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Patient Education Program: Hypoglycemia & SMBG

Q:What is Hypoglycemia ?

Ans: As you all know that normally our regulatory systems maintains Blood Glucose levels between 80-116 mg per 100 ml of Blood i.e.‘mg%”This normal level is required for the normal functioning & day to day activities for each & every cell of our Body.Whenever the Glucose levels get lower than this normal we call it technically-Hypoglycemia & SMBG. 

Q:Why at all the levels should go down ?

  • Ans As we have told you already that treatment of Diabetes mainly evolves around the increasing the Insulin levels upwards either by stimulating it’s production from pancreas if it is feasible;or by supplying Insulin from outside by Injections!in both the situations this Insulin is not under the regulatory controls of the Body!if now the Glucose levels go down say because of –

1.Delay in food intake
2.Less Food Intake-less than usual

  • 3.Excessive exertion –more than usual- consuming excess Glucose                                                            
  • 4.Accidentally larger dose of Insulin injected
  • 5.Larger dosage of Oral Pills-intentional or by mistake

In all these situations there is Relative Excess Of Insulin as compared to Glucose & the latter is consumed by cells and levels go down Dangerously!

Q: Why at all the Low Sugar levels are so dreadful ?

Ans: All our body systems need Glucose for their activity. Brain and all it’s Important areas which Govern our Alertness-i.e.wakeful sate, memory, speech, thinking or even the lower Brain functions like Breathing, BP regulation, Heart Beats etc all need CONTINUOUS supply of NORMAL levels of Glucose If these are not available all these functions will gradually Fail. Thus person can actually fall unconscious passing from various stages depending upon the speed & quantum of lowering in the Glucose levels; and this can actually happen if one fails to recognize the oncoming symptoms of reducingGlucose.

Q: How & when the Patient should suspect that stage of Hypoglycemia is approaching?

Ans: Symptoms that should make one alert of approaching Hypoglycemia & SMBG are as under:
Cold Sweats, Tremors, Goose Skin, weakness, Headache, Confusion, Memory lapses, Palpitations, Apprehensive feel, Slurred speech, Visual impairment, disturbed consciousness, Coma …and if not promptly corrected-medically or by compensatory mechanisms of the body, the person can actually pass into deep COMA. YES and this makes Hypoglycemia – dreadful & dangerous situation.

Q: How to avoid & correct Hypoglycemia ?

Ans: Simple, Avoid all the situations enumerated above, which can lead to Hypoglycemia.
If any of the warning symptoms (see above) alone or in combination appear in a patient of Diabetes he should immediately take something to eat or Drink-a biscuit, snack, cold drink-even plain sugar or a candy will do, and then immediately inform your physician. Stay calm, stop driving if in car, wait till someone arrives or you are fully fit to move.

If you have glucometer with you, check blood glucose every 20 mins. May be 2 - 3 times till it rises above 80-100 mg.

Self Monitoring of Blood Glucose OR SMBG:

INTRODUCTION — People with diabetes have an important role in their own medical care, and self-glucose monitoring is an opportunity for people with diabetes to take control of their own health, I frequently tell my patients  “My role is that of an air-traffic control tower and YOU are the pilot, controls of the plane are with you and you have to make a successful landing, I can only guide you to the runway”!
Although diabetes is a chronic condition, it can usually be controlled with lifestyle changes and medication. The main goal of treatment is to keep blood glucose levels in the normal or near-normal range. Monitoring blood glucose levels is one of the best ways of determining how well a diabetes treatment plan is working for you.
No doubt , your doctor will periodically order laboratory blood tests to determine your blood glucose levels and hemoglobin A1c (A1C). The results of these tests give an overall sense of how blood glucose levels are being controlled .However, fine-tuning of blood glucose levels and treatment also requires that patients monitor their own blood glucose levels on a day-to-day basis.

