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What Is The 15 15 Rule For Diabetics?

Diabetes Part 2

Diabetes Part 2

Sort Counter-regulatory Hormones of Hypoglycemia 1. Glucagon - alpha cell in pancreas 2. Epinephrine - medulla in adrenal gland 3. Cortisol - cortex in adrenal glands 4. Growth Hormone - pituitary gland *These are the Hormone that increase blood sugar level Glucagon increases glucose, if that doesn't do the job then epinephrine, then cortisol, then growth hormone Drug-Induced Hypoglycemia. What are the 4 drugs we should know of that can cause Hypoglycemia 1. Salicylates (generally need high doses) 2. β-blockers (decreases glycogenolysis and warning signs) 3. Alcohol 4. ACE inhibitors- can lower you blood sugar because it increase insulin sensitivity Others: Pentamidine (toxic to β-cells)- antimicrobial that could induce hypoglycemia Insulin, sulfonylureas, meglitinides Carbohydrate sources (15-20g) for treating hypoglycemia Lifesavers candies: 8-10 Brach's hard candies: 8-10 Raisins: 2 tablespoons Nondiet soft drinks: 4-6 oz Fruit juice: 4-6 oz Milk (no- or low-fat): 8 oz "Nondiet" because we need real sugar and not sugar substitute Foods high in fat that are poor choices for treating hypoglycemia Ice cream Doughnuts Candy bars Pies/cakes Cheese Potato chips Milkshakes We need low or no fat because the fat slows the absorption of the carbohydrates Which of the following is correct regarding blood glucose monitoring during hypoglycemia? A. Check BG when you feel you may be hypoglycemic B. Check BG 15 minutes after treating hypoglycemia C. Check BG every 15 minutes until normoglycemic D. All of the above D. All of the above Hyperglycemic Crisis: DKA Diabetic Ketoacidosis (DKA) Primarily seen in type 1 diabetes (especially new onset or with discontinuation of insulin) Type 2 patients at risk during catabolic stress (i.e., surgery, trauma, infections, stroke, MI) Must hav Continue reading >>

Treatment Of Mild Hypoglycemia

Treatment Of Mild Hypoglycemia

“Let food be thy medicine and medicine be thy food.” —Hippocrates It has been well established by studies such as the landmark Diabetes Control and Complications Trial (DCCT) that metabolic control delays the development and progression of microvascular complications in adults with type 1 diabetes.1 Unfortunately, improvement in metabolic control is associated with an increased incidence of treatment-induced hypoglycemia. This is a common side effect of insulin, as well as the insulin secretagogues frequently used in the treatment of type 2 diabetes.2 As insulin secretion diminishes in type 2 diabetes, hypoglycemia becomes more frequent and limiting. Five years after initiation of insulin therapy, the rate of severe hypoglycemia is reported to be as high as 35–70 episodes per 100 patient-years, higher than that in type 1 diabetes.3,4 Abnormal glucose counterregulation (and hypoglycemia unawareness) progresses based on the progression of insulin deficiency. Thus, because type 2 diabetes is more prevalent than type 1 diabetes, most episodes of hypoglycemia occur in people with type 2 diabetes.2 In both type 1 and type 2 diabetes, counterregulatory responses to hypoglycemia steadily decline with frequent and repetitive episodes.2 This can become a vicious circle; a hypoglycemia episode impairs defenses against a subsequent episode, and thus hypoglycemia can result in recurrent hypoglycemia. Hypoglycemia causes increased morbidity in most people with type 1 diabetes and in many with a long duration of type 2 diabetes and is sometimes fatal.2 There is growing evidence that older adults with known cardiovascular disease (CVD)5–8 and very young children who cannot independently recognize low glucose levels may be particularly vulnerable to adverse events associated w Continue reading >>

Treat Hypoglycemia Fast, But How?

Treat Hypoglycemia Fast, But How?

