Home Management of Diabetes
Monitoring Glucose (Blood Sugar) Levels
Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) are of concern, especially for patients who take insulin. Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. For patients who have become insulin-dependent, more intensive monitoring is necessary. Patients should aim for the following measurements:
- Pre-meal glucose levels of between 90 - 130 mg/dL
- Bedtime levels of between 110 - 150 mg/dL
Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.
Finger-Prick Test. A typical blood sugar test includes the following:
- A drop of blood is obtained by pricking the finger.
- The blood is then applied to a chemically treated strip.
- Monitors read and provide results.
Home monitors are about 10 - 15% less accurate than laboratory monitors, and many do not meet the standards of the American Diabetes Association. Most doctors believe, however, that they are accurate enough to indicate when blood sugar is too low.
Some simple procedures may improve accuracy:
- Testing the meter once a month.
- Recalibrating it whenever a new packet of strips is used.
- Using fresh strips; outdated strips may not provide accurate results.
- Keeping the meter clean.
- Periodically comparing the meter results with the results from a laboratory.
For patients who have trouble controlling hypoglycemia (low blood sugar) or fluctuating blood sugar levels, continuous glucose sensor monitors are also available. In 2007, the FDA approved the STS-7 System, which continuously measures glucose levels for up to 7 days through a sensor inserted beneath the skin of the abdomen. Continuous glucose sensor monitors do not replace fingerstick glucose meters and test strips, but are used in combination with them. [For more information, see In-Depth Report #9: Diabetes - type 1.]
Glycosylated Hemoglobin
Hemoglobin A1c (also called HbA1c , HA1c, or A1C) is measured periodically every 2 - 3 months to determine the average blood-sugar level over the lifespan of the red blood cell. Normal HbA1c levels should be below 7%. Home tests are also available for measuring A1C.
Preventing Hypoglycemia
The following tips may help avoid hypoglycemia or prepare for attacks:
- Patients are at highest risk for hypoglycemia at night. Bedtime snacks are advisable if blood glucose levels are below 180 mg/dL (10 mmol/L). Protein snacks may be best
- Patients who intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day. This is particularly important for patients with hypoglycemia unawareness.
- In adults, it is also particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous.
- Patients who use medications that put them at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes designed for individuals with diabetes.
Family and friends should be aware of the symptoms and be prepared:
- If the patient is helpless (but not unconscious), family or friends should administer three to five pieces of hard candy, two to three packets of sugar, half a cup (four ounces) of fruit juice, or a commercially available glucose solution.
- If there is inadequate response within 15 minutes, the patient should receive additional sugar by mouth and may need emergency medical treatment, possibly including an intravenous glucose solution.
- Family members and friends can learn to inject glucagon, a hormone, which, in contrast to insulin, raises blood glucose.
Patients are encouraged to wear at all times a medical alert ID bracelet or necklace that states they have diabetes. If patients take insulin, that information should be included as well.
Foot Care
Measures to Prevent Foot Ulcers. Preventive foot care can significantly reduce the risk of ulcers and amputation. Some tips for preventing problems include:
- Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
- When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward. Check water temperature with the hand or a thermometer before stepping in.
- Apply moisturizers, but NOT between the toes.
- Gently use pumice to remove corns and calluses (patients should not use medicated pads or try to shave the corns or calluses themselves.)
- Trim toenials short and file the edges to avoid cutting adjacent toes.
- Well-fitting footwear is very important. People should be sure the shoe is wide enough. Patients should also avoid high heels, sandals, thongs, and going barefoot. Shoes with a rocker sole reduce pressure under the heel and front of the foot and may be particularly helpful. Custom-molded boots increase the surface area over which foot pressure is distributed. This reduces stress on the ulcers and allows them to heal.
- Changes shoes often during the day.
- Wear socks, particularly with extra padding (which can be specially purchased).
- Patients should avoid tight stockings or any clothing that constricts the legs and feet.
- Consult a specialist in foot care for any problems.
