Low blood glucose
High blood glucose
If the insulin the body makes is not used appropriately, or too little is injected, you will experience high blood glucose. Mild to moderate hyperglycemia often has no symptoms. It is only when you get extremely high blood glucose that you may begin to show outward signs. The symptoms are recognizable – you may be very thirsty, very tired, and have to pass urine often. In order for you to know what your blood glucose levels are, testing is required.
In type 1 diabetes, when there is not enough insulin, the body breaks down fat (and muscle) as a fuel source. This releases ketones into the blood stream. Ketones alter the chemical balance in the body, which can make you even sicker. Ketoacidosis may develop. Some weight-loss diets promote a no-carb diet to force the body to burn ketones for energy. This is a very dangerous diet, especially for people who have diabetes, as the high ketones can cause lasting damage to your organs. It is not recommended that you force your body to resort to burning ketones for energy. If your blood glucose is over 14 mmol/L, consider testing for ketones if you have type 1 diabetes.
With type 2 diabetes, high blood glucose numbers may mean that your current treatment is not working. If your blood glucose is consistently outside of target range, talk to your doctor about changing your medications. Having high blood glucose for an extended period of time can cause organ damage. Those with type 2 diabetes often need insulin as their diabetes progresses. It may be used in the short term during an illness, or long term to help control blood glucose levels.
For both types of diabetes, you must have a plan to deal with illness before it strikes. Talk to your doctor or diabetes educator to tailor a sick day plan to your condition and medications, especially those that can cause low blood glucose like insulin and sulfonylurea. Having this plan in place lets you know when to call for help.
If you have type 1 diabetes, do ketone tests on either your blood or urine. Both types of ketone testing strips are available at your local pharmacy. Even a few days of nausea, vomiting or diarrhea can put your electrolytes and blood glucose severely outside the normal range. In this case, medical help may be necessary. Go to the doctor or hospital if illness means that you are becoming dehydrated and your blood glucose levels are getting too high.
If your blood glucose measures less than 4 mmol/L, treat it immediately by taking 15 grams of fast-acting carbohydrate such as:
Test again within 15 minutes. If it is still low, treat again. Evidence suggests that for most people, 15 grams of glucose will increase in blood glucose by about 2.1 mmol/L within 20 minutes.
Treatment changes if blood glucose levels are severely low. If you are conscious and able to swallow, 20 grams of fast-acting carbohydrate should be given to you. For instance, use:
If you are unconscious, someone must give you glucagon by injection and call 911. Your blood glucose must be checked again in 15 minutes and treated if it is less than 4 mmol/L.
Once your blood glucose is safely above 4 mmol/L, have the meal or snack you usually would at that time of day. If a meal is more than an hour away, eat a snack (with carbohydrates and protein) to sustain your blood glucose level. The rapid-acting glucose you have taken will not last in your blood stream for more than an hour or so, and you do not want a repeat low.
If you experience severe or frequent low blood glucose reactions, your body can lose its ability to recognize them. This is called hypoglycemia unawareness. If you have developed this condition, you can experience dangerously low blood glucose without having any warning symptoms. The only way to prevent this lack of awareness is to prevent frequent low blood glucose reactions.
Everyone needs physical activity to keep the mind and body healthy. One benefit of physical activity is that it makes the body more sensitive to the effects of insulin. If you take insulin or medications to increase your body’s insulin production, you must test before you exercise to ensure that your blood glucose level is safe.
Depending on the activity, you may need to eat some carbohydrates to keep your blood glucose above 4 mmol/L. The amount of carbohydrate you require depends on the type and intensity of the activity. If you feel symptoms of low blood glucose while you are exercising, check your glucose level and treat it if necessary.
Physical activity can lower blood glucose for up to 24 hours, so test often for a day or so after adding a new exercise to your routine.
Part of being a responsible driver is to check your blood glucose levels before you get behind the wheel. If you take insulin or medication to increase insulin production, your blood glucose may fall too low to allow you to drive safely. Low blood glucose (hypoglycemia) can impair reaction time and concentration. This affects you in much the same way as if you were impaired by alcohol. The brain needs carbohydrate as a fuel source to make decisions. Test before you drive, and if your blood glucose is less than 5 mmol/L, have a carbohydrate snack. Always carry dextrose or other quick-acting products in your vehicle as first aid for low blood glucose. If you are on a long drive or feel as though your blood glucose is getting low, you may need a carbohydrate top-up.
A variety of meters are available to assist with managing diabetes. Meter technology is advancing. Some meters have smartphone applications. Flash glucose readers reduce the frequency of finger pricks for people who test frequently.
Testing gives you an idea of:
As well, testing before you drive can help keep you safer on the road.
Check your blood glucose so you know how you and your body are managing your diabetes. Testing can help you enjoy a healthier lifestyle and avoid the complications of diabetes. The more you know, the better control you can have over your diabetes.