Managing blood glucose levels

Hypoglycaemia (Hypos / Lows)

• Have a Hypo treatment and retest your blood glucose in 15 minutes
• There is a list of Hypo treatments in the next section

Sometimes you might feel tired, hungry, pale, weak, sweaty, shaky, grumpy, dizzy or have a headache. This might mean that you blood glucose is low.

If you feel your blood glucose might be low: check with a fingerprick test.
If your blood glucose is below 4 mmol/L this is called Hypoglycaemia, or a hypo for short.

(Hypoglycaemia is the Greek word for low blood sugar!)

What causes Hypos?

• Too much insulin
• Not eating all the food you have taken insulin for
• More exercise than usual

What are the clues that I’m having a hypo?

• Feeling hungry, tired or looking pale
• Feeling sweaty, shaky or grumpy
• Having a headache, feeling faint or feeling sleepy
• Mood change
• Losing concentration
• If very blood glucose is very low, you may have seizures or lose consciousness

What do I do if I am having a Hypo?

If your blood glucose is less than 4, it means that your body soon won’t have enough glucose to work properly.

You need to give yourself a small amount of simple sugars straight away. This is called a HYPO-TREATMENT (see the next section for examples)

Your body can break simple sugars into glucose very quickly so the hypo-treatment will give you the energy you need straight away.

How much simple sugar you take depends on your age and how alert you are. The hypo-treatment table on the next page shows you which hypo-treatment to take. Draw a circle around the treatments that are right for your age.

Treating a Hypo (blood glucose less than 4)

Hypos can happen if your meal or snack is late, after exercise, or if you take too much insulin. Your body will give you warning signs, learn to recognise these so you can act quickly to treat the hypo.

Symptoms of Hypoglycaemia:

• Feeling hungry, tired or looking pale
• Feeling sweaty, shaky and irritable
• Having a headache, feeling faint or becoming drowsy

If in doubt always test your blood glucose level

If your Blood glucose is less than 4:

1) Take a hypo treatment from the table below

Alert and able to drink

Up to 10 years

• Fruit juice / soft drink 90ml
• Or Lucozade 100 ml
• Or 2-3 glucotabs

Older than 10 years

• Fruit juice / soft drink 100ml
• Or Lucozade 165 ml
• Or 3-4 glucotabs

Drowsy OR unable to drink

Less than 5 years

• Glucogel / dextrogel
  half a tube

5-10 years

• Glucogel / dextrogel
  1 tube

Older than 10 years

• Glucogel / dextrogel
  1.5 tubes

Unconscious / seizures

Up to 10 years

• Glucagon 0.5mg IM +
• Call 999
• Do NOT give anything by mouth

Older than 10 years

• Glucagon 1 mg IM +
• Call 999
• Do NOT give anything by mouth

2) Re-test 10–15 minutes after treatment

If blood glucose is still less than 4 mmol/L on sensor reading, first check with a finger-prick and if less than 4 mmols

• Take another HYPO-TREATMENT and re-test in 10 – 15 minutes.

If blood glucose is more than 4mmol/L AND you will have your meal within 1 hour

• There is no need for further action – when it is time, follow your usual mealtime routine.

If Blood glucose is more than 4mmol/L and you will NOT have a meal within 1-2 hours

• You may need a SMALL SNACK (see below for options).

If blood sugar is less than 4mmol/L at meal time,

• ALWAYS have a sweet drink first, then the meal. Re-test 15 mins later, then give mealtime bolus insulin once the blood sugar has increased to > 4mmol/L.

Small snacks

10-15g carbohydrates

• One plain digestive biscuit (10 g)
• 1 slice bread with cheese or butter spread (15g)
• 2 rich tea biscuits (14 g)
• 3 cream crackers (16g)
• 100 ml glass of milk (not soya) (10 g)
• 2 Jaffa cakes (14 g)
• One small apple (10 g)

How to give a glucagon injection – for parents and carers

If your child’s blood glucose is low and they are drowsy; starting to lose consciousness or have seizures give a Glucagon injection and call an ambulance.

• For children under 8 years of age (or weighing less than 25kg) : give 0.5mg of Glucagon
• For children over 8 years of age (or weighing more than 25kg) : give 1mg of Glucagon

After giving Glucagon, the blood glucose should go up.

Once your child is alert and conscious AND their blood sugar greater than 4 give them a sandwich or substantial meal. This is to make sure their blood sugar doesn’t drop again.

Please contact the Diabetes Team if your blood sugar keeps going low.

Hyperglycaemia (Hypers / Highs)

• Your diabetes nurse will teach you how and when to give a correction bolus to “correct” your blood glucose
• You can see how to work out the correction bolus dose of insulin on page 10

If your blood glucose is above 14 mmol/L this is called Hyperglycaemia, or hyper for short.

(Hyperglycaemia is the Greek word for high blood sugar!).

When you have a lot of glucose in your blood for a long time, it starts to damage the blood vessels and veins all over your body.