Jay H. Shubrook, DO; Joy A. Dugan, MS, PA-C, MPH Jay H. Shubrook, DO: Hi, I am Jay Shubrook, family physician, diabetologist, and professor at Touro University, California. Today we are continuing our series on practical insulin use in primary care. When talking about insulin, one of the most important topics we need to discuss is hypoglycemia. We have brought back Joy Dugan, MS, PA-C, MPH, who is also a faculty member at Touro University, California, to talk about this important topic. Thank you for coming back to the program, Joy. Dr Shubrook: During our previous session , we talked about hypoglycemia and how to identify it. Today, I would like to focus on the treatment of hypoglycemia. First of all, how do you define hypoglycemia? PA Dugan: Hypoglycemia is defined as a blood sugar level below 70 mg/dL.[ 1 ] This can occur with or without symptoms. Dr Shubrook: Hypoglycemia is very common in people with diabetes, and even more common in people taking insulin. How do people treat hypoglycemia? PA Dugan: One of the most useful mnemonics you can teach a patient on insulin or with diabetes, especially those taking insulin, is the "15/15 rule." What that stands for is, at onset of hypoglycemia symptoms or if their glucometer number reads below 70 mg/dL, they should consume 15 g of carbohydrates [then wait 15 minutes and recheck their glucose level]. This is a really important time to introduce food labels, because your patients are not necessarily going to know how to read a food label. Examples of 15 g of carbohydrates include half a can of regular soda (not diet soda), half a cup of juice, and three to four glucose tablets. It is important that you teach patients to use three to four glucose tablets, because one glucose tablet only has about 4 g of carbohydrates. If ind Continue reading >>

How To Treat A Low Blood Glucose

How To Treat A Low Blood Glucose

A blood glucose of less than 70 mg/dl in general is considered a low blood glucose. Because you may feel some of the symptoms of low blood glucose when your glucose is normal, be sure, if possible, to check your blood glucose when you think it is low. The symptoms of a low blood glucose are: Sweaty and shaky Weak Headache Confused Irritable Hungry Pale Rapid heart rate Uncoordinated If your blood glucose is low, follow the steps below to treat: Follow the 15-15 rule: Eat or drink something from the list below equal to 15 grams of carbohydrate (carb). Rest for 15 minutes, then re-check your blood glucose. If it is still low, (below 70), repeat step 1 above. If your next meal is more than an hour away, you will need to eat one carbohydrate choice as a snack to keep your blood glucose from going low again. If you can't figure out why you have low blood glucose, call your healthcare provider, as your medicine may need to be adjusted. Always carry something with you to treat an insulin reaction. Use food from the list below. Foods equal to One Carbohydrate Choice (15 grams of carb): 3 Glucose tablets or 4 Dextrose tablets 4 ounces of fruit juice 5-6 ounces (about 1/2 can) of regular soda such as Coke or Pepsi 7-8 gummy or regular Life Savers 1 Tbsp. of sugar or jelly Call your doctor Call your doctor or healthcare provider if you have a low blood glucose reaction and do not know what caused it. If you pass out If you have type 1 diabetes and you do not take care of low blood glucose, you may pass out. If you do, a drug called glucagon should be injected into your skin, like you do with insulin. This can be done by a family member or friend who has been taught how to do it. Since glucagon may cause you to vomit, you should be placed on your side when the injection is given. I Continue reading >>

What Is The Difference Between Hyperglycemia And Hypoglycemia?

What Is The Difference Between Hyperglycemia And Hypoglycemia?

By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>

Control Your Weight And Diabetes With The Rule Of 15

Control Your Weight And Diabetes With The Rule Of 15

Rule of 15 The Church Health Center Wellness looks at the whole person. A disease like diabetes emerges from habits and attitudes of a lifetime. Improved wellness comes from understanding the disease and taking control of change. The center teaches people with diabetes to control their disease by following the Rule of 15. 1. 15 minutes. Movement is key to managing diabetes. If you have diabetes and are not currently exercising, start with simply walking 15 minutes at a time. Aim to take two 15-minute breaks each day and walk. If you cannot walk, do simple exercises such as shoulder rolls, ankle rolls, leg lifts, or arm circles. When you can do more, go for it. 2. 15 grams. Know which foods have 15 grams of carbohydrates. Become a savvy shopper by reading food labels and learning how many carbohydrates are in common foods. Fifteen grams equals one serving. One slice of bread, a half cup of juice, or a half cup of pasta have about 15 grams each. 3. 15 grams plus 15 minutes. If your blood sugar gets too low, eat 15 grams of a carbohydrate-rich food, wait 15 minutes, and test your blood sugar again. If it is still below 70, take another 15 grams of carbohydrates, wait another 15 minutes, and retest. 4. 15 days. New habits take time. Keep your diabetes supplies with you all the time. If you make a point to do this for 15 days, it will become a habit to always have what you need with you. 5. 15 percent. A 15 percent decrease in body weight will make a significant difference in controlling diabetes. Start with a short-term goal of losing just 5 percent. Once you accomplish this, aim for another 5 percent, and then another 5 percent. For more information about Dr. Morris and his programs visit Continue reading >>

