Making the Call for Help: Warning Signs of Diabetes Disaster
Whether it's the flu season or a time of year when variables collide that can send your glucose on a wild roller coaster ride, you need to know when to call for help. Knowing when to tap into the safety net of your healthcare providers can prevent an unnecessary trip to the hospital, or worse (use your imagination).
The top 7 reasons to call your doctor and why.
1. Low glucose. Hypoglycemia (glucose less than 70) is dangerous and the number one diabetes-related emergency. If left untreated, glucose levels can plummet and cause seizures, coma, and, in the worse case, stop you from ever having to pay taxes again. Hypoglycemia is a possible side effect associated with taking pills that make the pancreas release more insulin (like Glyburide, Glipizide, Prandin, Glucotrol), or injecting the hormone insulin itself. Example of triggers for hypoglycemia include more activity than usual (watch for lows hours after finishing exercise), less food intake, alcohol consumption (especially the morning after drinking), taking the wrong amount or type of insulin (accidentally injecting the morning dose in the evening), and glucose values coming down from the 300-400 range into the target range where medications then become more effective. If you have a low, treat it, then let your doctor know about it. Medications may be reduced or changed to prevent lows from happening again. (Treat lows with 15 grams of carbohydrate — 4 oz. Juice or 3 glucose tablets — followed by retesting glucose in 15 minutes, more juice if needed, then eat). If you have a severe hypoglycemic episode (less than 45) that doesn't respond to repeated doses of 15 grams of carbohydrate, call 911.
2. High glucose. Hyperglycemia (glucose more than 200), where most of your readings are more than 250 for two days in a row, can lead you into troubled waters. Hyperglycemia can occur related to stress, illness, infection, a dietary indiscretion, pain, outdated insulin (most insulin needs to be discarded after 28 days; some insulin pens after 2 weeks — check with your CDE or pharmacist), and the flu. Left untreated, hyperglycemia can spiral upwards, dehydrating the body and putting a person at risk for ketosis, a dangerous, life-threatening situation. Treating hyperglycemia starts with staying hydrated. Unless you have developed a plan with your physician on how to handle highs (by taking extra insulin or adjusting oral medications), your best bet is to get a dial tone and call the doctor. Tell the receptionist you need to talk to your doctor or whomever is on-call today. Tell them it is urgent. Tell them you have a diabetes crisis and you want to avoid the Emergency Room. One of the biggest pitfalls is this last step where people know they are in trouble and can't get through to their doctor. Be persistent.
3. Illness. You can be healthy for years but the minute a cold or the flu finds you, or if you have nausea, vomiting, diarrhea, or an infection, your diabetes control can go right out the window. Check your glucose at least every four hours. As a guide, if your glucose if more than 180, continue your regular dose of medication. If it's less than 180, you may need less medicine, based on the recommendation of your healthcare provider. Communicate any health issues immediately. Small problems are much easier to manage. Don't play the waiting game. It can save you a lot of time, hassle, and suffering if you pick up the phone sooner rather than later.
4. Chest discomfort or shortness of breath. It has been said that diabetes is heart disease. If you notice any change in your ability to walk up a flight of stairs, or have odd sensations going on in your chest, jaw, neck, or arm, please don't keep it to yourself, unless your objective is to avoid paying any more taxes! Do you know your blood pressure and cholesterol values? Has your doctor suggested you take a baby aspirin a day? Do you have a family history of heart disease? Do you smoke? Know your risks and minimize accordingly.
5. Medication issues. Medications are like the Goldilocks and the Three Bears story: you might need to try a few before you find the medication that is just right! It may take time to figure out what's best for your body. Many people (25-50 percent) do not take their medications correctly. People stop their medications all the time because they don't like the way they feel, they are too expensive, etc. Some medications take weeks to reach full effect. Let your doctor in on how you feel. Even though a particular drug has a great track record, you may not tolerate it. Ask your doctor to try a different type. Pharmaceutical companies have programs to help offset the expense. Ask your friendly pharmacist to point you in the right direction with drug company-sponsored, low cost programs. Medications come and go. You may need some now, then not later and vice-a-versa. It's such a vital link to managing diabetes as is having a conversation with your doctor about what is working or not.
6. Painful anything. No pain, no gain is bologna. Pain is a red flag. If you have pain during urination, painful muscles, or any kind of painful condition, please share that information with your physician. Pain raises blood glucose and blood pressure. If your doctor is not taking your concerns seriously, talk to someone who will. The underlying cause of pain needs to be explored for its impact on quality of life, and for its interference with diabetes control.
7. Tune up time. Certain tests done on a regular basis assure you are on a path of health. Every 3 months, have the A1C test, and blood pressure test. Every 6 months, trot off to the dentist. Once a year, get your cholesterol checked as well as your urine microalbumin/creatinine level (big words for kidney function specific to diabetes), have an eye exam, and get your feet checked. Don't forget about the flu shot. Unless you are a dietitian, you should see one to get a refresher about food choices. And while you're there, see the nurse to look at overall blood glucose patterns.
An ounce of prevention will take you far. Your healthcare team is just a phone call away. It may be one of the best calls you make.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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