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UNDERSTANDINGA Client Care Module:
BLOOD SUGARMay be copied for use within each physical
location that purchases this inservice.
©1998-2016
A Client Care Module:
Understanding Blood Sugar
WHAT IS BLOOD SUGAR
Inside ThisInservice:
Monitoring Blood
Sugar
2-3
Hypoglycemia 4
Hyperglycemia 5
Diabetes Facts 6
Negative Effects of
Sugar
7
Blood Sugar Q & A 8
Blood Sugar Facts 9
Developing Top-Notch CNAs, One Inservice at a Time
You probably work with a numberof clients who have diabetes. Youmay hear about these clientshaving high blood sugar or lowblood sugar. You may even beresponsible for checking theirblood sugar levels with aglucometer. But what is the bigdeal about blood sugar anyway?Why is it so important for diabeticsto control their blood sugar levels?
Let’s start at the beginning. Ourbodies turn most of the food weeat into sugar. This sugar flowsthrough our blood, ready to giveour cells the energy that theyneed. But there’s a catch! The onlyway for the blood sugar to getinto our cells is by being“carried” in by insulin. (Insulin isa hormone that our bodies makenaturally.)
People with diabetes do not haveenough--or any-- insulin to carry allthe sugar from their blood to theircells. Their bodies don’t get theenergy they need, and the extrasugar in their blood can do lots ofdamage.
The trick is for diabetics to eat theright foods and to take the rightmedicines so that they have justenough insulin to carry the sugarfrom their blood into their cells.Too much insulin can make apatient just as sick as too muchblood sugar.
The best way to know if a diabeticclient is in balance is to keep trackof the blood sugar level. Bylearning more about blood sugar,you can play an important role inhelping your clients control theirdiabetes.
Controlling diabetes meanskeeping a balance
between the amountof blood sugar and the
amount of insulin.
© 2016 In the Know, Inc. Page 2A Client Care Module: Understanding Blood Sugar
After a meal, blood sugarshould be less than180 mg/dl.
Whether you have been trainedto check blood sugar levelsyourself, or a nurse or your clientsdo the checking, it’s important toknow the recommended levelsfor blood sugar. Here are thetypical normal levels:
Normal blood sugar beforebreakfast should be between 70mg/dl and 100 mg/dl. (Ablood sugar level of 126 mg/dl or higher after fastingovernight probably meansthe person has diabetes.)
Normal Blood Sugar Levels
Why Bother Checking Blood Sugar Levels?
Is it really necessaryfor diabetics to checktheir blood sugarlevels several timeseach day? YES!There are severalreasons why this isimportant, including:
Feeling better.When diabeticclients have stable blood sugarlevels, they feel better…physically, emotionally, andmentally. Frequent monitoring isthe only way to make sure thatdiabetics have achieved thatdelicate balance between bloodsugar and insulin.
Preventing long term problems.Research shows that high bloodsugar can lead to seriousdiseases, such as kidney disease.If your clients have their bloodsugar under control, it will lessenthe risk of developing any ofthese complications.
Avoiding emergencies.Diabetics who don’t check theirblood sugar are much more likelyto have an immediateemergency. If a client complainsof some of the symptoms of highor low blood sugar, do not ignorethem. Even if they test normally,consult your supervisor or theclient’s doctor immediately!
Blood sugar should be testedfour times per day, beforeevery meal, and before bedtime. Even one missed testcan lead to an emergency!Help your diabetic clients stickto a regular daily schedule ofmonitoring their blood sugar.
NOTE: “Milligrams per deciliter”(mg/dl) is the traditional unit formeasuring blood sugar.
Encourage clients to get inthe habit of charting andtracking their blood sugarlevels. This helps themwatch for any patternsdeveloping in their bloodsugar. Sometimes, thereare long term healthproblems that can bedetected through thesepatterns. Tracking dailylevels can beverybeneficialto theclientand tohealthcareworkers.
During everyday activities,blood sugar should rangefrom 100 mg/dl to 140 mg/dl.
© 2016 In the Know, Inc Page 3A Client Care Module: Understanding Blood Sugar
The Whole Blood Glucose Testis performed using a simplekit. Many diabetics learn tocomplete this test themselvesby doing a finger prick with asmall needle called a lancet. Asmall droplet of blood fromthe finger is then placed on amachine called a glucometer.
After a few seconds, the
The Whole Blood Glucose Test
glucometer comes up with ablood sugar reading,determining if the client haslow, normal, or high bloodsugar. This test is the easiesttest to perform withoutprofessional help. In somestates, nursing assistants areallowed to use a glucometer.
