Treatment

Treatment of diabetes is unique to every individual. Although very common, individuals with diabetes have very different physiological and psychological needs, and thus all treatment plans are also different. It is important once you are diagnosed with diabetes to seek medical advice and to increase your knowledge about the different symptoms (for type I and type II), causes and complications of diabetes

Diabetes is a common disease, yet every individual needs unique care. We encourage people with diabetes and their families to learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices. Good communication with a team of experts can help you feel in control and respond to changing needs.

Checking your blood glucose level

In any treatment plan, the best barometer of your diabetes condition is your blood glucose level. Monitoring it is an important part of your diabetes control plan. A simple blood glucose log (please download the one created by the American Diabetes Society for this purpose) can help you keep track of your results and review them to see how food, activity and stress affect your blood glucose. By analyzing and understanding what it is that affects your blood glucose level and leads it to be too high (hyperglycemia) or too low (hypoglycemia), you can manage your diabetes much more successfully. In addition, sharing these details with your doctor or diabetes group will help to customize a diabetes management plan.

There are certain groups of people that may benefit from checking blood glucose including the following: those taking insulin, pregnant women, those having difficulty controlling their blood glucose levels, those with consistently low blood glucose levels.

These groups of people can adopt several methods of testing blood glucose levels:

–       Traditional home tests: This method involves pricking your finger with a small, sharp needle and putting a drop of blood on a test strip and then placing the strip into a meter that displays your blood sugar level. The video here can give you an idea of this method.

–       Other meters: There have been newer meters that have been introduced to the market which allow you to test

 

Traditional Home Blood Sugar Monitoring. The traditional method of testing your blood sugar involves pricking your finger with a lancet (a small, sharp needle), putting a drop of blood on a test strip and then placing the strip into a meter that displays your blood sugar level. Meters vary in features, readability (with larger displays or spoken instructions for the visually impaired), portability, speed, size, and cost. Current devices provide results in less than 15 seconds and can store this information for future use. Some of these meters can also calculate an average blood sugar level over a period of time. Some meters also feature software kits that retrieve information from the meter and display graphs and charts of your past test results. Blood sugar meters and strips are available at your local pharmacy.

Meters That Test Alternative Sites. Newer meters may allow you to test sites other than your fingertip; these alternative testing sites may include upper arm, forearm, base of the thumb, and thigh. However, testing at alternative sites may give you results that are different from the blood sugar levels obtained from the fingertip. Blood sugar levels in the fingertips show changes more quickly than those in alternative testing sites. This is especially true when your blood sugar is rapidly changing, like after a meal or after exercise. It is also important to know that if you are checking your sugar while you are experiencing symptoms of hypoglycemia, you should use your fingertip if possible, because these readings will be more accurate.

Continuous Glucose Monitoring System. Also known as interstitial glucose measuring devices. Some of these devices are combined with insulin pumps. They are similar to fingerstick glucose results and can be used to see patterns and trends.

Hypoglycemia (Low blood glucose)

Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70 mg/dl. However, it is important to talk to your health care provider about your individual blood glucose targets, and what level is too low for you.

Hypoglycemia may also be referred to as an insulin reaction, or insulin shock.

Hypoglycemic symptoms are important clues that you have low blood glucose. Each person’s reaction to hypoglycemia is different, so it’s important that you learn your own signs and symptoms when your blood glucose is low.

The only sure way to know whether you are experiencing hypoglycemia is to check your blood glucose, if possible. If you are experiencing symptoms and you are unable to check your blood glucose for any reason, treat the hypoglycemia. Severe hypoglycemia has the potential to cause accidents, injuries, coma, and death.

