Lows and highs: blood elucose levels

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1 Lows and highs: Canadian Diabetes CPG Clinical Practice Guidelines blood elucose levels What is low blood glucose? When the amount of blood glucose (sugar in your blood) has dropped below your target range (less than 4 mmol/l), it is called low blood glucose or hypoglycemia. What are the signs of a low blood glucose level? You may feel: Shaky, light-headed, nauseated Nervous, irritable, anxious Confused, unable to concentrate Hungry Your heart rate is faster Sweaty, headachy Weak, drowsy A numbness or tingling in your tongue or lips What causes a low blood glucose level (hypoglycemia)? Low blood glucose may be caused by: More physical activity than usual Not eating on time Eating less than you should have Taking too much medication The effects of drinking alcohol How do I treat low blood glucose? If you are experiencing the signs of a low blood glucose level, check your blood glucose immediately. If you don't have your meter with you, treat the symptoms anyway. It is better to be safe. Eat or drink a fast-acting carbohydrate (15 grams): 15 g of glucose in the form of glucose tablets (preferred choice) 1 5 nil (1 tablespoon) or 3 packets of table sugar dissolved in water 175 ml (3A cup) of juice or regular soft drink 6 LifeSavers (1 = 2.5 g of carbohydrate) 15 ml (1 tablespoon) of honey (do not use for children less than 1 year old) Low blood glucose can happen quickly, so it is important to treat it right away. If your blood glucose drops very low, you may need help from another person. Very low blood glucose can make you: Confused and disoriented Lose consciousness Have a seizure Make sure you always wear your MedicAlert* identification, and talk to your doctor or diabetes educator about prevention and emergency treatment for severe low blood glucose. diabetes.ca BANTING ( ) /23I Canadian Vii] Diabetes

2 Wait 10 to 15 minutes, then check your blood glucose again. If it is still low: Treat again If your next meal is more than one hour away, or you are going to be active, eat a snack, such as half of a sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source) Think about why your blood glucose went low and make the necessary changes to avoid low blood glucose again Wait minutes before driving What is high blood glucose? When your fasting blood glucose is at or above 11 mmol/l, you may: Be thirsty Urinate more often than usual, especially during the night Be tired What causes high blood glucose (hyperglycemia)? High blood glucose can result when food, activity and medications are not balanced. High blood glucose may happen when you are sick or under stress. What do I do if I have high blood glucose? Follow the treatment recommended by your doctor, diabetes educator or other member of your healthcare team. If this happens often, you may need to call or see your doctor to: Adjust your meal plan Adjust your physical activity Adjust your medication and/or insulin Across the country, the Canadian Diabetes is leading the fight against diabetes by helping people with diabetes live healthy lives while we work to find a cure. Our community-based network of supporters help us provide education and services to people living with diabetes, advocate for our cause, break ground towards a cure and translate research into practical applications. DIABETES SECTION DES 'EDUCATOR EDUCATEURS SECTION DUDIABETE /fl I Canadian VidJ Diabetes /12 Q-140M diabetes.ca BANTING ( )

