People without diabetes have normal. blood sugar levels that stay between about People with diabetes may not be able to. keep their blood sugar in that normal …
Managing Your Diabetes
Controlling Blood Sugar
How to keep your blood sugar balanced
Lilly Partnership in Diabetes
Doing your level best
One of your main goals in treating diabetes is to keep your blood sugar level as close to normal as possible It takes some effort, but its worth it Youll feel better when your blood sugar level is normal or close to normal People without diabetes have normal blood sugar levels that stay between about 70 and 110 mg/dL mg/dLmilligrams of sugar for every 100 milliliters of blood People with diabetes may not be able to keep their blood sugar in that normal range all the time It may get too high or too low at times
Managing Your Diabetes
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New blood sugar target goals to consider
The American Diabetes Association ADA publishes guidelines for diabetes care every year1 Updated guidelines for blood sugar control were issued by the American College of Endocrinology ACE in 2001 Your healthcare team follows these guidelines to determine if your treatment is controlling blood sugar levels Here are the new target goals for people with diabetes:
New Blood Sugar Control Targets2
Before meals pre-prandial: less than 110 mg/dL 2 hours after meals
post-prandial: less than 140 mg/dL Note: These guidelines apply to many people, but not to everyone Your goals may be higher or lower than these guidelines Talk with your healthcare team They will help you set the blood sugar target thats right for you
1 Information available at http://diabetesorg 2 American College of Endocrinology ConsensusGlycemic 2 ACE Consensus Conference on Guidelines for Conference on Guidelines for Glycemic2001 Washington, DC The Vol 8 Control August 20-21, Control, Endocrine Practice, Suppl 1 January/February 2002 ACE Available at American College of Endocrinology http://wwwaacecom/pub/press/releases/diabetes consensuswhitepaperphp Accessed August 21, 2001
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Keeping your blood sugars in range
There are two good ways to check if your blood sugar level is in control You should do both
1 Check your blood sugar regularly with
a glucose meter
Work with your doctor or diabetes educator to learn how to use one of the many types of personal blood glucose meters that are available Ask your doctor or diabetes educator what your checking schedule should be You may need to check before meals and at bedtime Also, research suggests that checking after meals is a
good way to find out how food is affecting your blood sugar
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Managing Your Diabetes
Keep
track of your results in a diary and take it with you on office visits so you and your doctor can review the results together
2 Get the A1C test hemoglobin A1C
This shows your average blood sugar level over the past 2-3 months Depending on your treatment and level of diabetes control, an A1C test should be done in your doctors office every 3-6 months
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A1C testing a better long-term picture
The A1C test measures the amount of sugar that is attached to the hemoglobin inside the red blood cells Sugar that is not used for energy and is left in the blood attaches to the blood cells Because red blood cells live in the bloodstream for about 120 days, the A1C test shows the average blood sugar for the past 2-3 months
Sugar Red Blood Cell
High A1C Normal A1C
Sugar small blue balls sticks to the hemoglobin inside red blood cells and to other body proteins The amount of sugar stuck to the hemoglobin can be found with an A1C test, which gives an estimate of the average blood sugar level over the last two to three months
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Managing Your Diabetes
All people with diabetes benefit from
knowing their A1C number Though you may have high blood sugar now and then, an improved A1C result can help you feel confident that you are doing a good job of overall diabetes control If your number is higher than your target level, it will give you a starting point for working toward a lower number Discuss the A1C test with your doctor or diabetes educator The American Diabetes Association Standards of Care suggest that it should be done every three to six months, depending on your treatment and level of control The American College of Endocrinology guidelines recommend a goal of 65 for people with diabetes see chart on page 8 For people without diabetes, the normal range is about 4-6 Your doctor and/or diabetes educator will help you set your goal
My A1C will be checked every months My last A1C test result was My goal for A1C is
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How to compare the results of your daily blood sugar testing to your A1C test
This chart shows the average blood sugar that corresponds to the A1C test result Note that an A1C of 65 results when blood sugar averages about 135 mg/dL
How to compare3
Blood sugar mg/dL 60 90 120 150 180 210 240 270 300 330 A1C 4 5 6 7 8 9 10 11 12 13
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Reference: Diabetes Control and Complications Trial DCCT: Results of Feasibility Trial Diabetes Care Volume 10 1997, pp 1-19
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Managing Your Diabetes