Signs and Symptoms of Hypoglycemia (happen quickly)

  • Shakiness
  • Nervousness or anxiety
  • Sweating, chills and clamminess
  • Irritability or impatience
  • Confusion, including delirium
  • Rapid/fast heartbeat
  • Lightheadedness or dizziness
  • Hunger and nausea
  • Sleepiness
  • Blurred/impaired vision
  • Tingling or numbness in the lips or tongue
  • Headaches
  • Weakness or fatigue
  • Anger, stubbornness, or sadness
  • Lack of coordination
  • Nightmares or crying out during sleep
  • Seizures
  • Unconsciousness

Treatment

  1. Consume 15-20 grams of glucose or simple carbohydrates
  2. Recheck your blood glucose after 15 minutes
  3. If hypoglycemia continues, repeat.
  4. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

  • glucose tablets (follow package instructions)
  • gel tube (follow package instructions)
  • 2 tablespoons of raisins
  • ~100ml of juice or regular soda (not diet)
  • 1 tablespoon sugar, honey, or corn syrup
  • 8 ounces of milk
  • hard candies, jellybeans, or gumdrops

Glucagon

If left untreated, hypoglycemia may lead to a seizure or unconsciousness (passing out, a coma). In this case, someone else must take over.

Glucagon is a hormone that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. Injectable glucagon kits are used as a medication to treat someone with diabetes that has become unconscious from a severe insulin reaction. Glucagon kits are available by prescription. Speak with your health care provider about whether you should buy one, and how and when to use it.

The people you are in frequent contact with (for example, family members, significant others, and coworkers) should also be instructed on how to administer glucagon to treat severe hypoglycemic events. Have them call your health care provider immediately or the emergency line if they feel they can’t handle the situation (for example, if the hypoglycemic person passes out, does not regain consciousness, or has a seizure, if the care taker does not know how to inject glucagon, or if glucagon is not available).

If glucagon is needed:

  1. Inject glucagon into the individual’s buttock, arm, or thigh, following the manufacturer’s instructions.
  2. When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
  3. If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

  • Inject insulin (will lower blood glucose even more)
  • Provide food or fluids (individual can choke)
  • Put hands in mouth (individual can choke)

Hypoglycemia Unawareness

Very often, hypoglycemia symptoms occur when blood glucose levels fall below 70 mg/dl. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night.

Hypoglycemia unawareness occurs more frequently in those who:

  • frequently have low blood glucose episodes (which can cause you to stop sensing the early warning signs of hypoglycemia)
  • have had diabetes for a long time
  • tightly control their diabetes (which increases your chances of having low blood glucose reactions)

If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes.

Hyperglycemia (High blood glucose)

Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly.

What Causes Hyperglycemia?

A number of things can cause hyperglycemia:

  • If you have type 1, you may not have given yourself enough insulin.
  • If you have type 2, your body may have enough insulin, but it is not as effective as it should be.
  • You ate more than planned or exercised less than planned.
  • You have stress from an illness, such as a cold or flu.
  • You have other stress, such as family conflicts or school or dating problems.

What are the Symptoms of Hyperglycemia?

The signs and symptoms include the following:

  • High blood glucose
  • High levels of sugar in the urine
  • Frequent urination
  • Increased thirst

Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia.

 

Treatment

You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones.

Exercising when ketones are present may make your blood glucose level go even higher. You’ll need to work with your doctor to find the safest way for you to lower your blood glucose level.

Cutting down on the amount of food you eat might also help. Work with your dietician (refer to the Directory for a list of nutritionists and dieticians) to make changes in your meal plan. If exercise and changes in your diet don’t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

What if it Goes Untreated?

Hyperglycemia can be a serious problem if you don’t treat it, so it’s important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy.

When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

  • Shortness of breath
  • Breath that smells fruity
  • Nausea and vomiting
  • Very dry mouth

Talk to your doctor about how to handle this condition.

Medical IDs

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person’s full medical record for use in an emergency.

How Can I Prevent Hyperglycemia?

Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early — before it gets worse.

Reference:

Treatment & Care – American Diabetes Association®. 2013. [ONLINE] Available at:American Diabetes Society [ONLINE]: http://www.diabetes.org/living-with-diabetes/treatment-and-care/?loc=DropDownLWD-treatment