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Managing your blood sugar

  • Alternative Names
    • Hyperglycemia - control; Hypoglycemia - control; Diabetes - blood sugar control; Blood glucose - managing

  • Take Control of Your Diabetes
    • Know the basic steps for managing your diabetes to stay healthy. Poorly managed diabetes can lead to many health problems.

      Know how to:

      • Recognize and treat low blood sugar (hypoglycemia)
      • Recognize and treat high blood sugar (hyperglycemia)
      • Plan diabetes meals
      • Monitor your blood sugar (glucose)
      • Take care of yourself when you are sick
      • Find, buy, and store diabetes supplies
      • Get the checkups you need

      If you take insulin, you should also know how to:

      • Give yourself insulin
      • Adjust your insulin doses and the foods you eat to manage your blood sugar during exercise and on sick days

      You should also live a healthy lifestyle.

      • Exercise at least 30 minutes a day, 5 days a week. Do muscle strengthening exercises 2 or more days a week.
      • Try speed walking, swimming, or dancing. Pick an activity you enjoy. Always check with your doctor before starting any new exercise plans.
      • Follow your meal plan.

      Take your medicines the way your health care provider recommends.

  • Check Your Blood Sugar Often
    • Checking your blood sugar levels often and writing down the results will tell you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often you should check your blood sugar.

      • Not everyone with diabetes needs to check their blood sugar every day. But some people may need to check it many times a day.
      • If you have type 1 diabetes, check your blood sugar at least 4 times a day.

      Usually, you will test your blood sugar before meals and at bedtime. You may also check your blood sugar:

      • After you eat out, especially if you have eaten foods you DO NOT normally eat
      • If you feel sick
      • Before and after you exercise
      • If you have a lot of stress
      • If you eat too much
      • If you are taking new medicines

      Keep a record for yourself and your provider. This will be a big help if you are having problems managing your diabetes. It will also tell you what works and what doesn't work, to keep your blood sugar under control. Write down:

      • The time of day
      • Your blood sugar level
      • The amount of carbohydrates or sugar you ate
      • The type and dose of your diabetes medicines or insulin
      • The type of exercise you do and for how long
      • Any unusual events, such as feeling stressed, eating different foods, or being sick

      Many glucose meters let you store this information.

      You and your health care provider should set a target goal for your blood sugar levels for different times during the day. If your blood sugar is higher than your goals for 3 days and you DO NOT know why, call your doctor or nurse.

      Are You Managing Your Type 2 Diabetes?

      1. What can diabetes treatment help you do?

        1. A. Lower high blood glucose (“blood sugar”) levels
        2. B. Improve your energy
        3. C. Prevent problems from diabetes
        4. D. All of the above

        The correct answer is all of the above. Managing your diabetes involves keeping your blood sugar at your goal level. This will improve your energy and is the best way to prevent strokes, heart attacks, and health problems such as eye, foot, nerve, and kidney damage diabetes can cause.

      2. To manage diabetes, you need to learn how to:

        1. A. Test and track your blood sugar levels
        2. B. Know what to eat and when
        3. C. Take medicines, if needed
        4. D. Recognize and treat low and high blood sugar
        5. E. Learn how to manage diabetes when you don't feel well
        6. F. All of the above

        The correct answer is all of the above. It may take several months to learn the basic skills. Your doctor or diabetes educator can help. Always keep learning about diabetes, its complications, and how to control and live with the disease. Stay up-to-date on new research and treatments.

      3. You should test your blood sugar:

        1. A. Once or twice a day
        2. B. When you wake up, before meals, and at bedtime
        3. C.  A few times a week
        4. D. It depends on if your diabetes is controlled

        The correct answer is it depends on if your diabetes is controlled. Many people with type 2 diabetes check their blood sugar once or twice a day. If you keep your blood sugar under control, a few times a week may be enough. Ask your doctor what your blood sugar goals should be and how often to test it at home.

      4. Your doctor can give you a blood test to check the overall control of your diabetes.

        1. A. True
        2. B. False

        The correct answer is true. For most people, the hemoglobin A1c test shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabetes. You and your doctor will discuss the correct range for you. For many people the goal is to keep your level at or below 6.5 - 7%.

      5. Which situation does NOTrequire you to test your blood sugar more often?

        1. A. Eating too much, skipping meals, eating out, or drinking alcohol
        2. B. Taking a new medicine or taking medicine at the wrong dose or the wrong time
        3. C. Having blood sugar levels higher or lower than normal
        4. D. Being sick or under stress
        5. E. Exercising
        6. F. Taking a nap

        The correct answer is taking a nap. All the other situations listed above may affect your blood sugar, so it's best to test more often. Keep a record of your blood sugar readings and share it with your doctor. This will be a big help if you are having problems controlling your diabetes.

      6. How many days should you wait before calling your healthcare provider when your blood sugar level is higher than your goal?

        1. A. 3
        2. B. 5
        3. C. 8

        The correct answer is 3 straight days. Any number of things can affect your blood sugar, and your health care provider can help you identify what may be causing the problem.

