ACTION PLANS

It helps to have an action plan in place for certain occasions when your blood sugar is not within range.

Familiarise yourself with action plans for the following occasions:

1. Sick day Management

2. Ketone Management

3. Low blood sugar Management

1. Sick day Management

Infections and illness place stress and strain on your body, increasing it's need for insulin.

What kind of illnesses can affect your blood glucose levels?

Head or chest cold
Flu
Nausea and/or vomiting
Toothache
Sore throat
Fever (high temperature)
Diarrhoea
Other illnesses/infection

Your blood sugar levels can change very quickly when you are ill so it is important that you test more often.

Test for ketones in your urine if you have type 1 diabetes or your blood sugar level is over 14mmol/L or if you are vomitting or nauseous.

Watch out for signs of dehydration, like thrist, dry mouth, dry skin, dark urine or very little urination.

What can you do when you are sick?

Remember not to stop your diabetes pills or insulin, even if you cannot eat. Ask your diabetes care team how you should adjust your dosage of your medication.

If you drink lots of fluids you can avoid dehydration. Try to drink at least 1 cup (200ml) of liquid (kilojoule-free) every hour such as:

- Decaffeinated tea

- Diet soft drinks

- Water

- Broth or clear soup

If you have an upset stomach, try to take small sips of liquid every 15minutes, to prevent vomiting. If you cannot eat meals, you can drink liquids or try to eat soft foods to replace the carbohydrates you would have been eating.

15g carbohydratees (e.g 1 slice bread) can be replaced by any of the following:

1 cup fruit juice
1 cup ice cream
1 cup regular soft drink with sugar
1 cup broth or clear soup (like chicken noodle)

2. Ketone Management

What are Ketones?

Ketones are what your body produces when it uses fat for energy and fuel. They are produced when there is not enough insulin to help the body use sugar as a source of energy. Sugar builds up in the blood resulting in high sugar levels, and the body then turns to fat in your body for a source of energy, creating ketones.

When to test for ketones?

Whenever one of the following is present, you should test for ketones:

Blood glucose level greater than or equal to 14mmol/L
Abdominal pain
Nausea/Vomiting
If you are suffering from any illness or infection

How to test for ketones?

There are two ways to test for ketones – either in the urine or in the blood.

It is recommended that for children blood ketone levels are tested as ketones first appear in the blood stream and are detected only later in the urine once processed by the kidneys.

1. Urine dipstick

Pass urine directly onto the strip, then read the colour change

against the scale on the bottle after exactly 15 seconds.

The result is shown as either negative (-) or positive (+) as follows:

Negative+/-++++++++++

***Remember:Ketone strips expire every 6months afteropening the bottle, so write the date of opening on the bottle and replace it after 6months.

2. Blood ketone testing

Some glucometers measure blood glucose levels but

also blood ketone levels from a drop of blood.

Management

Treatment involves two parts, namely, correcting the insulin deficiency (insulin shortage) and correcting dehydration.

Follow the steps below:

3. Low Blood Sugar Management

Hypoglycaemia is the medical term for low blood glucose. It can also be called a "hypo". The term is derived as follows:

Hypo = low glyc= glucose (sugar) aemia = blood

Any blood glucose level less than 4mmol/L is considered too low and needs to be corrected. People who are on insulin therapy, or people who take a certain type of sugar control tablet (sulphonyureas), may experience hypo's.

Hypo-glycaemia must not be confused with hyper-glycaemia, which means high blood sugar.

Hypo's can be dangerous, and in the treatment and management of diabetes, we try to avoid them.

The most common causes of hypo's are:

Too much insulin/medication in relation to food intake (carbohydrates)
Excercise (with no adjustment of medication dose)
Alcohol (more than 2 drinks)

Signs and symptoms of a hypo are easy to recognise. It is important that you, your family and work colleagues all know what to look out for:

Early signs and symptoms

(usually felt by yourself)

Sweating
Shaking
Hunger
Anxiety
Fast heartbeat

Late signs and symptoms

(usually noticed by others)

Confusion
Behaviour change (often aggresive)
Drowsiness
Coma (with or without convulsions)

The signs and symptoms of hypoglycaemia can feel scary but this is the body's way of warning you that something is wrong.

People do react differently to a hypo, and in some people, the warning signs may be minimal, or they may not occur at all. The loss of these warning signs is dangerous, and people who do not experience warning signs need to take extra care. These people are commonly known as "hypo unaware".

People who have had high blood sugar levels for a prolonged time may feel symptoms of hypoglycaemia when their blood sugar levels drop to normal. This is called "relative hypoglycaemia".

What to do if experiencing a hypo:

Prompt treatment of hypo's is essential to prevent further dropping of the blood glucose level. THERE SHOULD BE NO DELAY.

Important: If the hypo is recognized by you early enough, you can take action yourself, to treat the hypo. If the hypo has progressed to the stage where you become unconscious, then people around you will have to assist.

Treatment of early stage hypo's

This is where you recognise the hypo and are able to eat, drink and measure your blood glucose levels.

The best treament is to eat/drink 15g of very quickly absorbed carbohydrate. Examples include:

- 1/2 glass of regular cold-drink (with sugar, like Coke)

- 3-5 glucose sweets

- small glass of fruit juice

If your next meal is more than 1 - 2 hours away, follow this with a slow release form of carbohydrate such as a glass of milk or a slice of bread. Always wait at least 10minutes after the quick release carbohydrate before eating the snack. This is to give the glucose a chance to get absorbed. Check your blood glucose 15 minutes later to make sure it is back in the target range.

Treatment of late stage hypo's

This is where you are unable to eat, drink and measure your blood glucose levels. In this case, someone else (family member/colleague) will have to assist you.

Patients on insulin should all have a Glucagen Hypkit.

This is an emergency injection that can be given by a family member/friend

who has been trained to do it. It raises the blood glucose level by stimulating

the liver to release stored glucose into the blood.

Importantly it takes 10minutes to work.

It is important to know that once this emergency injection has worked

(you have regained consciousness), you should then continue to monitor your

blood sugar levels and eat and drink if necessary. It is advisable to speak to your diabetes health care provider at this time.

What must I do after the hypo?

If you have had a hypo coma (become unconscious), contact your health care provider to disucss possilbe causes and steps to take to prevent a recurrence.

Keeping a diary can help you to assess specific causes of hypos which can help you to adjust your treatment to prevent them.

Remember, it is extremely dangerous to drive a motor vehicle if you have a hypo.