Low Blood Sugar - Hypoglycemia

Low Blood Sugar - Hypoglycemia

Symptoms from hypoglycemia may occur at almost any blood sugar level. A person who usually has a blood glucose in the 200 mg/dl range may have symptoms if the glucose decreases rapidly to a level of 110 mg/dl, for example. Symptoms are generally mild. A person with diabetes should not trust feelings to know if blood glucose is high or low. So doing can lead to a serious situation. The blood glucose should be checked with a glucose meter. IF THE RESULT IS VERY UNUSUAL, RECHECK IMMEDIATELY! At the Diabetes Control Center we consider hypoglycemia in three classes. Class 1. Mild symptoms such as hunger, sweating, fatigue. The person is alert, aware of surroundings and able to chew and swallow. This level of hypoglycemia can be self managed. Driving is not allowed until blood glucose is corrected and all symptoms corrected. Class 2. More severe symptoms including shaking, dizziness, headache, dulled mental function. The person is alert, aware of surroundings and able to chew and swallow. This level of hypoglycemia can be self managed. Driving is not allowed until blood glucose is corrected and all symptoms corrected, generally about 2 hours. Class 3. More severe symptoms may include irrational behavior, slurred speech, unconsciousness, and seizures. This is a more serious situation and requires the help of others. Any episode of requiring the help of others is considered a class 3 episode. Class 3 hypoglycemia generally requires emergency medical assistance. Driving is out of the question. For Classes 1 and 2 the Diabetes Control Center recommends the 15, 15, 15 rule. Take 3 glucose tablets (available at most pharmacies)*. If blood sugar is less than 110, take 3 more glucose tablets. If less than 110, take 3 more glucose tablets. Repeat this cycle until Sugar is over 110. * Continue reading >>

15/15 Rule: Medlineplus Medical Encyclopedia Image

15/15 Rule: Medlineplus Medical Encyclopedia Image

Half cup (4 ounces or 120 milliliters) of fruit juice or regular soda After the carbohydrate is eaten, the person should wait about 15 minutes for the sugar to get into their blood. If the person does not feel better within 15 minutes more carbohydrate can be consumed. Their blood sugar should be checked to make sure it has come within a safe range. Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy , editorial process and privacy policy . A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions. Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Noninsulin-dependent diabetes; Diabetes - type II; Adult-onset diabetes; Diabetic - type 2 diabetes; Oral hypoglycemic - type 2 diabetes; High blood sugar - type 2 diabetes Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Causes Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. When sugar cannot enter cells, a high level of sugar builds up in the blood. This is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 2 diabetes. Type 2 diabetes usually develops slowly over time. Most people with the disease are overweight or obese when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes can also develop in people who are thin. This is more common in older adults. Family history and genes play a role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your chance of getting the disease. Symptoms People with type 2 diabetes often have no symptoms at first. They may not have symptoms for many years. Early symptoms of diabetes caused by a high blood sugar level may include: After many years, diabetes can lead to serious health problems, and as a result, many other symptoms. Exams and Tests Your Continue reading >>

Hypoglycemia? Low Blood Glucose? Low Blood Sugar?

Hypoglycemia? Low Blood Glucose? Low Blood Sugar?

