A Guide for Persons with Diabetes: Navigating Highs and Lows Diabetes management can feel like a constant balancing act, especially when dealing with ...

A Guide for Persons with Diabetes: Navigating Highs and Lows

Diabetes management can feel like a constant balancing act, especially when dealing with the rollercoaster of high and low blood sugar levels. Understanding the causes, symptoms, and treatment strategies for both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) is crucial for maintaining good health and preventing long-term complications. This guide is designed to equip individuals with diabetes with the knowledge and tools needed to navigate these fluctuations with confidence.

Understanding Blood Sugar Levels

Before diving into the specifics of highs and lows, it's important to understand target blood sugar levels. These levels can vary depending on the individual, the type of diabetes, and other health conditions. Generally, the following ranges are considered desirable for many adults with diabetes:

Before Meals (Fasting): 80-130 mg/dL
1-2 Hours After Starting a Meal: Less than 180 mg/dL

However, it's essential to work with a healthcare professional to establish personalized blood sugar targets that are safe and appropriate. Remember that achieving perfect numbers all the time is unrealistic; the goal is to stay within the target range as often as possible and to promptly address deviations.

Hyperglycemia (High Blood Sugar): Recognizing the Signs and Taking Action

Hyperglycemia occurs when the blood sugar level is higher than the target range. Prolonged high blood sugar can lead to serious health problems, so it's essential to recognize the symptoms and take appropriate action.

Common Causes of Hyperglycemia:

Missed or inadequate dose of insulin or oral diabetes medication: This is a frequent cause, particularly in those with Type 1 diabetes or those on insulin therapy for Type 2 diabetes.
Overeating or consuming too many carbohydrates: The body may not be able to process the excess glucose effectively.
Infection or illness: The body releases hormones to fight illness, which can raise blood sugar levels.
Stress: Similar to illness, stress can also lead to increased hormone production and elevated blood sugar.
Inactivity: Physical activity helps lower blood sugar; lack of exercise can contribute to hyperglycemia.
Certain Medications: Some medications, such as steroids, can raise blood sugar levels.

Recognizing the Symptoms of Hyperglycemia:

Increased thirst: The body tries to dilute the excess glucose in the blood.
Frequent urination: The kidneys work harder to filter out excess glucose, leading to more urination.
Blurred vision: High blood sugar can affect the lens of the eye, causing temporary blurry vision.
Fatigue: The body struggles to use glucose effectively, leading to tiredness and lack of energy.
Headache: High blood sugar can sometimes cause headaches.
Slow-healing cuts and sores: Hyperglycemia can impair the body's healing process.

Steps to Take When Blood Sugar is High:

Check Blood Sugar: Confirm the high blood sugar with a blood glucose meter.
Administer Insulin (if prescribed): If you take insulin, follow your healthcare provider's instructions for correcting high blood sugar.
Drink Water: Staying hydrated helps flush out excess glucose.
Exercise (with caution): If your blood sugar is only moderately high (e.g., below 250 mg/dL) and you feel well, gentle exercise can help lower it. However, avoid exercise if you have ketones in your urine or if your blood sugar is very high (e.g., above 300 mg/dL), as it could potentially make the situation worse. Consult your doctor regarding exercise when your blood sugar is above target.
Monitor Closely: Check your blood sugar again in a few hours to see if it's coming down.
Call Your Doctor: If your blood sugar remains high despite taking corrective action, or if you have symptoms of diabetic ketoacidosis (DKA) (see below), contact your healthcare provider immediately.

Diabetic Ketoacidosis (DKA): A Serious Complication

DKA is a life-threatening condition that can occur when blood sugar is very high and the body doesn't have enough insulin. The body starts breaking down fat for energy, producing ketones as a byproduct. High levels of ketones can poison the body. Symptoms of DKA include:

Fruity-smelling breath
Nausea and vomiting
Abdominal pain
Rapid, deep breathing
Confusion
Loss of consciousness

If you suspect DKA, seek immediate medical attention.