To begin, the person’s bloodis drawn to get a “baseline”
blood sugar reading. Thislevel will most likely below, since the person hasfasted for eight hours.The person is then askedto drink a beveragecontaining 75 grams ofglucose.
The Oral Glucose ToleranceTest is performed tounderstand thedifferent reactions aclient may have tonormal levels ofsugar. A client can’teat or drink for eighthours before the startof the test.
The Oral Glucose Tolerance Test
The Fasting Plasma GlucoseTest measures the level ofsugar in the plasma portion ofthe blood. A sample of bloodis drawn from a vein on theinside of the elbow. Theblood is then spun at a highspeed inside of a machinecalled a centrifuge.
The Fasting Plasma Glucose Test
If you are helping clients checktheir blood sugar levels, makesure that their hands and yoursare cleaned with soap andwater.
It is less painful to prick the sideof a finger near the fingernail.This avoids damage on thefrequently used “pad” of thefingertip.
After two hours, the person’sblood is drawn again, and ablood sugar reading is taken.The “before” and “after”readings are compared, and adoctor is able to understandhow well the person’s bodyreacts to a normal amount ofsugar.
As the tube of blood spins,the plasma separates fromthe blood cells. The plasmarises to the top of the tube,and can then be measuredfor sugar levels. The normallevel of glucose for this typeof test is less than 120 mg/dl.
Like the Oral GlucoseTolerance Test, this test mustbe performed on an emptystomach. This means that aclient must not eat or drinkanything for eight hours. Ifyou have a client who isscheduled for these tests,make sure to remind themthey can’t eat or drink!
Hypoglycemia is the medicalterm for low blood sugar(<70mg/dl). A potentiallyserious condition, low bloodsugar usually develops fairlyquickly, sometimes within justa fewminutes.
What Is Hypoglycemia?
Dizziness
Pale skin color
Persistent sweating
Wet or clammy skin
Depressed mood
Irritability
As the body reacts to a suddendrop in blood sugar levels, anumber of symptoms may occur.Watch your diabetic clients forthese signs of hypoglycemia:
All over feelings of weakness
Drowsiness
Hunger
Trouble focusing and/orconfusion
Unexpected fainting
Unusually fast heart beat
A Client Care Module: Understanding Blood Sugar © 2016 In the Know, Inc Page 4
The Signs and Symptoms of Hypoglycemia
A sudden drop in your client’sblood sugar may be due to anillness or infection, too muchdiabetes medication, skippingmeals or snacks, consumingalcoholic beverages, orgetting more exercise thanusual.
If hypoglycemia goes untreated,it can lead to a life threateningcondition known as “insulinshock.” The following symptomsare signs of a severehypoglycemic problem:
Severe headache
Continued symptoms ofhypoglycemia after eating
Seizures
Loss of consciousness
If you notice any of these signs inyour clients, notify yoursupervisor right away. Your clientis facing a medical emergency!
Insulin Shock
IMPORTANT:
More than half of all episodesof low blood sugar occurs at
night, when the person is mostlikely to sleep through the
early warning signs. GET HELPIMMEDIATELY if you everhave trouble waking up a
diabetic client.
Remember...if the bloodsugar is LOW, the client will
be SLOW and WET.
Low blood sugar isuncommon in people who donot have diabetes.
Among diabetics, people whotake insulin are more likely tosuffer from hypoglycemiathan people who use pills ordiet to manage theircondition.
What Is Hyperglycemia?
A Client Care Module: Understanding Blood Sugar © 2016 In the Know, Inc. Page 5
Hyperglycemia is the medicalterm for high blood sugar(>180mg/dl). Hyperglycemiais a dangerouscondition and isthe major causeof complicationsamong peoplewith diabetes.
Undergo surgery.
Suffer from an infection orillness.
The onset of high blood sugar isusually slow. It can take from afew hours to a few days todevelop—depending on thecause.
High blood sugar can occurwhen diabetics:
Get off schedule with theirinsulin injections ordiabetes medication.
Eat more food thannormal or eat foods highin sugar.
Feel stressed out.
Diabetic Coma...And More!
If a person with high bloodsugar is not treated,something called a “diabeticcoma” canoccur. Thiscondition occurswhen the bodydoes not haveenough insulin.
This condition can be lifethreatening, and should betreated immediately. Thereare several symptoms whichinclude:
Dry mouth.
Nausea and/orvomiting.
Shortness of breath.
High blood sugar can lead tosome of the followingcomplications if not treated:
Nerve damage
Kidney disease
Damaged bloodvessels
Eye disorders
The Signs and Symptoms of Hyperglycemia
There are many warning signsthat a client is developing highblood sugar. Some symptomsmay be so subtle that they gounnoticed. Be prepared to watchfor all the symptoms ofhyperglycemia.
