Diabetic Living Questions And Answers By Dr. Ravi Shankar
- Should I check my blood sugar levels at home with a glucose monitor? How often should I check them?
Glucose monitors, usually called Glucometers are readily available in the market and are useful devices to monitor one’s blood glucose levels, in order to understand where one stands in terms of his or her glucose control. They facilitate achieving optimal glucose control, are user friendly and cost-effective.
They are invaluable tools for Type 1 Diabetics who are on Insulin treatment. Glucometers are also helpful in Type 2 Diabetics who are using Insulin and also are recommended sometimes in some Diabetics on Oral Diabetes medications.
Glucometers help readily recognize if a Diabetic is having low blood Glucose, fluctuations in blood glucose, very high blood glucose. They are not usually recommended for diagnosing Diabetes newly. Glucometers are reasonably accurate and check capillary blood glucose.
Whether one should buy a Glucometer and check at home depends on the type and severity of Diabetes, the stage of Diabetes, their clinical needs, risk of low glucose, whether on oral medications or Insulin, the type of oral medications used by the person and also affordability to a certain extent especially in the Indian context. The frequency of checking would also depend on these parameters and is advocated to take the advice of one’s doctor, so that one does not under use or over use Glucometer.
- What are my goals regarding blood sugar levels?
Goals of blood glucose can vary from person to person. It is essential to discuss this with one’s doctor so that optimal health outcomes are achieved by targeting the optimal blood glucose targets for that particular individual. The mantra is individualized and patient-centered approach.
For instance, if someone has long standing Diabetes for 40 years, old and frail and living alone, using Insulin, and at risk of low blood glucose; then that individual may be better with a less tight glucose control.
On the contrary, someone young and fit otherwise, at less risk of low blood glucose, needs to aim for a tight glucose control. Pregnant women with Diabetes or those Diabetics planning pregnancy ought to aim for a tight glucose control for the wellbeing of both mother and baby.
Fasting glucose targets may be between 70 to 140 mg/dl and random, post meal readings glucose targets can be between 70 to 200 mg/dl, depending on various clinical, and social factors. Specific individualized targets are essential from time to time for each individual Diabetic.
At the same time, it is of paramount importance to understand that HbA1c, also called Glycated Haemoglobin is the bench mark to judge one’s glucose control. This gives the last 2-3 month average of one’s blood glucose and is more accurate in predicting the future risk of one’s Diabetes-related complications. The usual target of HbA1c is around 7% in those with Diabetes, but again has to be individualized.
Suffice to say that blood glucose treatment goals have to be individualized, and it is pertinent to state in this context that other important goals relevant to Blood Pressure and Cholesterol control should not be ignored in those with Diabetes.
- What are the warning signs or symptoms that my blood sugars are too high? What do I do if my blood sugars are too high?
In a known Diabetic, the symptoms of high blood glucose levels could be excessive thirst, passing too much urine, waking up several times at night to pass urine, frequent infections like Thrush, weight loss, tiredness, fatigue and a feeling of being unwell. Some times, there may be no symptoms or signs even if the blood glucose is high, which reiterates the importance of regular monitoring!
Similar symptoms and signs are seen in undiagnosed Diabetics. Some newly Diagnosed Diabetics are in fact diagnosed when they present with other health related problems to hospital, like a heart attack; some are diagnosed on routine health check-ups for occupational screen or insurance purposes.
Some new diagnoses of Diabetes are made when individuals present with complications of Diabetes like Cataracts, damage to retina, burning pain in feet, kidney problems etc. Rarely the presentation can be with severe complications like Coma with high acid content in blood.
When a Diabetic knows he or she has high blood sugars, avoiding dehydration by drinking plenty of sugar-free fluids and seeking medical attention as soon as possible is essential.
- What are the warning signs or symptoms that my blood sugars are too low? What do I do if my blood sugars are too low?
A low blood glucose is defined as less than 70 mg/dl. A low blood glucose can be very dangerous if not recognized and attended immediately.
The symptoms and signs of low blood glucose in a Diabetic can be variable. The usual symptoms are feeling odd, confusion, excessive sweating, shakiness, excess hunger, and not being oneself. It is essential to be aware of these symptoms so that they can be recognized and treated immediately.
If possible, one needs to check the blood glucose with a glucometer and confirm that it is a low glucose. If not feasible, the treatment is to give 4 spoons of sugar with milk or water. Alternatives include honey, sweets, few chocolates. As soon as the person feels better, it is important to give some food such as a snack, sandwich, fruits, meals in order to prevent recurrence of the low glucose.
If someone is unconscious or semiconscious, it is essential to call for medical help to start a glucose drip at the earliest with higher medical care and monitoring.
Excess medications for glucose control; delayed, skipped or reduced food intake; excess work or exercise than usual are some of the common causes for low glucose. It is essential to seek appropriate medical advice and counselling to identify the causes of low glucose, know the signs and symptoms of low glucose, to prevent it and ensure the problem does not recur.
- How can I change my lifestyle and diet in a way that will be healthy?
Everyone needs to lead a healthy, balanced lifestyle, more so if the individual has Diabetes or at risk of developing it.
Stress plays an important role in many ailments and it is important to keep stress at bay as much as possible in our day-to-day lives. Right work-life balance is the key. Staying late at night is certainly not advisable as sound sleep is necessary for a healthy body.
Staying fit, regular exercise are essential. An hour of brisk walking 5 times a week or equivalent is a must. Simple changes in life style such as avoiding escalators and elevators, taking stairs whenever possible helps.
Good, balanced diet plays an important role. Right amount of the right food at the right time is a must. Avoiding junk and processed foods is necessary.
Quitting smoking and other tobacco products is mandatory. No or little Alcohol is advocated.
Understanding one’s own body, taking care of it and not leaving things till late if one has an ailment is fundamental .The good old adage, prevention is better than cure holds true even in this modern world !
Dr. Rav Sankar Erukulapati,
MBBS, MRCP(UK), CCT- GIM, Diabetes & Endocrinology (UK)
Consultant Endocrinologist, Apollo Hospital, Jubilee Hills, Hyderabad
Contact Number: 7702777503
E-Mail ID: firstname.lastname@example.org