LOW BLOOD GLUCOSE (Hypoglycemia)

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Thomasine Cooper
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1 Section Four DAILY CRISES In this section, you will learn about: Low blood glucose High blood glucose Diabetic Ketoacidosis Hyperosmolar Hyperglycemic Nonketotic Syndrome LOW BLOOD GLUCOSE (Hypoglycemia) For most people with diabetes, hypoglycemia is defined as 70 mg/dl and lower. For others, it could be lower than the target range. This range is given to you by your doctor. Talk to him/her about what YOUR target range is. Blood glucose can go too low when you are taking insulin or oral antidiabetes agents that cause the pancreas to make more insulin. What causes it? Too much insulin or antidiabetes agents that cause the pancreas to make more insulin. Taking insulin and/or diabetes pills at incorrect times. Missing a meal, snack, or eating late Moving (exercising) more than usual. Drinking alcohol High altitude 4-1

2 Symptoms of Hypoglycemia You may have one or more of the following Sweaty Hungry Forgetful Shaky Rapid Heart Rate Nervous Drowsy Headache 4-2

3 What do I do? 1. Check my blood glucose (if possible) If less than 70 or below target range, take one of the following: 2. Eat or drink a fast acting carbohydrate source (15 grams): 2-4 glucose tablets 1 cup skim milk 4 ounces (1/2 cup) of juice or regular soda 1/2 1 tube of glucose gel 8 Sweet Tarts 5-6 hard candies. 3. Wait 15 minutes and re-test blood glucose If blood glucose is still less than 70 mg/dl or below your target range, repeat treatment by eating or drinking one of the above. 4. When blood glucose is greater than 70 mg/dl, eat a snack if there is more than 1 hour until the next meal. Snack should include: 1 starch (example: 1 bread or 4-6 crackers) AND 1 protein source (example: 1 ounce of cheese) Note: Avoid over treating low blood glucose. Over treating can lead to HIGH blood glucose. Follow the 15:15 rule to prevent over treatment. Take 15 grams of carbohydrate Wait 15 minutes and check blood glucose 4-3

4 How to Prevent Low Blood Glucose Check your blood glucose often. Take the correct dose of diabetes pill or insulin at the right time Don t skip meals or snacks Eat on time. Have a snack at your regular mealtime if you must delay your meal Check your blood sugar before and after exercise. See Chapter eight Exercise on adding snacks for blood sugar and exercise. Carry a carbohydrate source with you (glucose tablets). Check blood sugar before driving and on a regular basis if going long distances. Drink alcohol moderately and only with food. Severe Low Blood Glucose Occurs when your blood glucose drops so low that you need help to treat it. May cause you to pass out or not be able to swallow. May require that you receive a glucagon injection. Glucagon is a hormone that causes stored glucose to be released and raises blood glucose. It is a prescription item and is sold as a single dose kit. Someone near you needs to know how to give it. Replace the kit if the expiration date has expired. How to give Glucagon Be very familiar with the kit BEFORE an emergency arises Prepare the kit as directed ( glucagon powder must be mixed with the included solution) Glucagon must be given immediately after mixing. Give the injection in a large muscle such as the hip. Position person on his/her side (Glucagaon makes some people nauseated and vomiting may occur). 4-4

5 After giving Glucagon The person should have a snack when he/she wakes up and can swallow. The person will usually wake up within 15 minutes. Give another dose of glucagon if he/she does not wake up within 15 minutes. Call 911 or get the person to nearest emergency room if he/she is not responding. Call your doctor to report what occurred. Replace the glucagon kit ASAP. Notify your doctor when: You cannot understand why your blood glucose is dropping too low. Your blood glucose levels drop more than three times in a week. You have a severe low blood glucose (You pass out, can t swallow, and/or need help to treat a low blood glucose). 4-5

6 HIGH BLOOD GLUCOSE (Hyperglycemia) Your blood glucose can go too high and stay too high. Another name for this is hyperglycemia. When this happens often, your diabetes is said to be out of control. Blood glucose levels will change for different reasons. Hyperglycemia is defined as blood glucose levels greater than 240 mg/dl or higher than your target range. What causes it? Not taking your diabetes pills or insulin as directed. Not following your meal plan. Not exercising Illness Stress Surgery, trauma, injury, pain Extra glucose made by the liver Symptoms Hungrier and/or thirstier than usual Urinating often, especially at night Dry or itchy skin Feeling tired or sleepy Blurred vision Frequent infections Slow healing of cuts and sores 4-6