3 Managing your blood glucose when you're ill When you are sick, your blood glucose levels may fluctuate and be unpredictable. During these times, it is a good idea to check your blood glucose levels more often than usual (for example, every two to four hours). It is also very important that you continue to take your diabetes medication. If you have a cold or flu and are considering using a cold remedy or cough syrup, ask your pharmacist to help you make a good choice. Many cold remedies and cough syrups contain sugar, so try to pick sugar-free products. When you are sick, it is VERY IMPORTANT that you: drink plenty of extra sugar-free fluids or water; try to avoid coffee, tea and colas, as they contain caffeine, which may cause you to lose more fluids. replace solid food with fluids that contain glucose if you can't eat according to your usual meal plan; try to consume 15 grams of carbohydrate every hour; call your doctor or go to an emergency room if you vomit and/or have had diarrhea two times or more in four hours; and if you are on insulin, be sure to continue taking it while you are sick. Check with your healthcare team about guidelines for insulin adjustment or medication changes during an illness. Recommended blood glucose targets for people with diabetes Target for most people with diabetes A1C** Fasting blood glucose/blood glucose before meals (mmol/l) Blood glucose two hours after eating (mmol/l) < 7.0% 4.0 to to 10.0 ( if A1C** targets not being met) This information is based on the Canadian Diabetes 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and is a guide. ** AlC is a measurement of your average blood glucose control for the last 2-3 months and approximately 50% of the value conies from the last 30 days. Talk to your healthcare provider about YOUR blood glucose target ranges. You should have your AlC measured every 3 months, when your blood glucose targets are not being met or when you are making changes to your diabetes management. All three measurements, before and after meal blood glucose levels and AlC, are important measurements of your diabetes control. How frequently you monitor your blood glucose levels should be decided accord ing to your own treatment plan. Your healthcare professional can discuss when and how often you should check your blood glucose levels. Across the country, the Canadian Diabetes is leading the fight against diabetes by helping people with diabetes live healthy lives while we work to find a cure. Our community-based network of supporters help us provide education and services to people living with diabetes, advocate for our cause, break ground towards a cure and translate research into practical applications. DIABETES SECTION DES EDUCATOR EDUCATEURS SECTION DU DIABETE < l Canadian Diabetes /12 Q-140M diabetes.ca BANTING ( )

4 Managing Canadian Diabetes CPG Clinical Practice Guidelines your blood glucose management What is blood glucose'i Blood glucose (sugar) is the amount of glucose in your blood at a given time. Why should you check your blood glucose levels? Checking your blood glucose levels will: provide a quick measurement of your blood glucose level at a given time; determine if you have a high or low blood glucose level at a given time; show you how your lifestyle and medication affect your blood glucose levels; and help you and your diabetes healthcare team to make lifestyle and medication changes that will improve your blood glucose levels. Checking your blood glucose levels is also called Self- Monitoring of Blood Glucose ().? How do you check your blood glucose levels? A blood glucose monitor is used to check your blood glucose at home. You can get these monitors at most pharmacies. Talk with your diabetes educator or pharmacist about which one is right for you. Once you receive a monitor, ensure you receive the proper training before you begin to use it. Ask your healthcare provider about: where to draw blood how to use a lancet (the device that punctures your skin) the size of the drop of blood needed the type of blood glucose strips to use how to clean the monitor how to check if the monitor is accurate how to code your monitor Note: Your province or territory may subsidize the cost of blood glucose monitoring supplies. Contact your local Canadian Diabetes branch to find out if this applies to you. How do you keep your blood glucose levels within target range? If you have diabetes, you should try to keep your blood glucose as close to target range as possible. This will help you to delay or prevent complications of diabetes. Maintaining healthy eating habits and an active lifestyle, and taking medication, if necessary, will help you keep your blood glucose levels within their target range. Target ranges for blood glucose can vary. Your target will depend on your age, medical condition and other risk factors. Targets for pregnant women and children 12 years of age and under are different. Ask your healthcare provider what your target levels should be. diabetes.ca BANTING ( ) < l Canadian Diabetes