BENEFITS: Therefore, SMBG can aid in diabetes control by the following :

A)Since no two patients will behave exactly the same, even with similar therapies being given ,SMBG facilitates the development of an individualized blood glucose profile, which can then guide doctors in treatment planning for an individualized diabetic regimen; 
B)Helps people with diabetes and their families by giving them  the ability to make appropriate day-to-day treatment choices in terms of  diet and physical activity as well as in insulin or other agents; 
C)By improving patients’ recognition of hypoglycemia or severe hyperglycemia : LOWS & HIGHS”. Allows  them to actually co-relate their symptoms with blood glucose levels.
D)By enhancing patient education & understanding of his diabetes and  imparting patient empowerment, regarding the effects of lifestyle and pharmaceutical intervention on control. 
E)Since they can easily correlate their symptoms with actual levels of glucose in their blood and can also see themselves, how the changes in lifestyle, diet and treatment are being translated into good control 
F)They do develop a better sense of responsibility and awareness towards their ailment.
G)SMBG helps them planning out necessary changes required during different and out of routine situations ,say their travel, religious fasts, sick days etc.
H)Patients can also cross check their levels with those of laboratories and learn soon to relate them with their HbA1c –a big step towards understanding the value and need of long term complications of the disease.
I) Understanding concepts of pathogenesis of Diabetes and of glucose generation vs utilization in the body ,become much easier to them.
J)Patients can actually measure the “glucose productions” after different meal compositions as well as different meal timings and get prepared to take appropriate corrective measures well in time, having learnt from their past experiences, this saves them from un-necessary hospitalizations and reduces monetary burdens involved , in other words a great saving of resources -at individual, family and national levels! 
E.G. avoiding hospitalization on account of Hypoglycemia ,when detected in time and at home saves money and trouble of hospital admission !
K)It gives people confidence about their glucose levels at critical times, such as prior to driving or in a work context.
L)It provides reassurance and supports psychological well-being by increasing feelings of control having things in-control!
M) It enables temporary insulin use.
N)Induces positive behavioral changes

IMP: Irrespective of the debate and controversies related to use of SMBG in Type 2 Diabetes NOT using Insulin, it(SMBG) makes every Diabetic In-charge of his/her own ailment and makes him responsible for his day to day conduct-Empowerment of the patient along with development of responsibility inducing behavior ,which develops automatically and this in my opinion is a big step towards controlling the onslaught of this otherwise ever enlarging problem.

For the family and society:
Better managed diabetics, better skilled diabetics, better educated diabetics means-
-less sickness and work absenteeism ,
-less burden on hospitals & national resources-
-less expenses on diabetes management
-lesser complication rates
-Huge savings in terms of money, resources , health, man-power .
More  healthy sets of skilled and semi skilled hands and brains available for national productivity and that too for longer durations- with increased longevity.

HOW TO TEST — The following steps include general guidelines for testing blood glucose levels; specific details for individual blood glucose monitors should be obtained from the package insert or a doctor/diabetes educator.
-Wash hands with soap and warm water. Dry them. Check setting on your lancing device it should be on the lower side 1 to 3 !
-Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet, and can cause more pain and injury to the skin.BUT you can use one lancet in the same patient for as many as 6 times!
-Prepare the blood glucose meter and test strip (instructions for this depend upon the type of glucose meter used).
-Use the lancing device to obtain a small drop of blood from the fingertip or alternate site (like the skin of the forearm). Alternate sites are often less painful than the fingertip. -However, results from alternate sites are not as accurate as fingertip samples when the blood glucose is rising or falling rapidly.
-Patients who have difficulty getting a good drop of blood from the fingertip can try rinsing the fingers with warm water, shaking the hand below the waist, or squeezing (“milking”) the fingertip. Preferably before the prick.
-Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds.
-Dispose of the used lancet in a puncture-resistant sharps container (not in household garbage bin).
SCIENCE BEHIND FREQUENCY OF TESTING — Studies have proven that patients with type 1 and 2 diabetes who maintain normal or near normal blood glucose levels most of the times I n 24 hrs and on day to day basis, have a lower risk of diabetes-related complications. The frequency of monitoring will depend upon the type of diabetes (1 or 2) and treatment used (insulin versus oral medications).