The benefits of staying in control
Blood sugar control protects your long-term health Maintaining a near normal blood sugar level helps protect you from many of the serious problems related to diabetes such as eye damage, kidney disease, and nerve problems Youll also feel much better if you keep your blood sugar close to normal When your blood sugar is higher or lower than normal, you may feel tired, sick, and/or uncomfortable
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High blood sugar
When blood sugars go above normal, its called high blood sugar or hyperglycemia When you have hyperglycemia, you may not feel your best Here are some of the things that can cause your blood sugar to increase: Causes of high blood sugar
Eating too much Emotional stress Physical stress being sick or in pain Getting less exercise than usual
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Managing Your Diabetes
Not taking enough or the right kind of diabetes medicine Extra sugar made by the liver
The tricky thing about hyperglycemia is that you can feel fine even though your blood sugar is too high So its important that
you test your blood sugar regularly and watch for the following symptoms: Symptoms of high blood sugar
More thirsty or hungry than usual Having to pass urine often, especially at night Dry or itchy skin Feeling more tired or sleepy than usual Blurred vision Frequent infections Slow healing of cuts or sores
If you have hyperglycemia, it needs to be treated If your blood sugar stays high for a long time, it can cause serious health problems such as:
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Damage to blood vessels This can cause poor blood flow to feet, legs and skin, increasing your risk for:
infections heart problems stroke blindness foot or leg amputation kidney disease
Damage to nerves If this happens, there is increased risk of:
infections nerve damage can cause your feet not to feel pain, so a cut or sore can get badly infected before you know it sexual problems stomach problems
Ketoacidosis This is a serious condition that usually occurs only in people with type 1 diabetes It happens when the body has become too acidic because of the high level of ketones in the blood This result of very high blood sugar can lead to diabetic coma
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Managing Your Diabetes
or, if left untreated, death
Check your blood sugar and urine ketone levels when you:
feel more hungry and thirsty than usual have to urinate more often than usual throw up or feel sick to your stomach have stomach pain have a fruity smell on your breath notice your breathing is fast and deep have a fever
Ketoacidosis is not a condition you should try to treat yourself Call your doctor immediately if your blood sugar is above 240 mg/dL AND you have keto 
nes in your urine Your doctor will tell you what to do If you cant reach your doctor, go to the nearest emergency room right away
What you can do about high blood sugar levels
If your blood sugar level is high, get back to your diabetes care plan It is the best way to treat high blood sugar Make sure that you:
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take the right amount of diabetes medication at the right time eat the right amount of food at the right time drink plenty of water check and record your blood sugar level often get regular physical activity
If following your diabetes care plan carefully does not bring your blood sugar level down, you may be getting sick There are long-term health risks related to hyperglycemia Talk with your doctor or diabetes educator about your
options for improving your blood sugar control These may include:
a change in medicines or doses more careful meal planning
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Managing Your Diabetes
more regular exercise or activity more frequent blood testing and a plan for acting on the results
Illness and high blood sugar levels
When you become sick, your blood sugar may go up A cold, a flu, or an infection among other reasons can cause this to happen It is important to take special care of yourself when you are sick Meet with your doctor or diabetes educator to work out a personal sick-day plan before you become ill The following rules will help
Always take your insulin or diabetes pills, even if you cannot eat Test your blood sugar every four hours, at least before each meal and at bedtime Test your urine for ketones The easiest products to use are dip-and-read test strips Test more often if your blood sugar is 240 mg/dL or if you throw up Drink extra fluids Try to drink at least 1/2 cup every hour The liquids you drink should not have calories Hot tea, water, and diet soda are all good choices
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Follow your meal plan This is very important to do if your stomach is not upset If you cannot keep food
down, you should try to take in at least 4 oz of a sugar-containing beverage every hour to keep your blood sugar from falling too low In addition, you can try to eat soft foods or liquids to take the place of breads and fruits you usually eat The following foods or drinks are good choices Each serving shown can replace one serving of bread or fruit
Food
Fruit juice Soda with sugar Gelatin with sugar Hot cereal cooked Ice cream vanilla
Amount
1/3 to 1/2 cup 1/2 cup 1/2 cup 1/2 cup 1/2 cup
Broth-based soup 1/2 cup for example,vegetable or chicken noodle