7 How to treat hyperglycemia Test your blood glucose more often Check urine or blood for ketones if you have type 1 diabetes Increase the amount of sugar-free, caffeine-free fluids, such as water, diet soda, herb tea or broth at least 8 glasses per day Follow your meal plan Call your doctor if you have: - type 1 diabetes and your blood glucose is 240 mg/dl and you have moderate large ketones for more than 2 tests in a row. - type 2 diabetes and your blood glucose is more than 240 mg/dl for over 24 hours. How to prevent high blood glucose Take the correct amount of insulin and or diabetes pill(s) at the right time Check blood glucose often Follow your diabetes meal plan Exercise regularly Treat an illness quickly. Follow sick day rules (See Section seven Taking Care When You Are Ill. 4-7

8 DIABETIC KETOACIDOSIS If you have type 1 diabetes, blood glucose levels can rise to a very high level and cause a dangerous problem called Diabetic Ketoacidosis (DKA). It happens because there is not enough available insulin to allow glucose to enter cells. The body cells don t have a fuel source so the body turns to fat. When fat breaks down to be used as a fuel source it breaks down into ketones. Ketones are a very strong acid and cause the body to become acidic, If you don t take insulin when your body begins to make ketones, three things can happen: Your blood glucose will continue to rise Ketones build up in your blood and make your body tissues too acidic. The cells become damaged and can lead to severe illness and even death. Symptoms There are several signs that you may be in ketoacidosis. Do NOT ignore them. Check your blood sugar and urine ketone levels when you: Feel hungrier and/or thirstier than usual Urinating more than usual Nauseated or throwing up Have stomach pain Your breath has a fruity odor Note that your breathing is fast and deep Have a fever How to prevent DKA when your blood glucose is high Follow sick day guidelines NEVER stop taking your insulin Test blood glucose every 2-4 hours Check for ketones if blood glucose if greater than 240 mg/dl Problem solve why your blood glucose levels are high Increase fluid intake 4-8

9 Treatment Call your doctor immediately if your blood sugar is greater than 240 mg/dl and you have ketones in your urine. This is not a condition that you should try and treat alone. If you are unable to reach your doctor, go to the nearest emergency room right away. Insulin Fluids Treatment of cause HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME If you have type 2 diabetes, high blood glucose (often over 800) can lead to a life-threatening condition none as hyperglycemic hyperosmolar nonketotic syndrome (HHNS). An illness, infection, dehydration, and/or missed medication can cause HHNS This condition often develops slowly. Symptoms Dehydration Very sluggish Confusion 4-9

10 How to prevent HHNS Take your diabetes medications Test your blood glucose more frequently Increase fluid intake drink sugar-free, caffeine-free fluids like water, diet soda, sugar-free tea, broth Problem solve why your blood glucose is high Call your doctor if blood glucose is higher than 240 mg/dl for 24 hours. Treatment Will require treatment in a hospital Fluids Insulin (until blood glucose is under control) Treatment of cause SUMMARY Low blood glucose occurs when your blood glucose is below your target range or below 70 mg/dl Treat a low blood glucose by eating or drinking a simple carbohydrate source. Glucagon is used to treat a low blood sugar when you cannot or will not swallow. Illness, injury, stress can make blood glucose go high. DKA (type 1 diabetes) and HHNS (type 2 diabetes) are dangerous conditions that demand immediate attention. 4-10

11 Type 1: I will call my doctor if I am unable to keep my blood glucose values in my target range and especially if I have many high or low blood glucose values and moderate to large ketones. (initials) Type 2: I will call my doctor if I am unable to keep my blood glucose values in my target range and especially if I have many high or low blood glucose values. (initials) 4-11

special circumstances

special circumstances circumstances circumstances circumstances circumstances Because so many factors affect your blood glucose, you need to be alert and flexible in how you take care of yourself. You