Diabetes Self Management Education Course

Amy BouthilletteClinical Dietitian, Certified Diabetes Educator

Carrie PalmerAdult Nurse Practitioner, Certified Diabetes Educator

MonitoringYour

Diabetes:Important Tests

and Goals

Learning Points

• Know why it is important to check glucoses

• Be able to describe a range for normal glucoses before food

• Be able to describe what A1c test measures and what the goal is for A1c

• Know when you need to test your glucose more often

Monitoring Your Diabetes: Target Blood Glucose Levels

Without Diabetes

With Diabetes (normal)

With Diabetes (target)

Before meals

70-115 mg/dL

< 110 mg/dL

80-130 mg/dL

Before bedtime

70-120 mg/dL

< 120 mg/dL

100-150 mg/dL

Hemoglobin A1c

< 6%

< 7%

< 7%

Not Good

Good Control 6

Know Your Number

A1c

13

12

7

5

8

11

Blood Sugar

9

120

180

210

270

300

360

90

150

14

330

10 240

Poor Control

Pretty Good

Monitoring Your Diabetes: What

does an A1c mean

An A1c measures how much sugar has been sticking to red blood cells over a 3 month period of time.

An A1c is a measure of long-term diabetes control.

Goal is A1c <7

Monitoring Your Diabetes: What is an A1c

Redbloodcell

Normal Blood Glucose

Above-Normal Blood Glucose

Red blood cell

Glucose particles

The higher your blood sugar, the more sugar that sticks to your red cells and the higher your A1c

Monitoring Your Diabetes: Testing your A1c

• Your doctor will check your A1cevery 3 to 6 months

• Your doctor may check your A1c more often if:– You have blood sugars above goal

– Your last A1c was high

– You have had symptoms of low blood sugar

Monitoring Your Diabetes:Controlled blood sugars and A1c

• Blood sugars and an A1c at or below goal (7% or less) can protect your:– Heart, brain, blood vessels– Eyes– Kidneys– Nerves – Feet

MonitoringYour

Diabetes:

Testing Your Sugars at

Home

Testing Sugars- How often?

• Depends what kinds of medicine you take:– Most patients taking pills test once a day

– Patients taking insulin may need to test between 1 and 4 times a day

• Determined by the type of insulin and its action

• Test more often if:– You have had low blood sugars (BG<70)

– Sugars have been unusually high (over 200)

– You are sick

– You are starting a new exercise program

Monitoring Your Diabetes:Sample Diabetes Record- Fasting

Monitoring Your Diabetes:Sample Diabetes Record- Alternating

Monitoring Your Diabetes:Sample Diabetes Record- Detailed

Breakfast Lunch Supper Bedtime OtherDose Blood

GlucoseDose Blood

GlucoseDose Blood

GlucoseDose Blood

GlucoseDose Blood

Glucose

Comments:Physical Activity, Stress,

etc.Sun 18L

6R220 10L

4R100

Mon 18L4R

80 120 12L4R

170 140 30

Tues 18L4R

240 180 12L4R

240 110 70

Wed 18L4R

90 10L4R

120 80 90

Thur 18L4R

100 10L4R

180

Fri 18L4R

120 150 10L4R

160 120

Sat 18L4R

90 70 10L4R

180 240

Number of 7 4 6 6 3 measurements

Total of blood 940 520 1050 790 190 glucose values

Average of 134 130 175 132 64 blood glucosevalues

Monitoring Your Diabetes:Your meter provides important

information

Other Points to Remember

• Make sure you know how to correctly use your meter

• Don’t share meters

• Always bring meter to doctor’s visits

What Affects Your Blood

Sugar?

What is hypoglycemia & hyperglycemia?

Learning Points

• Know signs of high blood sugar (hyperglycemia)

• Know the signs of low blood sugar (hypoglycemia)

• Know what to do when sugars are too high or too low

Your Blood Sugar:Hyperglycemia or High Blood Sugar

• Symptoms– Extreme thirst– Frequent urination– Dry skin– Hunger– Blurred vision– Drowsiness– Decreased healing

Your Blood Sugar:Hyperglycemia or High Blood Sugar

• Causes– Too much food– Too little insulin or diabetes medicine– Illness– Stress

• Onset– Gradual– If extremely high or you have type 1 diabetes it

may progress to diabetic coma– Damage to your eyes, kidneys, and nerves

happens over time

Your Blood Sugar:Hyperglycemia or High Blood Sugar

• What can you do when you have symptoms?– Test blood glucose more often– Don’t wait, call your doctor if your blood

sugar is over 200mg/dL for several tests or for 2 days

Your Blood Sugar:Symptoms of Hypoglycemia

• Shaking• Fast

heartbeat• Sweating• Dizziness• Anxiety

• Hunger• Impaired vision• Weakness/fatigue• Headache• Irritability

Your Blood Sugar:Hypoglycemia or Low Blood Sugar

• Causes– Too little food– Too much insulin or diabetes medicine– Extra activity or exercise

• Onset– Sudden

• May progress to unconsciousness, confusion, or insulin shock

Your Blood Sugar:Treatment of Hypoglycemia

4 Steps to treating your blood sugar:1. Quick sugar, 10 to 15 grams carbohydrate2. Recheck blood glucose in 15 to 20 minutes and

repeat treatment if necessary3. If your glucose is normal, eat a protein meal or snack4. If you have symptoms, but BG is over 70, have snack

*Treat all sugars under 70 mg/dl (with or without symptoms)

*If you have symptoms, but no meter, treat and try to be prepared and have meter with you the next time.

Hypoglycemia or Low Sugar:Step 1- 10 to 15 Grams of Carbs

Pick One of these

2 to 3 Glucose Tablets

5 to 8 Life Savers®

1/4 to 1/3 cup raisins

4 oz. orange juice

3 to 5 peppermint candies

8 oz. milk

½ can of regular soda

Hypoglycemia or Low Sugar:Step 2- Recheck Blood Sugar

Hypoglycemia or Low Sugar:Step 3- Eat a protein snack

Pick One

½ meat sandwich

crackers & cheese

peanut butter sandwich or

crackers

Hypoglycemia or Low Sugar:Foods to avoid for lows

Ice Cream

Doughnuts

Nuts

Pizza

Potato Chips

Chocolate

Cake

Cookies