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Managing Your Diabetes
Call your doctor when:
you are vomiting and cannot keep down food, liquids, or diabetes pills your illness lasts more than 24 hours moderate or large amount of ketones are present in your urine all your blood sugar tests are higher than 240 mg/dL for more than a day your temperature is over 101o F the time and results of blood sugar and urine ketone tests amount of food and liquid taken what medicines you have taken your temperature
When you call, be ready to tell your doctor:
If your doctor is not available, go to the emergency room
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Your healthcare team may have more steps for you
to take Use the space below to write them down:
Low blood sugar
Anyone who takes insulin or diabetes pills can have blood sugar that is too low below about 70 mg/dL Low blood sugar is also called hypoglycemia or insulin reaction One way to help prevent hypoglycemia is to avoid missing meals Low blood sugar is usually mild and easy to treat, but it can become serious If it is not treated right away, it may get worse If blood sugar falls very low, a person may pass out When blood sugar gets that low, it is a life-threatening emergency
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Managing Your Diabetes
Causes of low blood sugar
Taking
too much diabetes medicine
Eating meals or snacks at the wrong time Skipping meals or snacks Getting more physical activity than usual
When you have hypoglycemia, you may experience the following symptoms: Symptoms of low blood sugar
Feel shaky Become sweaty Feel tired
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Feel hungry Have a fast heartbeat Feel numbness or tingling in the mouth or lips Have blurred vision or a headache Become crabby and confused
Low blood sugar feels different to each person Learn to recognize your own symptoms Be aware that you may have no symptoms at all Thats why you should test
your blood sugar regularly
How to prevent low blood sugar hypoglycemia
Eat your meals on time Dont skip meals or snacks Learn to adjust your food and diabetes medicine for exercise Test your blood sugar on schedule Do extra tests when you feel different from normal and write down the results in a log book
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Managing Your Diabetes
How to treat low blood sugar hypoglycemia
You need to treat low blood sugar right away It will not get better on its own So be sure to keep food that contains sugar with you at all times If you feel your blood sugar level is too low, test your blood If it is less than 70 mg/dL, eat one of these foods right away, even if you feel fine:
3 glucose tablets 5 grams glucose each 1/2 cup of regular soda not sugar-free 1/2 cup fruit juice 1 small box of raisins 6 or 7 hard candies not sugar-free, chewed, not sucked 1 tablespoon of honey or sugar 5 small sugar cubes
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After eating or drinking something, follow these steps:
Wait
15 minutes then test your blood sugar again Record the number in your log book Also, be sure to write down that you had a low blood sugar reaction If you do not feel better in 15 minutes, eat the same amount of
food again
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Managing Your Diabetes
If your blood sugar is still low after the second dose, call your doctor, nurse, or diabetes educator If you cannot talk to one of them, go to the nearest emergency room If your next meal is more than an hour away, follow the treatment with an extra snack Be sure to eat your normal meal at the regular time, even if you have eaten a snack with a high sugar content
If you think your blood sugar is low but cannot test, eat something that contains sugar When in doubt, it is safer to eat the extra food than risk having serious hypoglycemia Learn your bodys warning signs of low blood sugar Before you need help, tell your family, friends, exercise partners, co-workers, and classmates that you have diabetes Tell them how they can help if you have low blood sugar And always wear or carry identification that says you have diabetes If you cannot talk, this will let people know what is wrong, and help you get the care you need
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Patients who use insulin should also be familiar with glucagon Its a naturally occurring hormone given as an injection to treat severe hypoglycemia Be sure to ask your doctor about glucagon
Control your
diabetes
Throughout this brochure, you have learned about valuable ways to manage your diabetes by keeping your blood sugar levels as near to normal as possible By controlling your diabetes, you keep it from controlling you
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Managing Your Diabetes
Notes
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With diabetes, knowledge is good medicine The more you learn, the better you can manage your diabetes and the better youll feel This brochure is only part of Lillys comprehensive diabetes patient education program Its available to patients at every level of learning Ask your healthcare provider for more information
wwwLillyDiabetescom wwwDiabetesEnEspanolcom
Managing Your Diabetes is a registered trademark of Eli Lilly and Company HI-25726 PRINTED IN USA 3000024883 0103250 COPYRIGHT 2003, ELI LILLY AND COMPANY ALL RIGHTS RESERVED
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