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10 Blood Sugar Hacks To Fix Post Meal Glucose SpikesBlood sugar management guidance -
Balance your meals and medicines. If you take diabetes medicine, it's important to balance what you eat and drink with your medicine.
Too little food in proportion to your diabetes medicine — especially insulin — can lead to dangerously low blood sugar. This is called hypoglycemia. Too much food may cause your blood sugar level to climb too high.
This is called hyperglycemia. Talk to your diabetes health care team about how to best coordinate meal and medicine schedules. Limit sugary drinks. Sugar-sweetened drinks tend to be high in calories and low in nutrition.
They also cause blood sugar to rise quickly. So it's best to limit these types of drinks if you have diabetes. The exception is if you have a low blood sugar level. Sugary drinks can be used to quickly raise blood sugar that is too low.
These drinks include regular soda, juice and sports drinks. Exercise is another important part of managing diabetes. When you move and get active, your muscles use blood sugar for energy. Regular physical activity also helps your body use insulin better.
These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts.
But even light activities can improve your blood sugar level. Light activities include housework, gardening and walking. Talk to your healthcare professional about an exercise plan.
Ask your healthcare professional what type of exercise is right for you. In general, most adults should get at least minutes a week of moderate aerobic activity.
That includes activities that get the heart pumping, such as walking, biking and swimming. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week. Most adults also should aim to do strength-building exercise 2 to 3 times a week.
If you haven't been active for a long time, your healthcare professional may want to check your overall health first. Then the right balance of aerobic and muscle-strengthening exercise can be recommended.
Keep an exercise schedule. Ask your healthcare professional about the best time of day for you to exercise. That way, your workout routine is aligned with your meal and medicine schedules. Know your numbers. Talk with your healthcare professional about what blood sugar levels are right for you before you start exercise.
Check your blood sugar level. Also talk with your healthcare professional about your blood sugar testing needs. If you don't take insulin or other diabetes medicines, you likely won't need to check your blood sugar before or during exercise. But if you take insulin or other diabetes medicines, testing is important.
Check your blood sugar before, during and after exercise. Many diabetes medicines lower blood sugar. So does exercise, and its effects can last up to a day later. The risk of low blood sugar is greater if the activity is new to you.
The risk also is greater if you start to exercise at a more intense level. Be aware of symptoms of low blood sugar.
These include feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused. See if you need a snack. Have a small snack before you exercise if you use insulin and your blood sugar level is low. The snack you have before exercise should contain about 15 to 30 grams of carbs.
Or you could take 10 to 20 grams of glucose products. This helps prevent a low blood sugar level. Stay hydrated. Drink plenty of water or other fluids while exercising.
Dehydration can affect blood sugar levels. Be prepared. Always have a small snack, glucose tablets or glucose gel with you during exercise. You'll need a quick way to boost your blood sugar if it drops too low. Carry medical identification too.
In case of an emergency, medical identification can show others that you have diabetes. It also can show whether you take diabetes medicine such as insulin. Medical IDs come in forms such as cards, bracelets and necklaces. Adjust your diabetes treatment plan as needed. If you take insulin, you may need to lower your insulin dose before you exercise.
You also may need to watch your blood sugar level closely for several hours after intense activity. That's because low blood sugar can happen later on.
Your healthcare professional can advise you how to correctly make changes to your medicine. You also may need to adjust your treatment if you've increased how often or how hard you exercise.
Insulin and other diabetes medicines are designed to lower blood sugar levels when diet and exercise alone don't help enough. How well these medicines work depends on the timing and size of the dose.
Medicines you take for conditions other than diabetes also can affect your blood sugar levels. Store insulin properly. Insulin that is not stored properly or is past its expiration date may not work. Keep insulin away from extreme heat or cold.
Don't store it in the freezer or in direct sunlight. Tell your healthcare professional about any medicine problems.
If your diabetes medicines cause your blood sugar level to drop too low, the dosage or timing may need to be changed. Your healthcare professional also might adjust your medicine if your blood sugar stays too high. Be cautious with new medicines. Talk with your healthcare team or pharmacist before you try new medicines.
That includes medicines sold without a prescription and those prescribed for other medical conditions. Ask how the new medicine might affect your blood sugar levels and any diabetes medicines you take. Sometimes a different medicine may be used to prevent dangerous side effects.
Or a different medicine might be used to prevent your current medicine from mixing poorly with a new one. With diabetes, it's important to be prepared for times of illness. When you're sick, your body makes stress-related hormones that help fight the illness.
But those hormones also can raise your blood sugar. Changes in your appetite and usual activity also may affect your blood sugar level. Plan ahead.
Work with your healthcare team to make a plan for sick days. Include instructions on what medicines to take and how to adjust your medicines if needed. Also note how often to measure your blood sugar. Ask your healthcare professional if you need to measure levels of acids in the urine called ketones.
Your plan also should include what foods and drinks to have, and what cold or flu medicines you can take. Know when to call your healthcare professional too. For example, it's important to call if you run a fever over degrees Fahrenheit Keep taking your diabetes medicine.
But call your healthcare professional if you can't eat because of an upset stomach or vomiting. In these situations, you may need to change your insulin dose. If you take rapid-acting or short-acting insulin or other diabetes medicine, you may need to lower the dose or stop taking it for a time.
These medicines need to be carefully balanced with food to prevent low blood sugar. But if you use long-acting insulin, do not stop taking it.
During times of illness, it's also important to check your blood sugar often. Stick to your diabetes meal plan if you can. Eating as usual helps you control your blood sugar. Keep a supply of foods that are easy on your stomach.
