Testing

I have to go to the hospital, what should I take into consideration when preparing?

You may have a stay in hospital (long or short). This may be for something diabetes related, or not.

Here are some things to think about:

  • The hospital should provide the insulin you normally use – but this may take some time so take some with you to avoid delays.
  • Take your own supplies of diabetes equipment, e.g., blood-testing kit or pump supplies (they probably won’t be able to provide this).
  • Ward staff should be up-to-date with your diabetes care, but do check that they have discussed it with your diabetes team. If they haven’t yet, make sure they do.
  • Don’t assume that everyone treating you will know you have diabetes – it’s always better to be over-cautious and keep mentioning it.
  • While in hospital, your blood glucose levels may be higher or lower than normal. Stress and longer periods of inactivity are just two reasons why. Your blood glucose levels might need to be tested more often and treatment adjusted.

If you want to manage your diabetes care yourself while in hospital you should be supported

Diabetes and exercise: When to monitor your blood sugar

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.

Diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.

Before exercise: Check your blood sugar before your workout

If you’re taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.

Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

  • Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.
  • 100 to 250 mg/dL (5.6 to 13.9 mmol/L):  You’re good to go. For most people, this is a safe pre-exercise blood sugar range.
  • 250 mg/dL (13.9 mmol/L) or higher: This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn’t have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.
  • 300 mg/dL (16.7 mmol/L) or higher.: Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

Preventing long-term conditions

Preventing long-term conditions – Your own help is needed

Don’t smoke

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage, and kidney disease. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

Keep your blood pressure and cholesterol under control.

Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.

Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Sometimes medication is needed, too.

Schedule yearly physicals and regular eye exams.

Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

How to correctly manage medication intake

Medication non-compliance is the failure to take drugs on time in the dosages prescribed. It’s a common problem. According to an April 2011 Mayo Clinic Proceedings article, only about half of those who are prescribed medication take it exactly as prescribed.

There are many reasons you might not take your medication as prescribed. They include not understanding medical terms, not being involved in the medical decision making, poor communication on the part of your health care provider, your doctor having an incomplete medical history, limited finances or access to health care, complex medication regimens, cultural barriers, memory issues, health beliefs or misconceptions and many others. It’s a complex issue with no single solution.

So then what can be done? What can you do?

First, ask questions. You have the right to understand your own medical program. Consider inviting a family member or friend to your appointments in order to assist with understanding instructions.

A lot people tend to forget to take their medication. Taking medication is a behavior, and all behaviors can be changed, although change isn’t always easy. Consider tools designed to help — such as medication organizers, dispensers, pill box timers, alarms and written schedules or calendars.

Preparing for your next Doctor appointment

Prepare for your next Appointment

Here’s some information to help you get ready for your next appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance. This will likely include restricting your diet, if you need to complete a fasting blood sugar test.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated.
  • Write down key personal information, including major stresses or recent life changes. If you’re monitoring your glucose levels at home, bring a record of the glucose results, detailing the dates and times of testing.
  • Take a family member or friend, if possible. Someone who accompanies you can help you remember information you need.
  • Write down questions to ask your doctor. Ask about aspects of your diabetes management you’re unclear about.
  • Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you’re there.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

  • Are the symptoms I’m having related to my diabetes or another condition?
  • What else can I do to protect my health?
  • What are other options to manage my diabetes?
  • I have other health conditions. How can I best manage these conditions together?
  • Should I see another specialist, such as a dietitian or diabetes educator?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don’t hesitate to ask any other questions you have.

Insulin Safety

For many people with diabetes, injecting two types of insulin is a daily requirement. Giving yourself your injections can become so much a part of your routine that you can do it without thinking — which can lead to errors.

To increase insulin safety and avoid taking the wrong insulin:

  • Pause and double-check that you’re taking the correct insulin.
  • Label insulin vials or pens with different-colored tape, so that you can differentiate between them. For example, use red tape for short-acting insulin and yellow tape for long-acting insulin.

If you accidentally give yourself the wrong insulin:

  • Call your local emergency number.
  • Test your blood sugar frequently until help arrives. Eat or drink a fast-acting carbohydrate to maintain a blood sugar within your goal range.

In preparation for such issues, it’s a good idea to always carry a simple sugar source with you, such as glucose tablets, juice, regular soda or hard candy.

During a hypoglycemic event

Treatment

  1. Consume 15-20 grams of glucose or simple carbohydrates
  2. Recheck your blood glucose after 15 minutes
  3. If hypoglycemia continues, repeat.
  4. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

  • glucose tablets (follow package instructions)
  • gel tube (follow package instructions)
  • 2 tablespoons of raisins
  • 4 ounces (1/2 cup) of juice or regular soft drink (not diet)
  • 1 tablespoon sugar or honey
  • 8 ounces of nonfat or 1% milk
  • hard candies, jellybeans, or gumdrops (see package to determine how many to consume)

Glucagon

If untreated, hypoglycemia may lead to severe consequences, such as unconsciousness or even coma. In case of unconsciousness someone else should be ready to take over.

There is a hormone, glucagon, able to stimulate your liver to release stored glucose into the blood. In case your blood sugar level is too low, you may need injectable glucagon kits. These kits are used as a medication to treat somebody who has become unconscious. Your doctor is the one that can prescribe glucagon kits. You may ask him/her whether it would be useful for you to have one home, and if need be, how to use it properly.

If you possess a glucagon kit then you should instruct people with whom you are in frequent contact on how to use it in case it is ever needed.

If glucagon is needed:

  1. Inject glucagon into the individual’s buttock, arm, or thigh, following the manufacturer’s instructions.
  2. When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
  3. If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

  • Inject insulin (it will lower blood glucose even more)
  • Provide food or fluids (individual can choke)
  • Put hands in mouth (individual can choke)

During a hyperglycemic event

Treating Hyperglycemia

Your blood sugar level can be lowered by exercising. However there is a counter indication to that. In case your blood sugar level is above 240 mg/dl, you may check your urine for ketones. If you have ketones, you should not exercise. Exercising with ketones is counterproductive, and may make your blood sugar level even higher.

Making changes in your food intake can help as well. Your dietitian can help cutting the amount of food you eat. If exercising and dieting are not enough then your doctor may change your medication or insulin, or even the timing of that.

Work with your doctor to find the safest way for you to lower your blood glucose level.

Hyperglycemia can be prevented with good diabetes management. Another important practice is to learn to detect hyperglycemia early so that you can  treat it before it worsen.

How do I measure my blood glucose? Home blood glucose testing tips

  • Make sure your hands are clean before you begin. Use water rather than wet wipes (wet wipes contain glycerine that could alter the result).
  • Prick the side of a finger – avoid the forefinger and thumb – not the middle, or too close to a nail, because this will really hurt.
  • Use a different finger each time and a different part – this will hurt less.
  • If you don’t get much blood, hold your hand down towards the ground. This should make more blood flow to the fingers.
  • Make sure your hands are warm – if they are really cold it’s hard to draw blood, and finger-pricking will hurt more.

How often should I measure?

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night.

Preparing for visits with your doctor

Here are some examples of how you can prepare for your visits with your doctor:

  • Be aware of any pre-appointment  restrictions. If your doctor is going to test your blood sugar, you will need to follow instructions for the tests to be conducted
  • Write down any symptoms you’re experiencing
  • Ask a family member or friend to join you, if possible
  • Bring a notebook and a pen or pencil
  • Write down questions to ask your doctor