Hypoglycemia (Low Blood Sugar): Responding Quickly to Prevent Complications

Hypoglycemia occurs when the blood sugar level falls below the target range, typically considered to be below 70 mg/dL. Hypoglycemia can be dangerous if left untreated, as the brain relies on glucose for energy.

Common Causes of Hypoglycemia:

Taking too much insulin or oral diabetes medication: This is the most common cause, especially if the dose is not properly matched to food intake and activity levels.
Skipping meals or not eating enough carbohydrates: Not enough glucose is available to maintain blood sugar.
Exercising more vigorously or for longer than usual without adjusting insulin or food intake: Exercise increases glucose uptake by the muscles.
Drinking alcohol, especially on an empty stomach: Alcohol can interfere with the liver's ability to release glucose into the bloodstream.
Kidney or Liver Problems: Impaired organ function can affect medication clearance and glucose regulation.

Recognizing the Symptoms of Hypoglycemia:

Shakiness or tremors
Sweating
Dizziness or lightheadedness
Hunger
Irritability or anxiety
Confusion or difficulty concentrating
Rapid heartbeat
Blurred vision
Weakness
Headache
In severe cases, seizures or loss of consciousness

The "15-15 Rule" for Treating Hypoglycemia:

Check Blood Sugar: Confirm the low blood sugar with a blood glucose meter.
Consume 15 Grams of Fast-Acting Carbohydrates: Examples include:
- 4 ounces (1/2 cup) of fruit juice (orange, apple, grape)
- 4 ounces (1/2 cup) of regular (non-diet) soda
- 1 tablespoon of honey or syrup
- Glucose tablets (follow package instructions)
- Hard candies (check label for carbohydrate content)
Wait 15 Minutes: Allow the carbohydrates to raise your blood sugar.
Recheck Blood Sugar: After 15 minutes, recheck your blood glucose level.
Repeat if Necessary: If your blood sugar is still below 70 mg/dL, repeat steps 2-4.
Eat a Meal or Snack: Once your blood sugar is above 70 mg/dL, eat a meal or snack containing protein and complex carbohydrates to stabilize your blood sugar and prevent another low.

Severe Hypoglycemia: When Someone Else Needs to Help

Severe hypoglycemia occurs when a person with diabetes becomes unable to treat themselves because they are confused, disoriented, or unconscious. In this situation, someone else needs to administer glucagon, a hormone that raises blood sugar.

Glucagon Kit: People at risk of severe hypoglycemia should have a glucagon emergency kit and teach family members, friends, and caregivers how to use it. Glucagon can be injected or administered as a nasal spray.
Call Emergency Services: After administering glucagon, call emergency services (911) to ensure the person receives appropriate medical care.
Explain the Situation: When emergency responders arrive, explain that the person has diabetes and was experiencing severe hypoglycemia.

Preventing Hypoglycemia:

Monitor Blood Sugar Regularly: Frequent blood sugar checks help identify patterns and prevent lows.
Take Medications as Prescribed: Follow your healthcare provider's instructions carefully regarding insulin or oral diabetes medications.
Eat Regular Meals and Snacks: Avoid skipping meals or delaying snacks, especially if you are taking medications that can cause hypoglycemia.
Adjust Insulin Doses for Exercise: Talk to your healthcare provider about how to adjust your insulin doses based on your activity level.
Carry a Fast-Acting Carbohydrate Source: Always have a source of glucose with you to treat hypoglycemia promptly.
Wear a Medical Alert Identification: This will inform others that you have diabetes in case of an emergency.

Continuous Glucose Monitoring (CGM): A Game Changer

Continuous glucose monitoring (CGM) systems have revolutionized diabetes management. These devices track blood glucose levels in real-time throughout the day and night. They consist of a small sensor inserted under the skin that measures glucose levels in the interstitial fluid. The sensor sends readings to a receiver or smartphone, providing continuous data on blood sugar trends.

