1. UNIT FOUR LESSON 10 Monitoring Blood Glucose

2. Objectives At the end of the lesson, participants should be able to: 1. State the benefits of blood glucose monitoring 2. Identify recommended blood glucose ranges for different periods of the day 3. Identify causes for high and low blood glucose 4. Choose to monitor their blood glucose daily 5. Continue to set or revise goals that relate to managing their diabetes 6. Describe feelings and experiences of living with diabetes 7. Identify ways to modify everyday recipes to fit into the diabetes meal plan

3. L-esson

4. Monitoring Blood Glucose Lets you know your blood glucose level at the time of testing Monitoring is especially important if you: Take insulin Notice blood glucose is very low or very high Have difficulty managing your blood glucose

5. Benefits of Monitoring Blood Glucose Tells your blood glucose at the time of testing Shows if your blood glucose level is high, low, or within target range Helps you make appropriate changes in your daily habits Helps your doctor or health care team make changes to your treatment plan

6. When Should You Monitor? Before meals or after a big snack

7. When Should You Monitor? One to two hours after breakfast, lunch, and dinner (or an especially big snack)

8. When Should You Monitor? Before you go to bed

9. Monitor More Often When: You are sick You are stressed

10. Monitor More Often When: You are taking a new medication that affects your blood glucose

11. Monitor More Often When: You change your physical activity pattern

12. Monitor More Often When: You change the amount of carbohydrates containing foods you eat each day

13. Monitor More Often When: Blood glucose level is consistently outside the range set by your doctor

14. Monitor More Often When: You have symptoms of high blood glucose

15. Monitor More Often When: You have symptoms of low blood glucose: Palpitations Rapid heart rate Nervousness Sweating

16. Monitor More Often When: You have symptoms of low blood glucose: Hunger Headache Sudden moodiness or behavior change Difficulty paying attention

17. How to Treat Hypoglycemia Take a blood glucose reading

18. How to Treat Hypoglycemia Take: 3 to 4 glucose tablets ½ cup of juice or regular soda (not diet) 2 tablespoons raisins 1 cup milk 5 to 6 pieces of hard candy 1 tablespoon of sugar or honey

19. How to Treat Hypoglycemia After 15 minutes, check your blood glucose again If it’s still too low, have another serving Repeat these steps until your blood glucose level is 70 mg/dL or higher If it will be an hour or more before your next meal, have a snack as well

20. Important! If the signs of hypoglycemia do not improve after eating a snack or you are not able to take anything by mouth, contact an emergency number such as 911

21. Blood Glucose Goals TimeGoal Before you eat70 to 130 mg/dL 2 hours after eatingLess than 180 mg/dL Bedtime110 to 150 mg/dL

22. What Is Needed to Monitor Blood Glucose Blood glucose meter or monitor Lancing device (tool used to get a drop of blood) Alcohol pads Soap and water to wash hands before testing

23. How to Monitor Blood Glucose Levels Wash and dry your hands Insert the test strip into the meter Prick yourself with a sterile lancet to get a drop of blood Squeeze finger until the drop of blood forms (the amount of blood that is needed varies depending on the type of meter)

24. How to Monitor Blood Glucose Levels Place the drop of blood on the test strip Place the strip in the meter and wait for your blood glucose number to appear. Record the number (test result) in your diabetes record book. Also include: date, time, medication and dosage, what you ate, and exercise. Make a note about anything that was out of the ordinary. Dispose of the lancet and strip in a safe place.

25. How to Record Blood Glucose Results Keep track of your blood glucose levels in a journal Write down the blood glucose value each time you check Take note of everything that changed your blood glucose, such as eating too much or being sick

26. How to Record Blood Glucose Results Use the results to make changes in your diet and physical activity as needed Take your record to every health appointment Ask your doctor or health care team what you should do if your numbers are higher or lower than your goal level

27. Changes in Blood Glucose Levels Causes of HIGH levels Eating more than usual Exercising less than usual Taking certain medicines Not taking your diabetes medication Sickness Stress Eating foods high in glucose (sugar) Causes of LOW levels Eating less than usual or delaying or skipping a meal Exercising more than usual Taking more insulin than needed Taking too much medication Drinking alcohol

28. E-mpowerment Diabetes Education Series: Monitoring Blood Glucose

29. Diabetes Education Series Describe your experiences with monitoring blood glucose. What was most difficult for you? What are ways that you could overcome some of these difficulties?

30. A-ction Did you accomplish the goal you set last week? Set a goal related to monitoring blood glucose

31. R-eal-Life Problem Solving Annabelle’s Story

33. Questions about Annabelle’s Story What is Annabelle’s problem? What can Annabelle do if her doctor tells her that her problem is not severe hypoglycemia ? What other information would you pass on to Annabelle about checking her blood glucose number?

34. Questions about Annabelle’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Annabelle’s story

35. N-utrition Menu: Two-Cheese Pizza Spinach Dip with Vegetables

36. See you next week! Topic for the next week: Foot Care You are in control; work at reaching your goal.

37. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors