Checking & control

Blood glucose testing
You may be advised to check your blood glucose levels. Learning how to test your blood glucose levels gives you the information to help control your diabetes. Blood glucose testing enables you to see how well your body is responding to your medication, diet and activity levels.

What should it be?
It is normal for your blood glucose to fluctuate throughout the day. Your blood glucose will also rise after eating a meal. The best times to test are just before a meal, or two hours after a meal.

It is normal for your blood glucose to fluctuate throughout the day. Your blood glucose will also rise after eating a meal. The best times to test are just before a meal, or two hours after a meal.

Your blood glucose (glucose) readings should ideally be between 4-7 mmol/L (don’t worry about the mmol/L, just remember the 4-7) before meals. However, your GP or diabetes specialist nurse will tell you what is an acceptable blood glucose level for you to strive for, as well as how often you should test and how to perform the test accurately.

What if my blood glucose levels are too high? (Hyperglycaemia)
Hyperglycaemia is a blood glucose level that is too high. This is a blood glucose level above the healthy range or acceptable level for you. Your GP or your diabetes specialist nurse will advise you what your acceptable blood glucose level is.

• The symptoms of a high blood glucose level are:
• tiredness and loss of energy,
• increased thirst,
• passing urine more frequently, and
• susceptibility to infections.

How is it caused and what should I do?
You can have high blood glucose levels for many reasons, the main reasons are:

• eating large meals containing too much starchy or sugary carbohydrate foods,
• not having enough medication (insulin or tablets),
• less exercise taken than usual,
• emotional stress, and
• having an infection or fever.

Without treatment you may become increasingly unwell. If your blood glucose levels are consistently high, it is best to make an appointment to see your GP or diabetes specialist nurse to discuss what to do. Remember, long-term high blood glucose levels can also cause complications associated with diabetes.

What if my blood glucose levels are too low? (Hypoglycaemia or ‘hypo’)
If you require medication for your diabetes (insulin or some tablets), you could experience hypoglycaemia. Hypoglycaemia or ‘hypo’ is a blood glucose that is too low, that is below the healthy range for a blood glucose level (less than 4 mmol/L). Hypoglycaemia does not occur when people are not on diabetes medication, or when the tablet used is metformin.

You need to ask yourself why is it happening? These are some of the reasons:-
A low blood glucose can occur when:

• you have missed a meal, snack or are late for a meal,
• eating too little or dieting,
• you have done more physical activity than usual or restarted exercise

after a break,

• you have taken too much insulin or diabetes tablets,
• you have drunk alcohol without food,
• if the weather is hot, or
• if you are feeling very stressed.

What do I do to treat a low blood glucose/‘hypo’?

Do not delay – take one of the following steps:

• you can use glucose tablets (such as Dextrose). These are available from any pharmacy, or
• if you do not have glucose tablets take something sugary, such as:
  - one tablespoon of sugar or glucose powder in half a glass of water,
  - half a glass of ordinary cordial, fizzy drink, or lucozade (not diet drink).

If you do not feel better in 5-10 minutes or your blood glucose level is still less than 4 mmol/L, repeat one of the above.

Once you are feeling better (usually after 5-10 minutes) or your blood glucose is 4 mmol/L or higher, then have something to eat, such as:

• a slice of bread,
• two plain biscuits or crackers,
• a glass of milk,
• banana,
• or your usual meal if it is meal time.

It is important to never stop your diabetes medication if you have had a ‘hypo’. If you are having low blood glucose/’hypos’ regularly, you MUST go and see your GP or diabetes specialist nurse to review your treatment.

Sick day rules

When you become physically unwell, your body reacts by raising your blood glucose levels, so worsening your diabetes control. Illnesses and infection that can upset your diabetes control include:

• colds, bronchitis and flu,
• vomiting and diarrhoea,
• urinary infections (e.g. Cystitis), and
• skin infections (e.g. boils, skin ulcers and inflamed cuts).

Below is a guide to help you through this challenging time.

1. blood glucose testing Measure your blood glucose levels more frequently when you are ill, as infections/fevers will increase your blood glucose levels. You should aim to test at least 4 times per day.

2. Medication It is important at the time of illness not to stop taking your tablets or insulin. You need to get advice from your GP or Diabetes Team if any of the following occur:

• if your blood glucose levels are high (greater than 13 mmol/L) you may need your doses of tablets or insulin to be increased,
• if your blood glucose levels are continuously high, you are vomiting and are unable to keep anything down, or if you are unsure what to do,
• if you are taking the following medications, metformin, acabose, pioglitazone or rosiglitazone, or
• if you are taking other medications e.g. blood pressure pills as these may be affected by illness.

3. Food and Drink During times of illness your appetite and fluid intake may be affected. Here are some tips to help speed your recovery:

• drink plenty of fluids, aim for five pints (3L) of unsweetened fluids a day.
• if you cannot eat solid food, try to take in some carbohydrate in the form of some easier to eat foods such as:
  - milk drinks,
  - soup,
  - ice-cream,
  - liquid replacement drinks,
  - drinking chocolate,
  - ordinary squash or fizzy drinks, or
  - yoghurt.
• if you are not hungry try eating small regular meals/snacks.