Blood Glucose Awareness & Management

Managing Blood Glucose

Managing your Blood Glucose (BG) levels and keeping them in range for as long as possible (for people with type 1 and 2 diabetes the range is between 4.4 to 7.2 mmol/L  before a meal and under 9mmol/L after a meal for type 1 diabetics and under 8.5mmo/L for a type 2 diabetic) to prevent chronic health problems, such as vision loss, kidney disease and heart disease. In this post, you will find the answers to the most common questions about blood sugar for diabetics.

Checking your Blood glucose

The most common way of checking your BG levels is through the use of a BGM (Blood Glucose Monitor) or a CGM (Continuous Glucose Monitor). A BGM uses a small sample of blood usually from your fingertips to measure the level of glucose in your blood. A CGM makes use of a sensor that is inserted under the skin which measures the glucose levels from a fluid found just under the skin called Interstitial Fluid, this fluid contains other nutrients as well such as salt, calcium and potassium which all come from blood capillaries (small blood vessels). If you use a CGM you will still need to check your blog glucose levels with a BGM to confirm the accuracy of your CGM.

When should you be checking Blood Glucose?

The frequency with which you check your BG levels depends on your type of diabetes and if you take any other regular diabetes medications.

The most common times you should check your BG levels are as follows: 

• When you first wake up
• Before any meal, snack or drink with sugar
• 2 hours after a meal, snack or sugary drink
• At bedtime

If you have type 1 or type 2 diabetes and are taking insulin or suffer from frequent low BG events your Doctor may want you to check your sugars more regularly and especially if you are doing physical activities such as swimming or running.

What are BG target ranges?

Blood Glucose targets are the range in which you need to try to stay in for as long as possible to avoid the long-term effects of keeping your sugar high, the following targets are typically recommended by health care professionals:

• Before a meal, your BG levels should be between 4.4mmol/L and 7.2 mmol/L (80-130mg/dL) 
• 2 hours after you started eating a meal your BG levels should be at or below 10.0mmol/L (≤180mg/dL) 
• Before bed, you should have a target range between 5.5mmol/L to 10.0mmol/L (100mg/dL – 180mg/dL)

Your BG level targets may differ depending on your age, any other pre-existing health problems and other factors. Make sure you consult a medical professional about what targets are best for you.

Causes of low blood sugar (Hypoglycemia) 

Low blood Glucose (Hypoglycemia) has many possible causes, skipping a meal, injecting too much insulin, taking other diabetes medications, intense exercising and drinking alcohol can all affect BG levels. Blood Glucose levels below 4.0mmol/L (72 mg/dL) are considered ‘low’.

The signs that someone has low Blood Glucose may vary from person to person. The most common symptoms are:

• Hunger
• Sweating (Clammy hands)
• Shaking/Trembling (Most noticeable in the hands)
• Confusion 
• Irritability (In some cases aggression)
• Dizziness (General disorientation)
• Anxiety or feeling very nervous
• Hunger (This tends to feel like ‘Extreme’ Hunger)

Knowing and understanding your individual symptoms so you can recognise low BG levels as early as possible and treat it. If you believe you have low BG levels, check them using a BGM even if you are not displaying any immediate symptoms. Low Blood Glucose can be extremely dangerous and should always be treated as soon as possible.

Treating hypoglycemia (Low sugar)

You can never really be sure what happens in life at any time, which is why being prepared is key. Carry supplies like sweets, glucose tablets or any non-diet drink with sugar with you. If you feel shaky, sweaty or any other symptom of low BG. Check your BG levels even if you just feel a little anxious you may have low BG do not risk it. If your BG levels are lower than 4.ommol/L (72 mg/dL) do one of the following without delay:

• Take 3 to 6 dextrose or glucose sweets
• Eat 5 to 7 jelly babies 
• Drink 1 glass or 1 can of a sugary drink (mini cans of fizzy drinks are ideal) 
• Drink 1 glass of fruit juice such as Orange or Apple juice

After you have done any of the above, wait for 15 minutes and check your BG levels again, repeat one of the treatments again if your BG level has not changed or still going lower. If you in particular are having difficulties with low BG levels, ask your doctor if you may need a new treatment plan or medications. 

What is a ketone?

Ketones are a form of chemical that your liver produces in the process of breaking down fats.

Your body typically uses ketones for energy most commonly during fasting periods, long periods of exercise or when you do not have as many carbohydrates in your diet. Having low amounts of Ketones present in your blood is normal and does not cause problems. 

However, high levels of ketones in your blood are an indicator that something is wrong. You can check your Ketones by purchasing over-the-counter ketone test kits. Your diabetes team should have given you an idea of what range your ketones should be in and what to do if they go above it.

If you treat your diabetes with insulin, your body uses that insulin to convert blood glucose into energy for your body. But when there is a lack of insulin present in your body, you will start to use stored fat for energy, and when this happens your liver will start producing ketones.

When Ketones build up in the blood, they can become acidic and lead to Diabetic Ketoacidosis (DKA). This can be life-threatening.

Causes of High Blood Glucose (Hyperglycemia)

Hyperglycemia can be caused by many different factors which include, being stressed, being sick, eating more than planned and not dosing enough insulin. Over long periods of time, high BG levels can cause serious chronic health problems. Symptoms of Hyperglycemia are:

• Feeling very thirsty 
• Blurred vision
• Frequent urination (A lot more often than usual to the point it even disrupts sleep)
• Feeling very lethargic or sleepy 

When you are ill, your BG can be increasingly difficult to manage. You may also have a loss of appetite thus not allowing you to eat or drink normally, which can also affect your BG levels. If you are sick and your BG level is at 12.0mmol/L (216 mg/dL) or above, it is highly recommended to get an over-the-counter ketone test kit, some check your urine and some check your blood for ketones.

