Blood glucose levels and targets

Home blood glucose monitoring
The aim of treatment is to try to maintain their glucose level to as near a” non -diabetic” range as possible. In general terms this means to aim towards 4 -7 mmol/l before meals, and around 8 mmol/l if testing 2 hours after meals. This can be difficult at times as you are trying to mimic what the body had previously done of its own accord, and readings may vary depending their carbohydrate intake, exercise and many other daily factors.

This management takes time and practice and requires that you work closely with your doctor, diabetes nurse specialist and other members of your diabetes care team. They’ll guide you to maintain the best possible blood glucose control.

It is also important that you monitor your child’s food intake, exercise and any other factors that could affect their blood glucose level. Talk to your child and make sure they know how important it is to tell you if they have had extra carbohydrates or exercise and to let you know about any thing that could affect their blood glucose levels.

This is known as the “long term test” and is performed by a medical professional. This is a measure of blood glucose control over a period of the previous approx 3 months. It is a very good indicator of overall control of their condition.

Hyperglycaemia or Hypoglycaemia
This can be caused by high or low glucose levels.

High blood glucose levels, also know as Hyperglycaemia or Hyper
You will notice that your child’s blood glucose level may be higher if they:
Are not taking enough insulin
Miss or forget to take insulin ( or take a lower amount in error)
Eat more carbohydrate foods than usual
Are less active than usual
Are under stress
Have an illness eg cold flu, infection (see further info re illness below)
Sometimes it may be difficult to find a reason

Low blood glucose levels, also known as Hypoglycaemia or Hypo
You may notice that your child’s blood glucose may go to low (ie. Under 4 mmol/l) if they:
Take too much insulin
Eat less carbohydrate than usual
Leave too long between meals
Do more activity than usual

Sometimes you may not find an obvious reason. People with diabetes tend to “get to know” what situations they may be likely to experience a HYPO. Talk to your child and try to try to pinpoint these situations so you can both learn to try avoid or pre-empt these situations where possible.

Symptoms may include;
• Feeling sweaty or cold
• Trembling or feeling weak
• Feeling irritable upset or angry
• Inability to concentrate
• Drowsy or difficulty in waking up

It’s important you both learn to recognise their particular warning signs and understand how to take appropriate action promptly.
HYPOS can happen in minutes and need to be treated immediately so BE RESPONSIBLE.

• Be aware of hypo symptoms and treat as necessary
• Always make sure you, your child or whoever is caring for them has access to quick acting carbs
• Inform those around your child about diabetes , the need to take insulin, test glucose levels and very importantly what to do in the event of a hypo event
• Make sure your child carries diabetes identification

Walking the tightrope
Few people with diabetes can avoid episodes of low blood glucose completely. Hypoglycaemia is, to some extent, a result of trying to keep the blood glucose near to normal. Most people who strive for good blood glucose control experience hypoglycaemia more often than those who are less motivated.

When a person develops type 1 diabetes it is necessary to take insulin injections via a pump or a pen. You will be instructed about injection technique/pump use by your child’s diabetes nurse. He/ She will guide you about where and when to inject your child’s insulin and give you tips for injection management.
The amount of injections’ they require each day depends on the treatment plan worked out with their diabetes team.

Once daily injection using longer acting insulin (most usual for those with Type 2 diabetes now requiring insulin)
Twice daily injection using premixed mixture of short and longer acting insulin
Multiple daily injections or Basal Bolus Regimen using short acting insulin at meal times with a longer acting insulin taken morning or evening also.

Insulin pens are the most common delivery device used. The insulin comes in a prefilled cartridge to insert into a pen device , or in a prefilled disposable pen device. Following initial instruction from the diabetes nurses, these devices are convenient to use.Insulin syringes are used on occasion in paediatric situations.
A lot of children now are on insulin pumps which deliver fast acting insulin continuously through a narrow cannula, and the person adjusts the rate according to requirements, and current blood glucose levels.

They will also bolus at mealtimes to match requirements for carbohydrate intake.