January 30, 2015

Help in Diabetes Management Education – Part 4

Part 4 of 12

I have a difficult time understanding people with type 2 diabetes that have never heard of hypoglycemia or hyperglycemia. This last fall, I had two people say they had not heard these terms and because their doctor had not mentioned them, they did want to talk about them. They were quick to separate from A.J and me when we were talking to them and I had to wonder if this was a topic that the doctor had mentioned and they had selective hearing loss at the time.

Many men do this regularly and some women, then they use the excuse that the doctor did not mention or talk about this. In our support group, we do get in the face of a person that says this and ask them point blank why they think they can get away with this. We have lost one member over this, but the rest realize that we are trying to teach them something and we don't hear this phrase again.

Hypoglycemia is the fear of all doctors and they are very careful to avoid insulin for this reason. Patients  need to learn about both hypoglycemia and hyperglycemia to be able to manage their diabetes. Yet this is something many patients do not want to learn about, especially the older type 2 diabetes people.

What many forget is that both conditions can result in a coma and even death and that is one reason the members of our support group learn about these and why we have a call tree for single people that don't call in every morning. This was discussed by all the members and while only two of the single people opted out at the beginning, everyone is now part of this. Yes, our deceased member was one of the two. Those that are still working have a procedure with their boss if they are over 15 minutes late for work. The boss has a list of phone numbers by day to call and a member will check on them.

Hypoglycemia is considered for blood glucose (BG) readings below 70 mg/dl (3.9 mmol/L). Most people get noticeable symptoms when BG goes below 80 mg/dl (4.4 mmol/L), but others do not until BG gets lower. Readings of 70 mg/dl and above are normal for most people and generally of no concern. Trends below 80 mg/dl need to be watched carefully if they get near the 70 mg/dl level. Why do I use the mg/dl behind the numbers? This is what the meters are set to read in the USA. All other countries use the mmol/L.

Symptoms of hypoglycemia vary by individual, but may include extreme hunger, nervousness, excessive perspiration, rapid heartbeat (tachycardia), headache, fatigue, mood changes, blurred vision and difficulty concentration and completing mental tasks. Extremely low glucose levels can lead to disorientation and convulsions, even coma and death

Hyperglycemia is difficult to detect for most individuals. There is much disagreement as to where hyperglycemia starts. Irrespective of what number you choose to believe, the American Diabetes Association (ADA) has set the upper limit for A1c's at 7.0 percent. This equates to 154 mg/dl (8.6 mmol/L). I have also seen ADA use the number of 180 mg/dl (10.0 mmol/L). It is known that complication damage occurs at an A1c value of 7.0% and higher. Some will argue that damage occurs above 140 mg/dl (7.8 mmol/L). I prefer using the 140 mg/dl as the starting point for complication damage and as the starting point for hyperglycemia.

Most people can only detect hyperglycemia by testing. When your blood glucose levels are above 200 mg/dl (11.1 mmol/L) it may be several days before you may notice any signs. Some people do not notice frequent urination and increased thirst, even then. This is another reason to test regularly. If you are a person that exercises regularly, a blood glucose reading of 240 mg/dl (13.3 mmol/L) means you must not exercise until your BG is below 200 mg/dl. It is always advisable to talk to your doctor about the amount of medication to use to bring high BG numbers down. Unless you have previously discussed this with your doctor and know what to do, it is always wise to talk with the doctor.

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