Hypo & Hyper Management

 

Home blood glucose monitoring

The aim of treatment is to try to maintain your 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 your readings may vary depending your 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.

HbA1c
This is known as the “long term test” and is performed by a medical professional. This is a measure of your blood glucose control over a period of the previous approx 6 -8 weeks. It is a very good indicator of your overall control of your condition despite the odd high or low readings you may have had during that time.

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 blood glucose level may be higher if you:

  • Are not taking enough insulin
  • Miss or forget to take your 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 blood glucose may go to low (ie. Under 4 mmol/l) if you:

  • Take too much insulin
  • Eat less carbohydrate than usual
  • Leave too long between meals
  • Do more activity than usual
  • Following alcohol (which may not occur until a few hours later)*
  • 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, and 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 that you learn to recognise your 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.

Remember: 
• Be aware of your hypo symptoms and treat as necessary
• Always carry quick acting carbs with you
• Inform your friends and colleagues about diabetes, the need to take insulin, test glucose levels and very importantly what to do in the event of a hypo event
• Carry 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 sugar near to normal. Most people who strive for good blood sugar control experience hypoglycaemia more often than those who are less motivated.

Ketones in urine
If you find ketones in your blood or urine, it shows that your diabetes is not in control. High levels of ketones may lead to a serious condition called ketoacidosis. Ketones in the blood or urine are a danger signal, a sign that you must take action right away to prevent problems. Talk to your diabetes care team about whether you need to test your urine for ketones, and if so, how to do carry out the test.

Test urine for ketones
Ketones are acid waste products that are formed in large amounts if you lack insulin and your blood glucose is rising. When ketones reach your kidneys, some flow out in the urine together with glucose. You should test your urine for ketones if you are ill with a fever or if your blood glucose is higher than 15 mmol/l.

Insulin
When you develop type 1 diabetes it is necessary to take insulin injections. You will be instructed about injection technique by your diabetes nurse. He/ She will guide you about where and when to inject your insulin and give you tips for injection management.
The amount of injections’ you require each day depends on your treatment plan worked out with your diabetes team.
Examples:

  • 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 (Basal bolus regimen) using short acting insulin at meal times with a longer acting insulin taken morning or evening also.

Injection devices
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.
Some people will be using an insulin pump which delivers fast acting insulin continuously through a narrow cannula, and the person adjusts the rate according to requirements, and current blood glucose levels.

 

Treatment Options for Hypoglycaemia