Taking the right amount of insulin at the right time lets the glucose out of your blood and into your muscles where it’s needed. This brings your blood glucose level down.

What causes a hyper?

• Not enough insulin
• Eating or drinking too much carbohydrate
• Less exercise than usual
• Infection or illness
• Stress

What are the clues that I am having a hyper?

• Feeling thirsty
• Weeing a lot
• Feeling tired
• Tummy pain
• Mood change
• Losing concentration

Rules for when you are sick

• Check your blood glucose every two hours.
• Check your blood ketones every two hours.
• Follow the SICK DAY RULES in the next section.

When you are ill with a cough, cold or tummy bug, your body needs more energy to fight the illness; and you might not eat as much as usual. These things together can make you very ill.

When you are ill, it is very important that you:

• Check your blood glucose every two hours
• Check your blood ketones every two hours
• Follow the SICK DAY RULES to work out if you need extra insulin and/or hypo treatments

What are Ketones and what is DKA?

When your body can’t get enough energy from your blood glucose, it starts to breakdown your body fat into glucose to try and get more energy.

When fat breaks down into glucose, it also produces acids called ketones. If ketones build up in your blood they can make you very poorly. This is called DKA, which is short for Diabetic Keto-acidosis.

1. Without insulin, glucose is unable to be processed by the body.
2. The liver produces more glucose to feed the body, but without insulin, the glucose accumulates in the bloodstream.
3. The body needs to find an alternative source of energy and starts breaking down fat. The breakdown of fat produces ketones, which then build up in the bloodstream.
4. Ketones and glucose are transferred into the urine. The kidneys use water to clear the blood of excess glucose and ketones.
5. While the body attempts to get rid of the ketones and glucose, a lot of water is lost. This can lead to dehydration and may worsen the ketoacidosis.

What causes DKA?

• Being ill
• Not taking enough insulin

What are the clues that I moving towards DKA?

• Thirst
• Weeing a lot
• Tummy pain
• Drowsiness, rapid breathing
• High blood sugars
• Nausea / vomiting

How do I avoid getting DKA?

DKA can happen when:

• you haven’t taken enough insulin – because your body can’t move the glucose into the muscles where it is needed.
• you are ill – because your body might use up all your blood glucose to fight off infection

To avoid DKA:

• Always take your insulin at the right time and in the right quantities.
• When you are ill, test your blood glucose and ketones every two hours.
• If you have ketones in your blood: Follow the SICK DAY RULES: these tell you how to get rid of the ketones that are building up in your blood.
• If you are ill; if your blood glucose is consistently high OR if you know you haven’t taken enough insulin: Follow the SICK DAY RULES to stop ketones building up
• The simple sick day rules below show what to do when you are Ill or have ketones over 0.6. 

SICK acronym:

Sugar

Check your blood glucose every two hours.

Insulin

Always take your insulin – not taking it could lead to DKA.

Carbs

Sip lots of fluid.

If your blood glucose is high, drink sugar-free liquids.

If your blood glucose is low, drink carb-containing liquids.

Ketones

Check your ketones every four house. If your ketones are above 0.6 call for advice.

How do I test for ketones?

To test your blood ketone levels with the finger prick method you will need:

• Blood glucose meter
• Blood ketone test strips
• Finger pricker device (lancing device)
• Lancets

How to test your blood ketones with the finger prick method:

• Wash your hands in soap and warm water
• Dry your hands thoroughly
• Put a fresh blood ketone test strip into the blood glucose meter
• Put a lancet into the lancing device
• Prick your finger (remember Not to squeeze the finger)
• Put the blood onto the test strip
• Record the result in your app or write it down
• Throw away the used lancet in the sharps bin
• Throw away the used test strip

Results

Normal ketones

• Less than 0.6

Moderate ketones

• 0.6 – 1.5

High ketones

• 1.5 or higher

What to do if: your BG is less than 14 with Ketones over 0.6

ALWAYS TAKE YOUR INSULIN – EVEN IF YOU’RE UNWELL AND DON’T FEEL LIKE EATING, YOU WILL STILL NEED INSULIN

BG less than 4

• Treat for a Hypo as shown on page 21 and retest BG after 15 minutes
• If your child is struggling to keep food down or can’t eat / drink –
  give dextrose gel and call for advice
• If your child is drowsy or has reduced consciousness give IM Glucagon and call 999

BG 4 – 7

• Drink sugary drinks. Sip 150ml every two hours
• You may need to decrease your bolus insulin
• Call for advice

BG 8 – 14

• Keep sipping sugar free drinks
• Take the usual meal insulin bolus and correction dose at meal times

Re-check your BG and ketones every two hours

If your child is vomiting, unable to eat or has ketones over 1.5. Call for advice.