These are all names for the same thing: a drop in blood glucose (sugar) that can be dangerous if not treated. What causes it? Hypoglycemia is low blood glucose (sugar), usually less than 70 mg/dl (although you and your health care provider may come up with a different number). It means the body has too much insulin, too little glucose, or both. This can happen if: you don't eat enough food, or you don't eat on time you are taking too much diabetes medication you exercise a lot you drink alcohol without eating enough food Certain diabetes medications, including insulin and some pills, can also make blood glucose more likely to go low. Warning signs Low blood glucose can make you feel: sweaty or clammy nervous or anxious lightheaded confused Some people don't get any early warning signs of a low. This is called “hypoglycemia unawareness.” It can be dangerous because their blood glucose level can drop severely low before they know it. → Hypoglycemia must be treated immediately. While at first it can feel bad and upsetting, low blood glucose can quickly get more serious. Severe low blood glucose can make someone pass out, have seizures, or even go into a coma. How to treat it If you have hypoglycemia, you need to have food or a drink that is a fast-acting carbohydrate. Good sources include fruit juice, regular (not diet) soda, glucose tablets, or glucose gel. A good rule of thumb is to eat or drink 15 grams of carbohydrate, wait 15 minutes, and then test your blood again. If your blood glucose is still lower than 70 mg/dl, take another 15 grams and test again 15 minutes later. Although you may feel like you want to eat more, be aware that eating too much can send your glucose too high. There are about 15 grams of fast-acting carbohydrate in: 8 ounces of skim milk If y Continue reading >>

Hypoglycaemia

Hypoglycaemia

Hypoglycaemia, sometimes called a hypo or low, is a condition that occurs when a person’s blood glucose level (BGL) has dropped too low, below 4mmol/L. It is important to treat a hypo quickly to stop the BGL from falling even lower and the person becoming seriously unwell. Hypoglycaemia can make it hard to concentrate and carry out everyday activities. Some activities, such as driving and operating machinery, are not safe if BGLs are less than 5.0mmol/L. Hypoglycaemia is much more common in people who take insulin or certain other glucose lowering tablets, however it can occur in people with diabetes who are not using insulin. Hypoglycaemia can be caused by one or a number of events, such as: Too much insulin or other glucose lowering diabetes tablets Delaying or missing a meal Not eating enough carbohydrate Unplanned physical activity* More strenuous exercise than usual* Drinking alcohol - the risk of hypoglycaemia increases, the more alcohol you drink *Hypoglycaemia may be delayed for 12 hours or more after exercise Symptoms of hypoglycaemia vary from person to person. Early signs and symptoms may include: Shaking, trembling or weakness Sweating Paleness Hunger Light headedness Headache Dizziness Pins and needles around mouth Mood change If the BGL continues to drop, more serious signs and symptoms may occur. Later signs and symptoms of hypoglycaemia may include: Lack of concentration/ behaviour change Confusion Slurred speech Not able to treat own hypo Not able to drink or swallow Not able to follow instructions Loss of consciousness Fitting/seizures Hypoglycaemia can be classified as mild or severe. A mild hypo occurs when a person can treat their own hypo. A severe hypo occurs when a person needs help from someone else to treat their hypo. What should I do if I s Continue reading >>

What To Do If Someone Goes Into Diabetic Shock

What To Do If Someone Goes Into Diabetic Shock

Although most people equate diabetes with high blood sugars, individuals using insulin or certain diabetes pills may experience low blood sugar levels, especially if they miss a meal or exercise more than usual. Hypoglycemia, or low blood sugar, may be mild and easily treated or can worsen to a medical emergency. When a person suffering from low blood sugar requires the help of others for treatment, this is considered severe hypoglycemia, according to the 2015 practice guidelines of the American Association of Clinical Endocrinologists. Severe hypoglycemia is also referred to as diabetic shock or an insulin reaction. Most low blood sugar episodes are minor and easily recognized and treated. However, severe cases require emergency treatment at home or warrant a 911 call. Video of the Day Hypoglycemia is typically defined as a blood sugar level below 70 mg/dL. Common symptoms of mildly low blood sugar levels include shakiness, dizziness, sweating and a fast heartbeat. As blood sugar levels continue to drop, irritability and confusion are common, and severely low blood sugars can cause nightmares, combative behavior, seizures and unconsciousness. People with longstanding diabetes may have hypoglycemia unawareness, which means they have very subtle or no early warning signs of low blood sugar levels. Hypoglycemia unawareness may be related to diabetes nerve damage; however, people with frequent bouts of severe hypoglycemia are also at risk for this problem. The lack of early warning signs puts a person a greater risk for the serious consequences of low blood sugars. The 15-15 Rule If a person has symptoms of hypoglycemia, and a blood sugar testing kit is available, a test can be done to confirm the blood sugar level. Although levels below 70 mg/dL are considered low, severe Continue reading >>

