hungry, or if your next meal is more than two hours away.