What to do if: your BG is over 14 (insulin pen user)

ALWAYS TAKE YOUR INSULIN – EVEN IF YOU’RE UNWELL AND DON’T FEEL LIKE EATING, YOU WILL STILL NEED INSULIN

Normal ketones (Less than 0.6)

• Take your usual correction dose of insulin with your usual meal insulin bolus
• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If blood glucose level is going down, it is a good sign but monitor closely throughout the dayIf BG is increasing but ketones are less than 0.6mmol/L give another correction dose

  If ketones 0.6-1.5mmol/L follow ‘Moderate Ketones‘ advice

  If ketones >1.5mmol/L follow ‘High Ketones‘ advice

Moderate ketones (0.6 – 1.5)

• Take 5% of your total daily dose (TDD) as additional NovorapidOR

  Take your usual correction dose of Novorapid, if that is higher

• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If ketones are less than 0.6 follow ‘Normal Ketones‘ adviceIf BG is increasing but ketones still 0.6 – 1.5mmol/L:
  Take another 5% of TDD or usual correction dose as additional novorapid

  Re-check BG and ketones every 2 hours even through the night.
  If ketones increase to 1.5mmol/l or more, follow the ‘High Ketones‘ advice

  If ketones are not dropping despite 2 correction call for advice

High ketones (1.5 or higher)

• Take 10% of your total daily dose (TDD)OR

  0.1 unit/kg body weight as additional Novorapid

• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If ketones are less than 0.6 follow ‘Normal Ketones‘ adviceIf BG is increasing but ketones have reduced to

  0.6 – 1.5mmol/L, follow ‘Moderate Ketones‘ advice

  If ketones are still >1.5mmol/L: take another 10% of TDD or 0.1units/kg as additional novorapid

  If ketones are not dropping despite 2, corrections call for advice

  If vomiting with high ketones, they may have DKA, Call for advice.

If your child has BG over 14 with ketones and is vomiting, this could be DKA. Call for advice  

What to do if: your BG is over 14 (insulin pump user)

ALWAYS TAKE YOUR INSULIN – EVEN IF YOU’RE UNWELL AND DON’T FEEL LIKE EATING, YOU WILL STILL NEED INSULIN

Normal ketones (Less than 0.6)

• Take your usual correction dose of insulin with your usual meal insulin bolus
• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If blood glucose level is going down, it is a good sign but monitor closely throughout the dayIf BG is increasing but ketones are less than 0.6mmol/L give another correction dose

  If ketones 0.6-1.5 follow ‘Moderate Ketones‘ advice

  If ketones 1.5 or higher follow ‘High Ketones‘ advice

Moderate ketones (0.6 – 1.5)

• Take 5% of your total daily dose (TDD) as additional NovorapidOR

  Take your usual correction dose of Novorapid, if that is higher

• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If ketones are less than 0.6 follow ‘Normal Ketones‘ adviceIf BG is increasing but ketones still 0.6 – 1.5:
  Continue to give 5% of TDD or usual correction dose as additional novorapid

  Re-check BG and ketones every 2 hours even through the night.

  If ketones are 1.5 or higher, follow the ‘High Ketones‘ advice

  If ketones are not dropping despite 2 correction call for advice

High ketones (1.5 or higher)

• Give 10% of your total daily dose (TDD)OR

  0.1 unit/kg body weight as additional Novorapid

• Drink plenty of water/sugar free drinks to stay hydratedRe-check your BG and ketones in two hours
• If ketones are less than 0.6 follow ‘Normal Ketones‘ adviceIf BG is increasing but ketones are 0.6 – 1.5mmol/L, follow ‘Moderate Ketones‘ advice

  If ketones are 1.5 or higher:
  Give another 10% TDD or 0.1units/kg as additional novorapid

  If ketones are not dropping despite 2 corrections call for advice

  If vomiting with high ketones, they may have DKA, call for advice

If your child has BG over 14 with ketones and is vomiting, this could be DKA. Call for advice

• Test your blood glucose before you start
• Follow the chart below to get your blood glucose above 5

When you exercise, your body uses up more glucose for energy. So, before you exercise, check your blood glucose.

The amount of activity recommended for children and young people is a minimum of 60 minutes per day. There is no exercise that you cannot do. However, there are a few simple steps to follow.

Always check your blood glucose levels before exercising

This can include walking and cycling to get somewhere!

Blood Glucose Level:

Less than 4

• Have a Hypo Treatment
• Re – test blood glucose in 15 minutes
• Only exercise once your blood glucose is above 5 and rising
• If, after 3 hypo treatments your blood glucose is still below 4, call for advice

Between 4 and 7

• Have a small snack before exercising (10 – 20g carbs)

Between 7 and 14

• Go ahead and exercise!
• Check your BG after exercising and have a hypo treatment / small snack if needed

Above 14

• If you are not expecting high BG or are feeling poorly check for ketones.
• If Ketones are below 0.6 go ahead and exercise
• If ketones are above 0.6 call the team for advice and follow Sick Day Rules

Remember:

• Always keep hypo treatments and snacks available when you are exercising
• Be aware of how you feel
• Stay hydrated
  • And have fun!