Constant fatigue
Body aches
Dry or itchy skin
Dry mouth
Excessive thirst
Excessive hunger
Frequent urination
Blurred vision
Headaches
And some long term signs:
Weight loss
Slow healing time forcuts and scrapes
Remember...if the bloodsugar is HIGH, the client
will feel DRY.
© 2016 In the Know, Inc. Page 6A Client Care Module: Understanding Blood Sugar
Diabetes has jumped up tothe fourth leading cause ofdeath in the United States.Most of these deaths are theresult of heart disease andhigh blood pressure.
The risk of stroke andheart disease is 2 to 4times higher in peoplewith diabetes.
Up to 65% ofpeople withdiabetes have high
Diabetes is a chronic diseasefor which there is no cure.
It’s true! Diabetes is definitelyon the rise—in the U.S. andaround the globe. Every year,more than one millionAmericans learn that theyhave diabetes...and manymore face a high risk for thedisease.
Nearly one in four Americansover the age of 65 havediabetes.
The Facts on Diabetes
Diabetes Can Happen To Anyone!
Have you heard of Elvis Presley,Ernest Hemingway, Arthur Ashe,Sugar Ray Robinson, Mary TylerMoore, Halle Barry, Thomas Edison,or Elizabeth Taylor? Did you knowthey were all diabetics?
The Centers for DiseaseControl wants everyone toknow that more and morepeople are developingdiabetes, especially theelderly and certainminority populations.Doctors are workingon a cure fordiabetes, but forright now, if youhave diabetes, youhave it for life.
$176 billion are spent everyyear in the United Statestaking care of diabeticpatients. Much of this moneyis spent treating thecomplications caused bydiabetes. And, why are thereso many complications?
blood pressure and up to 70%have some level of nervedamage.
Over 20,000 people lose theirsight every year due tocomplications from diabetes.
Every year, morepeople die fromdiabetes than all thedeaths from AIDS,breast cancer, and caraccidents combined.
New studies show that one inthree American children willdevelop diabetes in theirlifetime. Why? ManyAmerican kids do not exerciseenough and are taught toovereat. These unhealthyhabits increase a person’s riskfor developing diabetes laterin life.
Two out of threepeople who have diabetes
will develop some typeof complication,whether it is heartdisease, blindness, orkidney failure.
The average American consumesabout 150 pounds of sugar everyyear! In addition to the risk fordiabetes, consuming a high sugardiet can:
1. Weaken the immune system.
2. Make the body less able tofight off bacterial infections.
3. Cause kidney damage.
4. Increase the risk for cancer ofthe gall bladder.
5. Lead to cancer of the breast,ovaries, prostate, and rectum.
6. Weaken eyesight drastically.
7. Increase the risk forhypoglycemia—lowblood sugar!
8. Heighten the risk fordeveloping coronaryheart disease.
9. Speed up the aging process,promoting grey hairand wrinkles!
10. Contribute to alcoholism.
11. Promote tooth decay.
12. Add to excess weight gainand obesity. (Sugar is storedas fat within the body, andis very hard to burn offduring exercise.)
13. Promote the developmentof arthritis.
14. Increase the likelihood ofdeveloping gallstones.
15. Trigger the onset ofappendicitis.
16. Contribute to thedevelopment of osteoporosisin the elderly.
17. Decrease growth hormonelevels in the body.
18. Increase blood cholesterollevels.
19. Cause a jump in the systolicblood pressure.
20. Generate food allergies.
21. Provoke cardiovasculardisease.
22. Damage the composition of aperson’s DNA.
23. Increase the amount of fat in aperson’s liver.
24. Put an extreme amount ofstress on the pancreas.
25. Be a factor in constipation.
26. Influence vision, causingnearsightedness.
27. Cause hypertension.
28. Lead to headaches, includingpainful and persistentmigraines.
29. Cause depression.
30. Increase the risk fordeveloping Alzheimer’sdisease.
Eating a diet full of excess sugarcan be very unhealthy for anyone.However, for people withdiabetes, surplus sugar can haveserious...andimmediate...consequences. Youcan help your diabetic clientsavoid hyperglycemia byencouraging a balanced andnutritious diet and steering themaway from sugar-filled foods.
Thirty Negative Effects of Eating Sugar
More than 8% of theU.S. population has
diabetes. This meansthat there are more
than 26 millionAmericans with
diabetes.Unfortunately, nearly
one third of them haveNOT been diagnosed.
