Blood Glucose Levels- What you should know about your readings

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BLOOD GLUCOSE LEVEL TARGETS

Glycemic targets are individualized based on the individual’s age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease and life expectancy. Therefore it is important to speak to the physician and health care team.

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RECOMMENDED BLOOD GLUCOSE (SUGAR) TARGETS 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% or less 4.0 to 7.0 5.0 to 10.0 (5.0 – 8.0 if A1C** targets not being met)

* This information is based on the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and is a guide.

** A1C is a measurement of your average blood glucose (sugar) control for the last two to three months and approximately 50 per

 

WHAT SHOULD YOU DO IF BLOOD GLUCOSE LEVELS ARE HIGH (HYPERGLYCEMIA)?

If blood sugar is too high (usually >14mmol/L), patient may experience symptoms such as: blurry vision, headache, increased thirst, increased urination, irritability, tiredness and unexplained weight loss. Think about why the blood glucose level might be high and

To help bring blood glucose down, consider the following:

 Drink more water and sugar-free fluids (limit fluids with sugar, including fruit juices).

 Follow the recommended meal plan (if patient does not have a plan, meet with a dietitian).

 Ensure patient is taking medication as prescribed by their physician. If the blood glucose remains high, ensure patient sees

 Test the blood glucose more often (every three to four hours).

 If the blood glucose level is below 14 mmol/L and they feel well, increase their physical activity (e.g., go for a walk)

*Always ask the physician before starting a new exercise routine.

*Speak to patient’s physician on what readings the patient should seek medical emergency as this is individualized. Any patients

experiencing severe symptoms of hyperglycemia mentioned above, 911 should be called IMMEDIETLY. This is an emergency!

(Adapted from Canadian Diabetes Association- Clinical Practice Guidelines)

WHAT SHOULD YOU DO IF BLOOD GLUCOSE LEVELS ARE LOW (HYPOGLYCEMIA)?

1) the development of autonomic or neuroglycopenic symptoms (Table 1)

2) a low plasma glucose level (<4.0 mmol/L for patients treated with insulin or an insulin secretagogue)

3) symptoms responding to the administration of carbohydrate

*The severity of hypoglycemia is defined by clinical manifestations (see below)

 

Types of Severity of hypoglycemia:

Mild: Autonomic symptoms are present. The individual is able to self-treat.

Moderate: Autonomic and neuroglycopenic symptoms are present. The individual is able to self-treat.

Severe: Individual requires assistance of another person. Unconsciousness may occur. PG is typically <2.8 mmol/L.

 

Risk factors for severe hypoglycemia: Prior episode of severe hypoglycemia, Current low A1C (<6.0%), Hypoglycemia unawareness,>Long duration of insulin therapy, Autonomic neuropathy, Low economic status, Food insecurity, Low health literacy, Cognitive impairment, Adolescence, Preschool-age children unable to detect and/or treat mild hypoglycemia on their own.

(**If your patient has these risk factors, speak to the physician about an action plan for hypoglycemia)

 

To treat Mild or Moderate hypoglycemia eat or drink fast-acting sugar such as:

 15 mL (3 tsp) of sugar dissolved in water

 15 g of glucose in the form of glucose tablets

 175 mL (3/4 cup) of regular soft drink or juice

 Wait 15 minutes, then check your blood glucose again. If your blood glucose is still below 4 mmol/L,repeat treatment and blood glucose test again.

 Follow with one portion of starch and one portion of protein if your next meal is more than one hour

If patient is showing signs of moderate to SEVERE symptoms, CALL 911. This is a MEDICAL EMERGENCY. When in doubt, call 911.

**It is very important to follow the directives of the patient’s physician in terms of treating different levels of hypoglycemia. If you do not have a directive, speak to the patient’s physician about creating an action plan for the patient.*

(Adapted from Canadian Diabetes Association- Clinical Practice Guidelines)

 

MANAGING BLOOD GLUCOSE (SUGAR) WHEN PATIENT IS ILL

When a patient is sick, their blood glucose (sugar) levels may fluctuate and be unpredictable. During these times, it is a good idea to check their blood glucose (sugar) levels more often than usual (for example, every two to four hours). It is also very important that they continue to take their diabetes medication unless directed otherwise by their physician. If patient is experiencing severe signs and symptoms of low or high blood sugar, contact the physician or go to the emergency room immediately. If they have a cold or flu and are considering using a cold remedy or cough syrup, ask the pharmacist to help you make a good choice. Many cold remedies and cough syrups contain sugar, so try to pick sugar-free products.

When a patient is sick, it is VERY IMPORTANT that the patient:

 Drink plenty of extra sugar-free fluids or water; try to avoid coffee, tea and colas, as they contain caffeine, which may cause

 Replace solid food with fluids that contain glucose if they can’t eat according to their usual meal plan;

 Try to consume 15 grams of carbohydrate every hour;

 Call the doctor or go to an emergency room if the patient vomit and/or have had diarrhea two times or more in four hours;

 If patient are on insulin, be sure to continue taking it while you are sick. Check with the health-care team about guidelines

for insulin adjustment or medication changes during an illness.

(Adapted from Canadian Diabetes Association- Clinical Practice Guidelines)