Treating Hypoglycemia

Treating Hypoglycemia

Treating for hypoglycemia (low blood glucose) is usually recommended when a persons blood glucose level is 70 mg/dl or less. The rule of 15 is commonly used as a guideline for treatment: After checking your blood glucose level with your meter and seeing that your level is under 70 mg/dl, consume 15 grams of carbohydrate, wait about 15 minutes, then recheck your blood glucose level. If your blood glucose is still low, consume another 15 grams of carbohydrate and recheck 15 minutes later. Since blood glucose levels may begin to drop again about 4060 minutes after treatment, it is a good idea to recheck your blood glucose approximately one hour after treating a low. Although the rule of 15 is an accepted method for treating hypoglycemia, it should not replace the advice of your diabetes care team. The following items contain 15 grams of carbohydrate: 1 dose of glucose gel (in most cases, 1 small tube is one dose) 1/2 cup of orange juice or regular soda (not sugar-free) 1 tablespoon of sugar or 5 small sugar cubes Continue reading >>

Beating The Lows: Diabetes Forecast

Beating The Lows: Diabetes Forecast

You may already have learned that diabetes means there's too much of the sugar called glucose in your blood. But sometimes blood glucose levels fall too low. This condition is called hypoglycemia, and it can be dangerous. Hypoglycemia more frequently occurs in people with type 1 diabetes, especially those who try to tightly control their blood glucose. Everyone with type 1 must take insulin, which lowers blood glucose levels. However, insulin cannot adapt to changes in your routine. So your blood glucose can drop too low if you: Sometimes, you may get hypoglycemia just because your body responded differently to your insulin than usual. And when you are sick or under stress, your blood glucose levels may drop, too. People with type 2 diabetes can also get hypoglycemia for the reasons listed above. In addition, the following pills used to treat type 2 can cause hypoglycemia: sulfonylureas, which include glyburide, glipizide, and glimepiride as well as the older agents tolbutamide, tolazamide, chlorpropamide, and acetoheximide meglitinide drugs, which include repaglinide and nateglinide. Combinations of insulin, sulfonylureas or meglitinides with other diabetes pills and injectable drugs also carry a risk of hypoglycemia. Hypoglycemia symptoms vary by individual. Sometimes symptoms change over time, and people have to learn new warning signs. Typical symptoms include any of the following: nervousness, shakiness, hunger, lightheadedness, sweating, irritability, impatience, chills, sweating, fast heartbeat, anxiety, anger, sadness, clumsiness, blurred vision, sleepiness, stubbornness, nausea, tingly or numb tongue or lips, nightmares, headaches, unusual behavior, and confusion. When blood glucose falls low enough, unconsciousness and seizures may occur. Sometimes people los Continue reading >>

Hypoglycemia - Hyperglycemia

Hypoglycemia - Hyperglycemia

Low blood sugar – hypoglycemia Hypoglycemia means "low blood glucose." It is sometimes called a "hypo" and it can happen at any time during the day or night. You suffer from hypoglycemia when your body has insufficient sugar to use as energy, or when your blood glucose level is 70 mg/dL and below. Signs and symptoms of low blood sugar include: Sudden, extreme hunger Headache Blurred vision Trembling Weakness/tiredness Cold sweat Fast heartbeat Anxiety/nervousness Irritability What to do if you have low blood sugar: Check your blood sugar to confirm that your blood glucose is 70 mg/dL or below. Apply the 15/15 rule: Have 15 grams of a quick-acting carbohydrate, for example: a glass of fruit juice; three to four teaspoons (1 tablespoon) of sugar in water; or five-six hard candies. Or-- you can take glucose gel or glucose tablets (see label for 15g amount) Wait 15 minutes and check your blood sugar again. If your blood glucose level is still low, continue to: Alternate 15 grams of glucose with waiting 15 minutes to test your blood glucose until it reaches an acceptable target. Be sure to eat your next meal to prevent another low blood sugar reaction. If symptoms persist, call your doctor. High blood glucose – hyperglycemia High blood glucose can occur when your food, activity and medication are not balanced: too much food, not enough activity and not enough medicine. It can also happen when you are unwell or under stress. If you have high blood glucose levels, you may be more prone to infection. And an infection can cause your blood glucose level to rise even more. Signs of hyperglycemia Hyperglycemia or high blood glucose is a key indicator of diabetes and therefore, the symptoms are the same as the symptoms of diabetes. These include: Frequent urination Excessive thi Continue reading >>

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