      7. Testing your blood sugar helps you:

        1. A. Change your meals, activity, or medicines to keep your blood sugar levels in the right range
        2. B. Feel better because your blood sugar is better controlled
        3. C. Identify high and low blood sugar levels before you have serious problems
        4. D. Prevent complications from diabetes
        5. E. All of the above

        The correct answer is all of the above. By testing your blood sugar, you can see how food, activity, or illness affects it. Then you can adjust the foods you eat or your diabetes medicine as needed to help keep your blood sugar at your goal level. Also ask your health care provider which high or low blood sugar readings mean you should call right away.

      8. What should your LDL, or bad, cholesterol level be if you don't have any heart problems?

        1. A. Less than 200 mg/dL
        2. B. Less than 100 mg/dL
        3. C. Less than 70 mg/dL

        The correct answer is 100 mg/dL. Managing your cholesterol can help you prevent heart disease, stroke, and kidney damage. Most people with diabetes should keep their LDL below 100 mg/dL. If you already have heart disease, the lower target of 70 mg/dL may be better. Ask your doctor what your LDL target is. Also learn how to shop for and cook foods that are low in fat and healthy for your heart.

      9. Which is a good blood pressure goal for most people with diabetes?

        1. A. Lower than 120/80 mm/Hg
        2. B. Lower than 130/80 mm/Hg
        3. C.   Lower than 140/80 mm/Hg

        The correct answer is lower than 140/80 mm/Hg. If your blood pressure is 140/80 mm/Hg or above, your doctor may want to prescribe medicine to help you lower it. Some people with diabetes may have a lower blood pressure target such as 130/80 mm/Hg. Check with your doctor to see what your blood pressure target is.

      10. Which of the following will NOT help keep your feet healthy:

        1. A. Checking and caring for your feet EVERY DAY
        2. B. Getting a foot exam by your doctor at least every 6 - 12 months and learning whether you have nerve damage
        3. C. Making sure you are wearing the right kind of shoes
        4. D. Getting a monthly pedicure

        The correct answer is getting a monthly pedicure. Only trained healthcare providers should care for your feet if you have diabetes. Caring for your feet is an important part of managing diabetes. So be sure to tell your doctor if you notice a cut, ingrown toenail, or break in the skin.

      11. If you have diabetes, how often should you see your doctor?

        1. A. Once a month
        2. B. Every 3 to 6 months
        3. C. Once a year

        The correct answer is every 3 to 6 months. You should also see your dentist every 6 months and your eye doctor once a year. Stay in close contact with your health care providers. That way, any minor health problems get treated quickly before possibly becoming more serious.

  • Recommended Blood Sugar Targets
    • For people with type 1 diabetes, the American Diabetes Association recommends that blood sugar targets be based on a person's needs and goals. Talk to your doctor and diabetes educator about these goals. A general guideline is:

      Before meals, your blood sugar should be:

      • From 90 to 130 mg/dl (5 to 7.3 mmol/L) for adults
      • From 90 to 130 mg/dl (5 to 7.3 mmol/L) for children, 13 to 19 years old
      • From 90 to 180 mg/dl (5 to 10 mmol/L) for children, 6 to 12 years old
      • From 100 to 180 mg/dl (5.5 to 10 mmol/L) for children under 6 years old

      After meals (1 to 2 hours after eating), your blood sugar should be:

      • Less than 180 mg/dl (10 mmol/L) for adults

      At bedtime, your blood sugar should be:

      • From 90 to 150 mg/dl (5 to 8.3 mmol/L) for adults
      • From 90 to 150 mg/dl (5 to 8.3 mmol/L) for children, 13 to 19 years old
      • From 100 to 180 mg/dl (5.5 to 10 mmol/L) for children, 6 to 12 years old
      • From 110 to 200 mg/dl (6.1 to 11.1 mmol/L) for children under 6 years old

      For people with type 2 diabetes, the American Diabetes Association also recommends that blood sugar targets be individualized. Talk to your doctor and diabetes educator about your goals.

      In general, before meals, your blood sugar should be:

      • From 70 to 130 mg/dl (3.9 to 7.3 mmol/L) for adults

      After meals (1 to 2 hours after eating), your blood sugar should be:

      • Less than 180 mg/dl (10 mmol/L) for adults
  • What to do When Your Blood Sugar is High or low
    • High blood sugar can harm you. If your blood sugar is high, you need to know how to bring it down. Here are some questions to ask yourself if your blood sugar is high.

      • Are you eating too much or too little? Have you been following your diabetes meal plan?
      • Are you taking your diabetes medicines correctly?
      • Has your doctor changed your medicines?
      • If you take insulin, have you been taking the correct dose?
      • Are you afraid of having low blood sugar? Is that causing you to eat too much or take too little insulin or other diabetes medicine?
      • Have you injected insulin into a scar or overused area? Have you been rotating sites?
      • Have you been less or more active than usual?
      • Do you have a cold, the flu, or another illness?
      • Have you had some stress?
      • Have you been checking your blood sugar every day?
      • Have you gained or lost weight?
  • When to Call the Doctor
    • Call your provider if your blood sugar is too high or too low and you do not understand why. When your blood sugar is in your target range, you will feel better and your health will be better.

  • References
    • Crandall J, Shamoon H. Diabetes mellitus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 229.

      Dungan KM. Management of type 2 diabetes mellitus. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 48.

      Standards of medical care in diabetes - 2016: summary of revisions. Diabetes Care. 2016;39:S4-S5. PMID: 26696680 www.ncbi.nlm.nih.gov/pubmed/26696680.