Doing your level best

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1 New blood sugar target goals to consider Doing your level best One of your main goals in treating diabetes is to keep your blood sugar level as close to normal as possible. It takes some effort, but it s worth it. You ll feel better when your blood sugar level is normal or close to normal. People without diabetes have normal blood sugar levels that stay between about 70 and 110 mg/dl (mg/dl=milligrams of sugar for every 100 milliliters of blood). People with diabetes may not be able to keep their blood sugar in that normal range all the time. It may get too high or too low at times. The American Diabetes Association (ADA) publishes guidelines for diabetes care every year. 1 Updated guidelines for blood sugar control were issued by the American College of Endocrinology (ACE) in Your healthcare team follows these guidelines to determine if your treatment is controlling blood sugar levels. Here are the new target goals for people with diabetes: New Blood Sugar Control Targets 2 Before meals (pre-prandial): less than 110 mg/dl 2 hours after meals (post-prandial): less than 140 mg/dl Note: These guidelines apply to many people, but not to everyone. Your goals may be higher or lower than these guidelines. Talk with your healthcare team. They will help you set the blood sugar target that s right for you 1. Information available at 2. ACE Consensus Conference on Guidelines for Glycemic Control. August 20-21, Washington, D.C. The American College of Endocrinology (ACE). Available at consensuswhitepaper.php. Accessed August 21, 2001.

2 Keeping your blood sugars in range There are two good ways to check if your blood sugar level is in control. You should do both. 1. Check your blood sugar regularly with a glucose meter. Work with your doctor or diabetes educator to learn how to use one of the many types of personal blood glucose meters that are available. Ask your doctor or diabetes educator what your checking schedule should be. You may need to check before meals and at bedtime. Also, research suggests that checking after meals is a good way to find out how food is affecting your blood sugar. Keep track of your results in a diary and take it with you on office visits so you and your doctor can review the results together. 2. Get the A1C test (hemoglobin A 1C ). This shows your average blood sugar level over the past 2-3 months. Depending on your treatment and level of diabetes control, an A1C test should be done in your doctor s office every 3-6 months. ACCU-CHEK COMPACT TM is a trademark of a member of the Roche Group.

3 A1C testing a better long-term picture The A1C test measures the amount of sugar that is attached to the hemoglobin inside the red blood cells. Sugar that is not used for energy and is left in the blood attaches to the blood cells. Because red blood cells live in the bloodstream for about 120 days, the A1C test shows the average blood sugar for the past 2-3 months. Sugar Red Blood Cell Normal A1C High A1C Sugar (small blue balls) sticks to the hemoglobin inside red blood cells and to other body proteins. The amount of sugar stuck to the hemoglobin can be found with an A1C test, which gives an estimate of the average blood sugar level over the last two to three months. All people with diabetes benefit from knowing their A1C number. Though you may have high blood sugar now and then, an improved A1C result can help you feel confident that you are doing a good job of overall diabetes control. If your number is higher than your target level, it will give you a starting point for working toward a lower number. Discuss the A1C test with your doctor or diabetes educator. The American Diabetes Association Standards of Care suggest that it should be done every three to six months, depending on your treatment and level of control. The American College of Endocrinology guidelines recommend a goal of 6.5% for people with diabetes (see chart on page 8). For people without diabetes, the normal range is about 4-6%. Your doctor and/or diabetes educator will help you set your goal. My A1C will be checked every months. My last A1C test result was %. My goal for A1C is %.

4 How to compare the results of your daily blood sugar testing to your A1C test This chart shows the average blood sugar that corresponds to the A1C test result. Note that an A1C of 6.5% results when blood sugar averages about 135 mg/dl. How to compare 3 Blood sugar (mg/dl) A1C 60 4% 90 5% 120 6% 150 7% 180 8% 210 9% % % % % 3. Reference: Diabetes Control and Complications Trial (DCCT): Results of Feasibility Trial. Diabetes Care. Volume , pp The benefits of staying in control Blood sugar control protects your long-term health. Maintaining a near normal blood sugar level helps protect you from many of the serious problems related to diabetes such as eye damage, kidney disease, and nerve problems. You ll also feel much better if you keep your blood sugar close to normal. When your blood sugar is higher or lower than normal, you may feel tired, sick, and/or uncomfortable.