5 Self-Monitoring of Blood Glucose () Recommendation Tool for Healthcare Providers Basic requirements (must be met) (f\ I Canadian >c J Diabetes The person with diabetes (or a family member/caregiver) must have the knowledge and skills to use a home blood glucose monitor and to record the results in an organized fashion. The person with diabetes and/or members of the healthcare team must be willing to review and act upon the results in addition to the AlC results. O A. REGULAR IS REQUIRED if the person with diabetes is: SITUATION RECOMMENDATION Using multiple daily injections of insulin (> 4 times per day) Using an insulin pump Using insulin < 4 times per day Pregnant (or planning a pregnancy), whether using insulin or not Hospitalized or acutely ill Starting a new medication known to cause hyperglycemia (e.g. steroids) Experiencing an illness known to cause hyperglycemia (e.g. infection) > 4 times per day (see page 2 - QID - [basal-bolus/mdi]) at least as often as insulin is being given (see page 2 - premixed or basal insulin only) individualized and may involve > 4 times per day individualized and may involve > 2 times per day % B. INCREASED FREQUENCY OF MAY BE REQUIRED if the person with diabetes is: SITUATION Using drugs known to cause hypoglycemia (e.g. sulfonylureas, meglitinides) Has an occupation that requires strict avoidance of hypoglycemia RECOMMENDATION at times when symptoms of hypoglycemia occur or at times when hypoglycemia has previously occurred as often as is required by employer Not meeting glycemic targets Newly diagnosed with diabetes (< 6 months) Treated with lifestyle and oral agents AND is meeting glycemic targets > 2 times per day, to assist in lifestyle and/or medication changes until such time as glycemic targets are met > 1 time per day (at different times of day) to learn the effects of various meals, exercise and/or medications on blood glucose Some people with diabetes might benefit from very infrequent checking ( once or twice per week) to ensure that glycemic targets are being met between A1C s C DAILY IS NOT USUALLY REQUIRED if the person with diabetes: Is treated only with lifestyle AND is meeting glycemic targets Has pre-diabetes Additional CDA resources Lows and highs: blood glucose levels Managing your blood glucose Monitoring for Glycemic Control. Canadian Diabetes 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2008;32(suppl 1):S32-S36. Self-Monitoring of Blood Glucose in People with Type 2 Diabetes: Canadian Diabetes Briefing Document for Healthcare Providers. Can J Diabetes. 2011;35: Page 1

6 Suggested Patterns for Patients Using Insulin Basal Insulin Only - NPH or long-acting insulin analog, typically given at bedtime. at least as often as insulin is being given. Optional, less frequent can be done at other times of day to ensure glycemic stability throughout the day. BREAKFAST LUNCH SUPPER BEDTIME NIGHT before after before after before after Insulin NPH/long (basal) pattern Adjustment Basal insulin t if BG high i if BG low Premixed typically given pre-breakfast and pre-supper. at least as often as insulin is being given. QID until glycemic targets are met; BID (alternating times) is usually sufficient once glycemic targets are met. BREA <FAST LUNCH SUPPER BEDTIME NIGHT before after before after before after Insulin premixed premixed pattern 1: Starting pattern 2: Stable Alternating daily Adjustment Pre-supper insulin 1 ifbglow Pre-breakfast insulin t if BG high I ifbglow Pre-breakfast Insulin Pre-supper insulin QID (basal-bolus/mdi) - typically given as a rapid-acting analog or regular insulin (bolus) before each meal and NPH or long-acting analog (basal) typically given at bedtime. should be QID, pre-meal and bedtime, in order to assess previous dose and to adjust next dose. Some patients find that post-prandial checking can also be helpful. BREAKFAST LUfv CH SUPPER BEDTIME NIGHT before after before after before after Insulin rapid/ regular (bolus) rapid/ regular (bolus) rapid/ regular (bolus) NPH/long (basal) pattern 1: Starting or Stable pattern 2: Stable, Focus on post-meal BG pattern 3: Intensive management Adjustment Basal insulin t if BC high J if BG low Pre-breakfast insulin t if BG high I if BG low Pre-lunch insulin Pre-supper insulin 1 ifbglow Basal insulin MDI = multiple daily injections No funding sources were used by the CD A for the development or launch of this document on. Page 2 Across the country, the Canadian Diabetes is leading the fight against diabetes by helping people with diabetes live healthy lives while we work to find a cure. Our community-based network of supporters help us provide education and services to people living with diabetes, advocate for our cause, break ground towards a cure and translate research into practical applications. DIABETES SECTION DES 'EDUCATOR EDUCATEURS SECTION DUDIABETE (1 Canadian Diabetes diabetes.ca BANTING ( ) /12 Q-37M