Monitoring and Diagnosis

Taking Control of your Diabetes
Your goal: Do your level best

One of the main goals of treating diabetes is to control the blood sugar level by maintaining it as close to normal as possible.

The American Diabetes Association 2010 recommends the following blood sugar goals for people with diabetes:

Goal ADA ACE IDF
Fasting plasma glucose (FPG) {mg/dL} 90-130 <110 100
2-hour postprandial plasma glucose (PPG) {mg/dL} <180 <140 140
A1c <7% <6.5% <6.5

Note: These guidelines apply to many people, but not to everyone. Your best "level" may be higher or lower than these guidelines. Your doctor will help you set the blood sugar target range that is right for you.

How to compare the results of your daily blood sugar test to HbA1c test:

This chart shows the average blood sugar that corresponds to the HbA1c test result. Note that an HbA1c of 6.5% results when blood sugar averages about 135 mg/dL.

Blood Sugar ( mg / dL ) HbA1c ( % )
135 6%
170 7%
205 8%
240 9%
275 10%
310 11%
345 12%

SMBG: Self Monitoring of Blood Sugar - this allows oneself to evaluate self response to therapy and assess whether glycemic targets are being achieved or not.

When to test the blood sugar?

Testing patterns are individualized and depend on the type of diabetes and treatment plan of the patient. The doctor sets these patterns.

However, there are standard times to test:

  • First thing in the morning ( Fasting )
  • Before meals
  • 2 hours after meals ( Post Prandial )
  • At bed time
  • During the night (2-3 a.m.)

Low Blood Sugar (What is Hypoglycemia?)

When your blood sugar falls below 70mg/dL ( 3-9mmol/L), you may have low blood sugar ( hypoglycemia). When this happens, most people experience unpleasant symptoms that can be both physical and emotional. These symptoms can come on quite suddenly. Hypoglycemia is usually easy to treat. However, if it is not dealt with quickly, serious reactions may result, including passing out or having convulsions. Talk with your doctor about what steps to take in case of a low blood sugar emergency, and most importantly, how to avoid one.

What causes Hypoglycemia?

The most common causes of hypoglycemia are:

  • Eating at the wrong time for the medicine you take
  • Skipping or not finishing meals or snacks
  • Drinking alcoholic beverages
  • Doing more exercise than usual
  • Taking too much diabetes medication

Skipping or delaying meals can cause low blood sugar in people who take sulfonlyureas, meglitinide or insulin. These drugs increase the body's insulin level which results in the blood sugar levels to fall too low.

Before you drink alcoholic beverages, discuss with your doctor whether moderate use of alcohol may be included in our meal plan.

Symptoms of Hypoglycemia

When blood sugar gets too low you may

  • Feel shaky
  • Be sweaty
  • Feel tired
  • Be hungry
  • Have a fast heartbeat
  • Become confused
  • Have blurred vision or a headache
  • Have no symptoms at all

Having no symptoms at all is a dangerous situation! First treat the low blood sugar level. If you ever have a blood sugar reading below 60 mg / dL, ( 3.3 mmol /L ) without experiencing symptoms, then call your doctor. A blood sugar level this low needs treatment, even if you are feeling fine.

Low blood sugar feels different to different people. Learn to recognize your own particular symptoms.

How to prevent hypoglycemia?

Low blood sugar can be prevented if you:

  • Eat your meals on time.
  • Don't skip meals
  • Learn to adjust your food and diabetes medicine.
  • Test your blood sugar on schedule.
  • Do extra tests when you feel different from normal and write down the results in your log book.

How to treat hypoglycemia?

You need to treat low blood sugar right away. It will not get better on its own. So be sure to keep foods that contain sugar or glucose products with you at all times. When you feel your blood sugar might be low, then test your blood. If your reading is less than 70 mg/ dL ( 3.9 mmol / L ) - or the level set by your doctor, take one of the following right away. Each one contains about 15gms of carbohydrate:

  • 3 glucose tablets ( 5 gms glucose each )
  • ½ cup of fruit juice
  • 1 tablespoon of honey or sugar

After eating or drinking something:

  • Wait for 15 minutes, and then test your blood sugar again. Record the number in your log book.
  • If you don't feel better in 15 minutes, eat something with sugar in it again.
  • If your blood sugar is still low, call your doctor's office.
  • If your next meal is more than an hour away, follow the sugar with something that provides carbohydrate and protein (like half a sandwich or some whole meal biscuit.)
  • Be sure to eat your normal meal at the regular time, even if you have eaten a snack with high sugar content.

Important to do:

  • Learn your body's warning signs of falling blood sugar
  • When you notice symptoms, test your blood and have a snack.
  • Always wear or carry your Diabetes Identification Card with you.
  • Teach family members, friends or coworkers about symptoms and your treatment for low blood sugar.