A Client Care Module: Understanding Blood Sugar © 2016 In the Know, Inc. Page 7
Q: I’ve heard that diabeticsshould eat complexcarbohydrates rather thansimple carbohydrates.What’s the difference andwhy does it matter?
A: Simple carbohydrates—likecandy, cake, jam, and whiteflour—are absorbed anddigested by the body veryquickly. This causes a suddensurge of sugar into thebloodstream, which can leadto problems, especially for adiabetic whose healthdepends on a stable bloodsugar level. Complexcarbohydrates—such aswhole wheat bread and pasta,brown rice, dried beans, andvegetables—are absorbedand digested slowly, resultingin a steady level of sugar inthe blood. It is a healthypractice for everyone,especially people withdiabetes, to include plenty ofcomplex carbohydrates intheir daily diet in order tomaintain the body’s delicateblood sugar balance.
Q: My diabetic client eats afairly balanced diet, but heloves to drink a glass of colaevery day. Should I try toget him to switch to fruitjuice instead?
A: While fruit juice offers morenutrition than cola, they willboth have a similar impact onyour client’s blood sugar. An8-oz glass of cola containsabout 6 teaspoons ofsugar...and a glass of orangejuice is about the same! Dietdrinks are one way to avoidexcess sugar, although someresearchers have found thatany sweet food or drink, eventhose containing artificialsweeteners, may cause aperson’s blood sugar to spike.Sweet drinks also keep aperson’s “sweet tooth” active.Your client would be betteroff drinking a big glass ofwater with a slice of lemon.Or, try flavoring a glass ofwater with just an ounce offruit juice.
Q: I’d like to learn more abouthow to read food labels sothat I know when a food ishigh in sugar. What aresome other names for“sugar” that I might seelisted on a food label?
A: You’re right! Sugar has manydifferent names and can be“hidden” in a long list ofingredients. Check foodlabels for any of the followingingredients—all of which aresome form of sugar:
Barley malt
Glucose, maltose,dextrose, sucrose,fructose, lactose—andother words endingin “ose”
Corn syrup, cornsweetener
Sorghum or molasses
Rice syrup
Honey
Grape sugar or grapesweetener
Mannitol, xylitol orsorbitol
Maple syrup
Turbinado
Fruit juice concentrate
Blood Sugar Q & A
A Client Care Module: Understanding Blood Sugar © 2016 In the Know, Inc. Page 8
If your diabetic client everpasses out, it is an emergency!This could happen if theblood sugar gets very high orvery low.
Most diabetics have beentaught what to do when theyfeel the symptoms of lowblood sugar. Ask yourdiabetic clients if their doctortold them to eat or drink oneof these things:
4 ounces of regular cola1 tablespoon of honey6 hard candies (chewed)1 cup of skim milk4 ounces of orange juice4 teaspoons of sugar6 sugar cubes
Your clients should not eatchocolate or ice cream whenthey feel like their blood sugaris low. These foods are highin fat, and that slows thesugar from getting into theblood where it is needed.
A few episodes of high bloodsugar are common fordiabetics. The problems reallystart when the blood sugarstays high for a long time.
Why do many diabetic clientshave an amputation? Highblood sugar causes damageto blood vessels. When theblood vessels are weakened,
Key Points About Blood Sugar
A Client Care Module: Understanding Blood Sugar © 2016 In the Know. Page 9
People with diabetes shouldalways be diligent to checktheir blood sugar regularly.They should be especiallycareful and test more oftenwhen they are:
Sick.
Pregnant.
Traveling.
Driving.
Changing their exercise oreating plan.
Drinking alcohol.
Starting new medications.
These factors can trigger adifferent body response, soyour clients should be extracautious.
Reminding yourdiabetic clients tocheck their bloodsugar may be the best
way to help controltheir diabetes. Ask
your supervisorfor other ways
you can helpeachindividualclient whohas diabetes.
blood can’t move as easilyfrom the heart to the rest ofthe body—especially the feet,legs, and skin. If body tissuedoesn’t get a good bloodsupply, it dies.
Diabetics should always taketheir insulin or diabetes pills,especially when they are sick.Let your supervisor know ifyour patient has the flu andrefuses to take his diabeticmedicine. Remember, whenyour client is sick, their bloodsugar levels can rise!
How can a diabetic clienthave a bad cut on the leg andnot notice? High blood sugardamages nerves. When thishappens, the patient may nolonger feel pain. A sore or cutcan get infected quicklybecause the patientdoesn’t even realize it’sthere.
Because the kidneys workso hard to filter out sugar,too much sugar in theblood can causedamage. Diabetescan also causeheart trouble,stroke, andblindness whenblood vessels aredamaged by theextra sugar.
