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Patient Instructions

If you have diabetes, you should know the basic steps for managing it so that you stay as healthy as possible. Poorly managed diabetes can lead to many health problems.

All people with diabetes should know:

• How to recognize and treat low blood sugar (hypoglycemia)
• How to recognize and treat high blood sugar (hyperglycemia)
• Diabetes meal planning
• How to monitor your blood sugar
• What to do when you are sick
• Where to buy diabetes supplies and how to store them
• What checkups you may need

If you take insulin, you should also know:

• How to give yourself insulin
• How to adjust your insulin doses and foods you eat if you exercise

You should also live a healthy lifestyle. This includes exercise. You should do at least 30 minutes of fast walking 5 days a week. Make sure you follow your meal plan.

Take your medicines the way your doctor and nurse ask you to.

Checking your blood sugar levels often and writing down the results will tell you how well you are managing your diabetes. Not everyone with diabetes needs to check their blood sugar every day, but some may need to check it many times a day.

Usual times to test your blood sugar are before meals and at bedtime. Other times to check your blood sugar may be:

• After you eat out, especially if you have eaten foods you do not normally eat
• If you feel sick
• Before and after you exercise
• If you have a lot of stress
• If you eat too much
• If you are taking new medicines

Keep a record for yourself and your doctor or nurse. This will be a big help if you are having problems managing your diabetes. It will also tell you what you did when your diabetes management is good. Write down:

• The time of day
• Your blood sugar level
• The amount of carbohydrates or sugar you ate
• The type and dose of your diabetes medicines or insulin
• The type of any exercise you do and how long you exercise for
• Any unusual events, such as stress, eating different foods, or being sick

You and your doctor should set a target goal for your blood sugar levels for different times during the day. If your blood sugar is higher than your goals for 3 days and you do not know why, call your doctor or nurse.

For people with type 1 diabetes, the American Diabetes Association recommends the following blood sugar targets.

Before meals, your blood sugar should be:

• From 90 to 130 mg/dl for adults
• From 90 to 130 mg/dl for children 13 to 19 years old
• From 90 to 180 mg/dl for children 6 to 12 years old
• From 100 to 180 mg/dl for children under 6 years old

After meals (1 to 2 hours after eating), your blood sugar should be:

• Less than 180 mg/dl for adults

At bedtime, your blood sugar should be:

• From 90 to 150 mg/dl for adults
• From 90 to 150 mg/dl for children 13 to 19 years old
• From 100 to 180 mg/dl for children 6 to 12 years old
• From 110 to 200 mg/dl for children under 6 years old

For people with type 2 diabetes, the American Diabetes Association recommends the following blood sugar targets.

Before meals, your blood sugar should be:

• From 70 to 130 mg/dl for adults

After meals (1 to 2 hours after eating), your blood sugar should be:

• Less than 180 mg/dl for adults

Symptoms of high blood sugar (hyperglycemia) may include:

• Being very thirsty
• Having blurry vision
• Having dry skin
• Feeling weak or tired
• Needing to urinate a lot

High blood sugar can harm you. If your blood sugar is high, you need to know how to bring it down. Here are some questions to ask yourself if your blood sugars are high:

• Are you eating too much? Have you been following your diabetes meal plan?
• Did you have a high-fat or high-fiber meal?
• Are you taking your diabetes medicines correctly?
  • Has your doctor changed your medicines?
  • If you take insulin, have you been taking the correct dose?
  • Are you afraid of having low blood sugar? Is that causing you to eat too much or take too little insulin or other diabetes medicine?
  • Have you injected insulin into a scar or overused area? Have you been rotating sites?
• Have you been less active than usual?
• Do you have a cold, the flu, or another illness?
• Have you had some stress?
• Have you been checking your blood sugar every day?
• Have you gained weight?

Call your doctor if your blood sugar is too high or too low and you don’t understand why. When your blood sugars are in your target range, you will feel better and your health will be better.

Hyperglycemia - control; Hypoglycemia - control; Diabetes - blood sugar control

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008 Jan;31 Suppl 1:S12-54.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.