5 Not taking enough or the right kind of diabetes medicine Extra sugar made by the liver High blood sugar When blood sugars go above normal, it s called high blood sugar or hyperglycemia. When you have hyperglycemia, you may not feel your best. Here are some of the things that can cause your blood sugar to increase: Causes of high blood sugar Eating too much Emotional stress Physical stress (being sick or in pain) Getting less exercise than usual The tricky thing about hyperglycemia is that you can feel fine even though your blood sugar is too high. So it s important that you test your blood sugar regularly and watch for the following symptoms: Symptoms of high blood sugar More thirsty or hungry than usual Having to pass urine often, especially at night Dry or itchy skin Feeling more tired or sleepy than usual Blurred vision Frequent infections Slow healing of cuts or sores If you have hyperglycemia, it needs to be treated. If your blood sugar stays high for a long time, it can cause serious health problems such as:

6 Damage to blood vessels. This can cause poor blood flow to feet, legs and skin, increasing your risk for: infections heart problems stroke blindness foot or leg amputation kidney disease Damage to nerves. If this happens, there is increased risk of: infections nerve damage can cause your feet not to feel pain, so a cut or sore can get badly infected before you know it sexual problems stomach problems Ketoacidosis. This is a serious condition that usually occurs only in people with type 1 diabetes. It happens when the body has become too acidic because of the high level of ketones in the blood. This result of very high blood sugar can lead to diabetic coma or, if left untreated, death. Check your blood sugar and urine ketone levels when you: feel more hungry and thirsty than usual have to urinate more often than usual throw up or feel sick to your stomach have stomach pain have a fruity smell on your breath notice your breathing is fast and deep have a fever Ketoacidosis is not a condition you should try to treat yourself. Call your doctor immediately if your blood sugar is above 240 mg/dl AND you have ketones in your urine. Your doctor will tell you what to do. If you can t reach your doctor, go to the nearest emergency room right away. What you can do about high blood sugar levels If your blood sugar level is high, get back to your diabetes care plan. It is the best way to treat high blood sugar. Make sure that you:

7 more regular exercise or activity more frequent blood testing and a plan for acting on the results Illness and high blood sugar levels take the right amount of diabetes medication at the right time eat the right amount of food at the right time drink plenty of water check and record your blood sugar level often get regular physical activity If following your diabetes care plan carefully does not bring your blood sugar level down, you may be getting sick. There are long-term health risks related to hyperglycemia. Talk with your doctor or diabetes educator about your options for improving your blood sugar control. These may include: a change in medicines or doses more careful meal planning When you become sick, your blood sugar may go up. A cold, a flu, or an infection among other reasons can cause this to happen. It is important to take special care of yourself when you are sick. Meet with your doctor or diabetes educator to work out a personal sick-day plan before you become ill. The following rules will help. Always take your insulin or diabetes pills, even if you cannot eat. Test your blood sugar every four hours, at least before each meal and at bedtime. Test your urine for ketones. The easiest products to use are dip-and-read test strips. Test more often if your blood sugar is 240 mg/dl or if you throw up. Drink extra fluids. Try to drink at least 1/2 cup every hour. The liquids you drink should not have calories. Hot tea, water, and diet soda are all good choices.

