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Live With Diabetes

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Part 2: Be prepared for low blood sugar

Knowing what to do when you have an episode of low blood sugar is one thing. (Follow the Rule of 15). But having access to what you need to manage an episode of low blood sugar is not automatic.

What do you do if you develop hypoglycemia at work, especially if it’s late at night? Plan ahead for this situation by making sure you have adequate carbohydrates on hand. Keep a packaged snack with a long shelf-life in your desk or locker. You should also know where the closest vending machines can be found.

If you have the flu or a stomach bug that causes you to vomit, it may be difficult to keep your blood sugar in line. Carbohydrate-rich fluids (eg, juices and regular sodas) may be your best bet in such cases. If you’re having trouble keeping solid food down, it might also be a good idea to check your blood sugar more often than usual.

Coping With Low Blood Sugar Quickly

When your blood sugar gets too low, your body releases a hormone (chemical messenger) called epinephrine (also known as adrenaline) into your blood. The immediate effects of epinephrine are the familiar symptoms of hypoglycemia:

• Shakiness
• Dizziness
• Nervousness
• Sweatiness or clamminess, including night sweats
• Irritability
• Unexplained anger, sadness, crankiness, combativeness
• Hunger
• Headache
• Impatience
• Anxiety
• Light-headedness
• Rapid heartbeat
• Fainting

If you feel any of these symptoms or have other reason to believe your blood sugar is low, you should check it. Generally, a blood glucose level below 70 mg/dL is considered too low. Your doctor may set a higher safe level for you, but whatever your safe level, if your blood sugar is too low, you should treat it immediately using the Rule of 15.

Rule of 15: “Eat 15, Wait 15”

1. Eat or drink about 15 grams of glucose or other fat-free carbohydrate (fats slow the absorption of carbohydrate and add unwanted calories)
2. Check your blood glucose in 15 minutes, and if it has not risen above your safe level, eat or drink another 15 grams of fat-free carbohydrate (see suggestions below)
3. Recheck your blood glucose in another 15 minutes. If it has not risen above your safe level, eat or drink another 15 grams of fat-free carbohydrate. Check your blood sugar level again in another 15 minutes, and if it still has not risen above the target safe level, contact your doctor or call 911
4. If your blood sugar rises above the safe level but it is the middle of the night or the next meal is more than one hour away, have a snack—for example, cheese and crackers.

Each of the examples below contains about 15 grams of carbohydrate:

• 2 to 5 glucose tablets, varies by brand
  (This is the best treatment.)
• One-half of a can of regular soda
• One-half of a cup (4 oz) of orange juice
• 5 to 7 LifeSavers® candies or
• 3 Jolly Ranchers® candies
• 2 large lumps of table sugar
• 1 tablespoon of honey or corn syrup
• 1 tube of Cake Mate® decorator gel
• 1 cup of skim milk

Finding the Long-Term Motivation for SMBG

Self-monitoring of your blood glucose (SMBG) is essential for people with diabetes, but it can be a bit of a challenge. You have to obtain a small sample of your blood, put the sample on a test strip, and put the strip in a meter. And testing supplies are not cheap. Some people with diabetes grow weary of SMBG after a while and question its value.

Here are four typical barriers to continued SMBG and some solutions to help keep you on track:

1. Testing is too painful
   • Ask a care team member—a nurse or your diabetes educator—to review the proper technique for getting a blood sample.
   • Fingertips have a lot of nerve endings. Ask about testing on the sides of your finger or at a site other than your fingertip (forearm, palm, or thigh). Samples from these sites may not give as accurate of a blood sugar reading as samples from fingertips, but they are acceptable substitutes if they help you to keep testing.
2. Testing can be inconvenient
   • Try using a smaller meter that is more conveniently carried in purse or pocket when you’re away from home, or keep a spare in another location (for example, in your desk at work).
   • Ask a care team member to help you establish a routine around SMBG so it becomes more natural.
3. Testing is too costly
   • Talk to your healthcare provider about ways to get the most valuable information out of the money you spend.
   • Some insurance companies cover tests and supplies. Ask your doctor or diabetes educator for a recommendation.
   • Medicare covers the cost of certain number of testing strips and lancets every three months for people with type 2 diabetes.
   • Medicaid usually covers diabetes supplies, but not in all states.
   • Ask your doctor or diabetes educator about the possibility of enrolling in a research study (clinical trial) in diabetes. Many clinical trials offer free testing supplies to participants.
4. I don’t need to test; I can tell when my blood sugar is off
   • Yes, there are symptoms of low and high blood sugar that you can learn to recognize, but they are not reliable. For proof of that, you might ask your doctor to hook you up temporarily to a continuous glucose meter.
   • It’s not just about the fact of hypoglycemia or hyperglycemia; it’s a matter of degree. The value of a meter is that it can give you and your doctor a specific measurement. Even if you didn’t need your meter to know you were hypoglycemic, you still need it to know by how much your blood sugar is off.
   • Testing gives you information about the effect of meals and medication on blood sugar.

Previous: Part 1: Diabetes Will Change Your Life (Maybe For The Better)

Related Article: Eat Well

Download These PDF Tools: Portion Size Guide, Weekly Blood Glucose Log