Benefits of CGM:

Real-Time Monitoring: Provides continuous blood glucose readings, eliminating the need for frequent fingersticks.
Trend Arrows: Shows the direction and rate of change of blood glucose, allowing for proactive adjustments.
Alerts and Alarms: Warns of high and low blood sugar, even before symptoms are noticeable.
Data Tracking and Analysis: Helps identify patterns and trends in blood glucose levels, enabling better medication and lifestyle adjustments.
Improved A1c Levels: Studies have shown that CGM use can lead to improved A1c levels (a measure of average blood sugar over 2-3 months).

Different Types of CGMs:

Real-Time CGMs: Display blood glucose readings continuously and send alerts and alarms to a receiver or smartphone.
Intermittently Scanned CGMs (Flash Glucose Monitoring): Require manual scanning of the sensor to display blood glucose readings.

Who Should Use a CGM?

CGMs are particularly beneficial for individuals with Type 1 diabetes or those with Type 2 diabetes who are on insulin therapy. However, anyone with diabetes who wants to improve their blood sugar control may benefit from using a CGM. Talk to your healthcare provider to determine if a CGM is right for you.

The Importance of Regular Blood Sugar Monitoring

Whether you use a traditional blood glucose meter or a CGM, regular blood sugar monitoring is essential for managing diabetes effectively. Monitoring helps you:

Understand how food, exercise, and medications affect your blood sugar.
Identify patterns and trends in your blood sugar levels.
Make informed decisions about insulin doses, meal planning, and activity levels.
Prevent hyperglycemia and hypoglycemia.
Achieve your blood sugar targets.

Tips for Effective Blood Sugar Monitoring:

Test at consistent times: Test at the same times each day to track patterns.
Keep a log: Record your blood sugar readings, food intake, activity levels, and medications to identify factors affecting your blood sugar.
Share your results with your healthcare provider: Discuss your blood sugar logs with your healthcare provider to adjust your diabetes management plan as needed.
Calibrate your CGM regularly: Follow the manufacturer's instructions for calibrating your CGM to ensure accurate readings.

Working with Your Healthcare Team

Managing diabetes is a team effort. Your healthcare team, which may include your primary care physician, endocrinologist, diabetes educator, registered dietitian, and other specialists, plays a vital role in your care.

Key Questions to Ask Your Healthcare Team:

What are my target blood sugar levels?
How often should I monitor my blood sugar?
How should I adjust my insulin doses based on my blood sugar levels, food intake, and activity levels?
What should I do if my blood sugar is high or low?
When should I contact you?
What are the potential side effects of my medications?
What are the signs and symptoms of diabetes complications?
What lifestyle changes can I make to improve my diabetes control?
Am I a candidate for CGM?

By actively participating in your diabetes care and working closely with your healthcare team, you can effectively manage your blood sugar levels, prevent complications, and live a long and healthy life.

Additional Tips for Success

Educate yourself: The more you know about diabetes, the better equipped you will be to manage it.
Follow a healthy diet: Focus on whole, unprocessed foods, and limit your intake of sugary drinks and processed carbohydrates.
Engage in regular physical activity: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
Manage stress: Find healthy ways to cope with stress, such as exercise, meditation, or spending time in nature.
Get enough sleep: Aim for 7-8 hours of sleep per night.
Don't smoke: Smoking can worsen diabetes complications.
Take care of your feet: Inspect your feet daily for cuts, blisters, or sores.
Get regular eye exams: Diabetes can damage the blood vessels in the eyes.
Get regular kidney screenings: Diabetes can damage the kidneys.
Join a diabetes support group: Connecting with others who have diabetes can provide emotional support and practical advice.

Diabetes management is a lifelong journey that requires ongoing effort and attention. By understanding the causes, symptoms, and treatment strategies for high and low blood sugar levels, and by working closely with your healthcare team, you can successfully navigate the highs and lows and live a full and active life.