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PREVENTION OF SHORT TERM COMPLICATIONS

Blood sugar testing
Keeping your diabetes in control will help you stay healthy as well as prevent long term problems.

You can monitor how well controlled you are by checking the amount of sugar in your blood on a regular basis at home. This is the most accurate method for checking control. In the past, urine tests were used to check the level of sugar in the urine as a rough guide to the blood sugar levels. However, this method is no longer used. Blood tests are generally accepted as the best method for monitoring day to day control of your diabetes.

How often and when do you test your blood sugar levels?

If you have recently been diagnosed with diabetes, you should ideally test your blood sugar every day, before meals or two hours after meals. When your diabetes becomes stabilised, your Doctor or Diabetes Educator will discuss with you how often you should test your blood sugar.
The normal range for blood sugars is 3.5 to 8 mmol/L. You should aim for blood sugar readings less than 10 mmol/L.

How is blood sugar tested?

Testing blood sugars involves obtaining a drop of blood from a finger prick and placing that drop onto a test strip.
There are two ways of testing:

1. using visual testing strips,
2. using blood glucose meters.

There are many testing strips and a large number of meters available for you to choose from. Whichever way you decide to test your blood sugar, it is recommended that you get advice from your Doctor or Diabetes Educator. It is important that you receive training and supervision on how to use this equipment correctly.

All blood sugar testing equipment can be purchased from Diabetes Australia or your local chemists. Diabetes Australia offers a discount price to members. Some private health funds will reimburse you for all or most of the cost.

It is important that you record your blood sugar results in the diary which is included in the testing kit and also available from your Doctor or Diabetes Educator. Your day to day results will help you and your Doctor make appropriate changes to the treatment of your diabetes.

As well as day to day testing at home, it is important that you have a long term sugar test named glycosylated haemoglobin or HbA1C. This test is usually ordered by your Doctor or Diabetes specialist ( Endocrinologist) 2 or 3 times per year. It measures the average blood sugar levels over several weeks.

KEY POINTS

• Blood sugar testing at home is the most accurate way for checking day to day diabetes control.
• Aim to keep your blood sugars between 4 -8 mmol /L.

• Always test your blood sugar before a meal or two hours after a meal.
• Long term control of your diabetes should be checked by your Doctor or Diabetes specialist, 2 to 3 times a year.

Hypoglycaemia

Hypoglycaemia or 'Hypo' is a lower than normal blood sugar level (below 3.5 mmol/L). This can happen when the balance is not right between food intake, exercise and medication.

What causes a Hypoglycaemia or 'Hypo'?

The main causes are:

• Not eating enough carbohydrate at meals or snacks, eating later than usual or missing meals.
• Taking too much insulin or diabetes tablets.
• Unplanned activity or increased exercise.
• Excessive alcohol consumption or alcohol on an empty stomach.

A Hypo can not happen if you are not taking diabetes tablets or insulin.

Warning symptoms of Hypoglycaemia 'Hypo'

• clammy and sweating
• palpitations
• shaking
• hunger
• anxiety
• tingling of lips and tongue

Further warning signs which result from the brain not getting enough glucose -

• blurred vision
• headache
• forgetfulness
• confusion
• vagueness
• slurred speech

What to do:

Eat or drink food that contains a high level of sugar (glucose) immediately, to increase your blood glucose level quickly.

Choose one of the following:

• 1 small glass of orange juice or lemonade (not low joule)
• 6 or 7 jellybeans
• 1 or 2 large glucose tablets
• 2 teaspoons honey, sugar or glucodin powder
• To maintain the increase in blood sugar have your usual meal (if its time) or eat one food containing complex carbohydrate, for example
• banana or apple
• 1 slice bread or 2 sandwich or 3 cracker biscuits

Hypos can be avoided by:

• Eating regular meals
• Not skipping meals
• Having carbohydrate with each meal
• Eating extra serves of carbohydrate before exercise
• Not drinking alcohol on an empty stomach
• Know the action and duration of your insulin or diabetes tablets
• See your doctor if the reason for the hypo is not known, as your tablets or insulin dose may be too high.
• Teach relatives, friends, workmates, how to recognise and treat a Hypo. Always carry some identification which indicates that you have diabetes.

Sick Days

Your blood glucose level can go higher than normal when you get sick. During times of illness such as flu and other infections, the body acts in a defensive way by increasing the production of "Stress Hormones" which make your insulin work much less effectively and this causes an increase in your blood sugar levels.
This can lead to the following symptoms:

• Thirst
• Passing urine excessively
• Tiredness
• Weight Loss

Special Precautions When You Are Sick

1. Check your blood sugar levels 2 - 4 hourly. Record results. If your blood sugar remains above 15 mmol/L for 24 hours, contact your doctor.
2. (If you take insulin you may need to check your urine for ketones and if the level is moderate or high. SEEK MEDICAL ADVICE.
3. Continue your usual medication. Metformin (Diabex, Glucophage, Diaformin, may aggravate a stomach upset and need stopping - consult your doctor.
4. To stop "Hypos' you can swap your usual meals with

• Ordinary soft drink (not low joule) or fruit juice, small glass
• Ordinary jelly or custard
• Icecream
• Thick Soup
• Milk (plain or flavoured)

Eat and drink small frequent serves throughout the day. Do not worry if for a few days not as much food as usual is eaten
Drink plenty of water and/or low joule soft drinks. It is important that you don't get dehydrated.

KEY POINTS

• Contact your Doctor early, if your blood sugar levels are high.
• Have someone to help if you are unwell enough to follow the precautions outlined or call your Doctor or go to a Hospital Emergency Department.