Blood Glucose (Blood Sugar) Management

Talk to your doctor and diabetes care team about your target glucose levels and how often you should check your blood sugar. Effective monitoring and treatment of high blood glucose will help avoid problems associated with levels that are outside of a normal, healthy range.

Your doctor may ask you to start checking your blood glucose regularly. This will tell you how food, activity and medicine affect your blood glucose and allow you to manage your level to ensure it isn’t too high or too low. Track your glucose levels in a logbook so you can share the information with your physician and other members of your diabetes care team. This will allow you and your care team to make better decisions about your diet, physical activity and medication to optimize control of your glucose.

You may especially benefit from regular checks if you:

• Take insulin
• Are pregnant
• Have a hard time controlling blood glucose levels
• Have low blood glucose levels
• Have low blood glucose levels without the usual warning signs
• Have ketones from high blood glucose levels

Before you buy a blood glucose meter (available at drug stores and other retailers), ask your doctor or diabetes educator to help you select one that will work best for you and is covered by your insurance plan.

How do I check?

1. After washing your hands or using an alcohol swab, insert a test strip into your meter
2. Use the lancing device to get a drop of blood from the side of your finger
3. Hold the edge of the test strip to the drop of blood and wait for the result
4. Your blood glucose level will appear on the meter's display

Note: Meters can differ slightly, so always refer to your user's manual for specific instructions.

Blood glucose (blood sugar) targets are individualized based on:

• Duration of diabetes (how long you have had diabetes)
• Age and life expectancy
• Comorbid conditions (conditions other than diabetes)
• Known cardiovascular disease (CVD) or advanced microvascular complications
• Hypoglycemia unawareness
• Individual patient considerations

The American Diabetes Association suggests the following targets for most non-pregnant adults with diabetes. More or less stringent glycemic goals may be appropriate for each individual.

• A1C: less than 7% A1C; may also be reported as eAG (estimated average glucose): 154 mg/dl
• Before a meal (pre-prandial) plasma glucose: 80–130 mg/dl
• 1-2 hours after beginning of the meal (postprandial) plasma glucose: Less than 180 mg/dl

Your doctor or diabetes educator may suggest your glycemic goals be more or less than these suggested values.

People who have diabetes can undergo spikes in their blood sugar (blood glucose) during which the levels are outside the normal range. These two conditions are called hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

Hyperglycemia (High Blood Glucose/Blood Sugar)

High blood sugar (hyperglycemia) occurs when there is too much sugar in your blood because your body does not have enough insulin or cannot use it properly. If high blood sugar is left untreated, it can become severe and lead to serious complications, such as diabetic coma, that require emergency care. Persistent high blood sugar, even if not severe, can lead to complications affecting eyes, kidneys, nerves, and heart.

Hyperglycemia is usually defined as a blood glucose level of 180 mg/dL or higher. It can occur for a variety of reasons:

• Skipped or not enough diabetes pills or insulin
• A meal or snack with more food or more carbohydrates than usual
• Too little exercise or physical activity
• Stress, illness, infection, or injury
• Using certain medications, such as steroids

Symptoms of high blood glucose include:

• Frequent urination
• Increased thirst
• Dry skin or mouth
• Hunger
• Blurred vision
• Drowsiness
• Decreased healing/frequent infections
• Numbness/tingling in hands and/or feet
• Unexplained weight loss

You can prevent hyperglycemia if you:

• Take your medications as prescribed
• Follow your meal plan – count the total amounts of carbs in each meal and snack
• Follow your exercise plan. Ask your doctor what kind of exercise is right for you
• Test your blood sugar regularly
• Tell your doctor if your blood sugar levels are persistently above 240 mg/dL
• Wear medical identification to let people know you have diabetes in case of an emergency

What to do if your blood sugar level is high (150-240):

• Try to figure out why it is high (Did you forget to take your medication? Are you nervous, upset or excited? Have you been eating more than you should?)
• Go out for a 30-minute walk or any activity that keeps you moving for at least 30 minutes
• Stick more closely to your food plan
• Drink plenty of sugar-free fluids (zero carbohydrates)

What to do if your blood sugar level is extremely high (240 or higher):

• Try to figure out why it is high (Did you forget to take your medication? Are you nervous, upset or excited? Have you been eating more than you should?)
• Stick more closely to your food plan
• Check your blood sugar every 2-4 hours for the next 24-hour period. If the level does not come down below 200, call your physician
• Drink plenty of sugar-free fluids (zero carbohydrates)
• If you have Type 2 diabetes, exercise should help lower the blood sugar. If you have Type 1 diabetes, check your urine for ketones and if present, DO NOT exercise (It may increase your blood sugar)

Hypoglycemia (Low Blood Glucose)

Hypoglycemia, or low blood sugar, is a condition where the body has abnormally low blood glucose levels, usually defined as 70 mg/dL or less. Hypoglycemia is a common problem for diabetics, especially those who take insulin, and can lead to serious complications.

Hypoglycemia can cause a variety of symptoms, so it is important to identify how your body reacts when your blood glucose is too low. Some people experience symptoms while others do not. Because severe hypoglycemia can lead to accidents, injuries, coma, and death, it is important to regularly check and control your blood glucose levels.

Some symptoms of low blood glucose include:

• Extreme hunger
• Weakness or fatigue
• Mood changes, irritability or impatience
• Lightheadedness
• Anxiety
• Headaches
• Sweating, chills and clamminess
• Confusion
• Trembling
• Dizziness
• Lack of coordination
• Rapid heartbeat
• Blurred vision
• Tingling or numbness in the lips or tongue
• Nightmares
• Seizures
• Unconsciousness

You can prevent hypoglycemia if you:

• Stay on your meal schedule and stick to your carbohydrate counts to prevent long periods of time between meals and fluctuations in carbohydrates
• Always carry a snack with you
• Monitor your blood glucose as recommended by your health care provider

What to do if your blood sugar (blood glucose) level is less than 70mg/dl:

Follow the rule of 15.

1. Drink or eat something with 15 grams of carbohydrate such as:
   • 4 oz. of juice
   • ½ can of regular soda
   • 5-6 Lifesavers
   • 4 glucose tablets
2. Wait 15 minutes and recheck your blood glucose.
   • If it’s less than 70 after you recheck, repeat step 1 and 2 until it’s above 70.
3. Once glucose is above 70, eat a snack or a meal.
4. Call your doctor if you cannot figure out why your blood glucose dropped.

The information presented on this page is educational and not intended as medical advice or the practice of medicine. Specific aspects of your outcomes and care should be addressed and answered after consultation with your physician.