8 Follow your meal plan. This is very important to do if your stomach is not upset. If you cannot keep food down, you should try to take in at least 4 oz. of a sugar-containing beverage every hour to keep your blood sugar from falling too low. In addition, you can try to eat soft foods or liquids to take the place of breads and fruits you usually eat. The following foods or drinks are good choices. Each serving shown can replace one serving of bread or fruit. Food Fruit juice Soda (with sugar) Gelatin (with sugar) Hot cereal (cooked) Ice cream (vanilla) Broth-based soup (for example,vegetable or chicken noodle) Amount 1/3 to 1/2 cup 1/2 cup 1/2 cup 1/2 cup 1/2 cup 1/2 cup Call your doctor when: you are vomiting and cannot keep down food, liquids, or diabetes pills. your illness lasts more than 24 hours. moderate or large amount of ketones are present in your urine. all your blood sugar tests are higher than 240 mg/dl for more than a day. your temperature is over 101 o F. When you call, be ready to tell your doctor: the time and results of blood sugar and urine ketone tests. amount of food and liquid taken. what medicines you have taken. your temperature. If your doctor is not available, go to the emergency room.

9 Your healthcare team may have more steps for you to take. Use the space below to write them down: Low blood sugar Anyone who takes insulin or diabetes pills can have blood sugar that is too low below about 70 mg/dl. Low blood sugar is also called hypoglycemia or insulin reaction. One way to help prevent hypoglycemia is to avoid missing meals. Low blood sugar is usually mild and easy to treat, but it can become serious. If it is not treated right away, it may get worse. If blood sugar falls very low, a person may pass out. When blood sugar gets that low, it is a life-threatening emergency. Causes of low blood sugar Taking too much diabetes medicine Eating meals or snacks at the wrong time Skipping meals or snacks Getting more physical activity than usual When you have hypoglycemia, you may experience the following symptoms: Symptoms of low blood sugar Feel shaky Become sweaty Feel tired

10 Feel hungry Have a fast heartbeat Feel numbness or tingling in the mouth or lips Have blurred vision or a headache Become crabby and confused Low blood sugar feels different to each person. Learn to recognize your own symptoms. Be aware that you may have no symptoms at all! That s why you should test your blood sugar regularly. How to prevent low blood sugar (hypoglycemia) Eat your meals on time Don t skip meals or snacks Learn to adjust your food and diabetes medicine for exercise Test your blood sugar on schedule Do extra tests when you feel different from normal and write down the results in a log book How to treat low blood sugar (hypoglycemia) You need to treat low blood sugar right away. It will not get better on its own. So be sure to keep food that contains sugar with you at all times. If you feel your blood sugar level is too low, test your blood. If it is less than 70 mg/dl, eat one of these foods right away, even if you feel fine: 3 glucose tablets (5 grams glucose each) 1/2 cup of regular soda (not sugar-free) 1/2 cup fruit juice 1 small box of raisins 6 or 7 hard candies (not sugar-free, chewed, not sucked) 1 tablespoon of honey or sugar 5 small sugar cubes

11 If your blood sugar is still low after the second dose, call your doctor, nurse, or diabetes educator. If you cannot talk to one of them, go to the nearest emergency room. If your next meal is more than an hour away, follow the treatment with an extra snack. Be sure to eat your normal meal at the regular time, even if you have eaten a snack with a high sugar content. After eating or drinking something, follow these steps: Wait 15 minutes then test your blood sugar again. Record the number in your log book. Also, be sure to write down that you had a low blood sugar reaction. If you do not feel better in 15 minutes, eat the same amount of food again. If you think your blood sugar is low but cannot test, eat something that contains sugar. When in doubt,it is safer to eat the extra food than risk having serious hypoglycemia. Learn your body s warning signs of low blood sugar. Before you need help, tell your family, friends, exercise partners, co-workers, and classmates that you have diabetes. Tell them how they can help if you have low blood sugar. And always wear or carry identification that says you have diabetes. If you cannot talk, this will let people know what is wrong, and help you get the care you need.

12 Notes Patients who use insulin should also be familiar with glucagon. It s a naturally occurring hormone given as an injection to treat severe hypoglycemia. Be sure to ask your doctor about glucagon. Control your diabetes Throughout this brochure, you have learned about valuable ways to manage your diabetes by keeping your blood sugar levels as near to normal as possible. By controlling your diabetes, you keep it from controlling you.

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