Diabetes Self-Management Articles

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How Well Do You Know Your Diabetes Management Plan?

by Allison Blass

If you check after meals, the time to do it is two hours after your first bite of a meal. If your after-meal blood glucose level is significantly higher than your premeal level, there are several possibilities to consider: Your premeal medicine dose (whether insulin, Symlin, Byetta, another injected drug such as long-acting exenatide [Bydureon] or liraglutide [Victoza] , or an oral drug) may not be large enough; your timing of your dose, particularly insulin, may need adjustment; or you may have consumed more carbohydrate or fat than you thought.

The American Diabetes Association recommends aiming for after-meal blood glucose levels below 180 mg/dl.

Lowering after-meal blood glucose levels can help lower your HbA1c level, the subject of the next question.

Do you know what your HbA1c level is?
Your HbA1c level (also known as A1C or glycosylated hemoglobin) is a measure of your overall blood glucose control over the past two to three months. It’s also the measure most commonly used in research studies that examine the relationship between blood glucose control and risk of long-term diabetes complications. Most studies have found that the lower your HbA1c, the lower your chance of developing complications. Therefore, if you keep tabs on your HbA1c, you have a better sense of whether your daily blood glucose control efforts are effective for protecting your long-term health.

Knowing your HbA1c can also fill in some of the gaps left by routine blood glucose monitoring. Unless you use a continuous glucose monitor, your usual monitoring gives only “snapshots” of information, and there are large stretches of time during which you have no idea what your blood glucose level is. If all of your daily monitoring results are within your target range but your HbA1c level is high, it means there are times when you are not monitoring that your blood glucose level is high.

The American Diabetes Association currently recommends maintaining an HbA1c level below 7% to prevent complications, but depending on your age and possibly other considerations, your goal may be different. No matter what your goal, however, an HbA1c level that is rising over time is a concern. Even relatively small increases in HbA1c level (when sustained over time) are associated with large increases in the risk of developing certain diabetes complications, including neuropathy (nerve damage), nephropathy (kidney disease), and retinopathy (eye disease). Typically, doctors order an HbA1c test every three to six months to see whether a person’s regimen is working as desired.

If you haven’t had an HbA1c test in the past six months or don’t know what your most recent test result was, ask your doctor about it at your next appointment.

Do you know how to treat hypoglycemia?
Hypoglycemia can be dangerous if not treated quickly and appropriately. If you have symptoms of low blood glucose, which may include shakiness, weakness, and disorientation, check your blood glucose with your meter to confirm that you are having a low.

The best way to treat low blood glucose is with a fat-free source of glucose such as fruit juice, hard candy such as SweeTarts or LifeSavers, or glucose tablets. For most people, 15–20 grams of carbohydrate — the amount in half a cup of juice, 6–8 SweeTarts, or 3–5 LifeSavers or glucose tablets — are enough to bring your blood glucose back up to the normal, safe range. However, because the brain is looking for a quick source of sugar, it’s very common for people to feel the need to eat much more than this. You don’t need to eat an entire meal to raise your blood glucose; if you do, you risk overtreating it and ending up with high blood glucose. Finding the source of glucose that seems to work quickest for you, and keeping premeasured amounts on hand, may help you fight the urge to eat lots of food when treating hypoglycemia.

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