This is what your Ketone test results mean:

• Anything lower than 0.6mmol/L is a normal reading
• 0.6 to 1.5mmol/L means you are at a slight risk of Diabetic Keto Acidosis (DKA) and you should check your BG levels and see if you need an adjustment dose of insulin to bring your sugar lower if it is above 10mmol/L (190mg/dL), and should test for ketones again in 2 hours. 
• 1.6 to 2.9mmol/L means you are at a high risk of DKA and should contact your Family doctor or diabetes team as soon as possible
• 3mmol/L or above means you either are in DKA or at a very increased risk of going into DKA and should seek Emergency Medical Help IMMEDIATELY

Please note if you are using a urine test kit, a result of more than 2+ means there is a high chance that you are already in DKA and should seek Emergency Medical Help IMMEDIATELY. 

Diabetic ketoacidosis

When too many ketones are produced by your liver, they can build up in your blood and cause Diabetic Ketoacidosis (DKA). DKA is extremely dangerous and can cause Coma or Death. 

Common symptoms are:

• Flushed Face
• Stomach pain
• Headache 
• Dry skin and dry mouth 
• Fruity smelling breath
• Nausea and vomiting 
• Muscle stiffness and aches

If you think you have DKA, please take the steps mentioned above and if your ketones are high call your Doctor, diabetes team or an Ambulance immediately.  

DKA most commonly occurs in Type 1 diabetics and is sometimes even the first sign of Type 1 diabetes in people who have yet to be diagnosed. Diabetics with Type 2 can also develop DKA, however, it is less common.

Treating high blood glucose 

Diabetes is a complex medical condition and requires a lot of Expertise and Knowledge to advise on insulting dosages and BG management in general, for this reason, you will not see any dosage advice for insulin and should treat this content for questions to bring up with your Diabetic team to provide you with a much more personalised explanation on how it will affect you and give you advice on what you should do according to your treatment plan.
The most typical suggestions given to me by my team are as follows: 

• Follow your diabetes meal plan. If you don’t have one now, this is a good time to take note and bring up the conversation about a meal plan with your Doctor or Dietitian. 
• Take your medicine or insulin dosages on time. If your BG is often high, your diabetes team or Doctor may ask you about how consistent you are with your dosages and may change when you take an insulin dose as opposed to changing the dose right away.
• Checking your BG levels as directed by your Doctor. If you are feeling sick or have an infection of any sort, check more often, being sick can affect your BG levels.
• Talk to your doctor about what else can help you, asking about a CGM if you don’t already have one is a great way to start. Over time your Doctor may also suggest an insulin pump or a change in the type of fast-acting insulin you use.

Carbohydrates and Blood Glucose

Carbohydrates (Carbs) in some foods increase your blood sugar levels when eaten as opposed to eating only proteins and fats. If you are diabetic you can still eat carbs, but you will have to monitor how many you eat in one given time to maintain your BG levels. Counting carbs is the most advantageous tool you can use as a diabetic to stay on top of your BG levels. Speak to your Doctor or Diabetes team about carb counting and what goals are best suited for you. 

HbA1c test???

The HbA1c test or most commonly referred to as the A1C test is a simple blood test that can measure your average BG levels over the past 3 months. This test is often done at the Hospital Lab or in the doctor’s Clinic it is not the same as a finger prick test. 

The A1C test is part of the catchy ABCs of diabetes, these are the basic important steps a diabetic can take to delay or prevent health complications later on in life: 

• [A]: Get regular A1C tests
• [B]: Try to keep your blood pressure low, or within the target, the doctor has set for you. (if you have BP issues)
• [C]: Manage your cholesterol
• [s]: Stop smoking or… why start? just don’t.

The A1C test measures in percentage that can normally be reflected in mmol/L the most common goal for your A1C test is between 6%-8% (6-8mmol/L average over the past 3 months) but you may have a different goal given to you by your Doctor which you should stick to.

Extra BG management tips

Diabetes is personal and complex, the best advice you will get is to discuss with your Doctor to get a personal plan and advice suited to you. That being said there are other things you can do and lifestyle changes you can make that can help you understand your diabetes. 

These are:

• When checking your BG levels take note of what you ate, keeping track of exactly what you ate and when can help you explain why your BG levels may be going high or low at a certain time of day. Also taking note of mood can help as increased levels of stress can increase your BG levels. 
• Choose a whole meal or brow variations of carbs, Brown bread has a lower glycemic index (basically lower in carbs) in comparison to white. Reducing amounts of fats and added sugars in your diet will also result in lower BG levels if you feel like yours are high.
• Make an eating timetable and stick to it, eating regularly and at consistent times helps keep BG levels consistent as you will be making consistent insulting doses, therefore making it easier to identify if something is wrong. Do not skip meals, especially if you are going to dose insulin, take your time to eat. If you are at work and feel like you don’t have time, you do, explain the urgency to your manager or whoever and that it is vital to your health. 
• Limit drinking alcohol or smoking cannabis. These substances can cause unpredictable and drastic BG changes that could be life-threatening. 
• Drink water or at least diet/no-sugar variations of juices and fizzy drinks.
• If you are craving something sweet try and swap it for some fruit instead, a hand full of grapes or a couple of tangerines are infinitely better for your health than artificial sugars. 
• Portion control. If you are like me and like big portions of rice or other carbs, try and replace those with either more proteins (any meat without sweet sauces/gravies) or more veg which that are lower in carbs, such as celery, broccoli and cucumber. 

I am very new to blog writing and would appreciate any feedback, please leave any comments, ideas or inquiries for more information below and I will do my best to update the blog or just respond to comments.