These include gelatin, crackers, soups, instant pudding and applesauce. Drink lots of water or other fluids that don't add calories, such as tea, to make sure you stay hydrated. If you take insulin, you may need to sip sugary drinks such as juice or sports drinks.
These drinks can help keep your blood sugar from dropping too low. It's risky for some people with diabetes to drink alcohol. Alcohol can lead to low blood sugar shortly after you drink it and for hours afterward. The liver usually releases stored sugar to offset falling blood sugar levels.
But if your liver is processing alcohol, it may not give your blood sugar the needed boost. Get your healthcare professional's OK to drink alcohol. With diabetes, drinking too much alcohol sometimes can lead to health conditions such as nerve damage. But if your diabetes is under control and your healthcare professional agrees, an occasional alcoholic drink is fine.
Women should have no more than one drink a day. Men should have no more than two drinks a day. One drink equals a ounce beer, 5 ounces of wine or 1. Don't drink alcohol on an empty stomach. If you take insulin or other diabetes medicines, eat before you drink alcohol.
This helps prevent low blood sugar. Or drink alcohol with a meal. Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, sugar-free mixers won't raise your blood sugar.
Some examples of sugar-free mixers are diet soda, diet tonic, club soda and seltzer. Add up calories from alcohol. If you count calories, include the calories from any alcohol you drink in your daily count. Ask your healthcare professional or a registered dietitian how to make calories and carbohydrates from alcoholic drinks part of your diet plan.
Check your blood sugar level before bed. Alcohol can lower blood sugar levels long after you've had your last drink. So check your blood sugar level before you go to sleep. The snack can counter a drop in your blood sugar. Changes in hormone levels the week before and during periods can lead to swings in blood sugar levels.
Look for patterns. Keep careful track of your blood sugar readings from month to month. You may be able to predict blood sugar changes related to your menstrual cycle. Your healthcare professional may recommend changes in your meal plan, activity level or diabetes medicines. These changes can make up for blood sugar swings.
Check blood sugar more often. If you're likely nearing menopause or if you're in menopause, talk with your healthcare professional. Ask whether you need to check your blood sugar more often. Also, be aware that menopause and low blood sugar have some symptoms in common, such as sweating and mood changes.
So whenever you can, check your blood sugar before you treat your symptoms. That way you can confirm whether your blood sugar is low. Most types of birth control are safe to use when you have diabetes.
But combination birth control pills may raise blood sugar levels in some people. It's very important to take charge of stress when you have diabetes. The hormones your body makes in response to prolonged stress may cause your blood sugar to rise.
It also may be harder to closely follow your usual routine to manage diabetes if you're under a lot of extra pressure. Take control. Once you know how stress affects your blood sugar level, make healthy changes. Learn relaxation techniques, rank tasks in order of importance and set limits.
Whenever you can, stay away from things that cause stress for you. Exercise often to help relieve stress and lower your blood sugar.
Get help. Learn new ways to manage stress. You may find that working with a psychologist or clinical social worker can help. These professionals can help you notice stressors, solve stressful problems and learn coping skills. The more you know about factors that have an effect on your blood sugar level, the better you can prepare to manage diabetes.
If you have trouble keeping your blood sugar in your target range, ask your diabetes healthcare team for help. There is a problem with information submitted for this request.
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You can print copies of this glucose self-check chart. Take these records with you when you visit your health care team.
Continuous glucose monitoring CGM is another way to check your glucose levels. Most CGM systems use a tiny sensor that you insert under your skin. If the CGM system shows that your glucose is too high or too low, you should check your glucose with a blood glucose meter before making any changes to your eating plan, physical activity, or medicines.
A CGM system is especially useful for people who use insulin and have problems with low blood glucose. Talk with your health care team about the best target range for you.
Be sure to tell your health care professional if your glucose levels often go above or below your target range. Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia. Hypoglycemia can be life threatening and needs to be treated right away.
Learn more about how to recognize and treat hypoglycemia. If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or medicines.
Most people with diabetes get health care from a primary care professional. Primary care professionals include internists, family physicians, and pediatricians. Sometimes physician assistants and nurses with extra training, called nurse practitioners, provide primary care.
You also will need to see other care professionals from time to time. A team of health care professionals can help you improve your diabetes self-care. Remember, you are the most important member of your health care team.
When you see members of your health care team, ask questions. Watch a video to help you get ready for your diabetes care visit. You should see your health care team at least twice a year, and more often if you are having problems or are having trouble reaching your blood glucose, blood pressure, or cholesterol goals.
At each visit, be sure you have a blood pressure check, foot check, and weight check; and review your self-care plan. Talk with your health care team about your medicines and whether you need to adjust them. Routine health care will help you find and treat any health problems early, or may be able to help prevent them.
Talk with your doctor about what vaccines you should get to keep from getting sick, such as a flu shot and pneumonia shot.
Preventing illness is an important part of taking care of your diabetes. Feeling stressed, sad, or angry is common when you live with diabetes. Stress can raise your blood glucose levels, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music.
Consider taking part in a diabetes education program or support group that teaches you techniques for managing stress. Learn more about healthy ways to cope with stress. Depression is common among people with a chronic, or long-term, illness.
Depression can get in the way of your efforts to manage your diabetes. Ask for help if you feel down. A mental health counselor, support group, clergy member, friend, or family member who will listen to your feelings may help you feel better.
Try to get 7 to 8 hours of sleep each night. Getting enough sleep can help improve your mood and energy level. You can take steps to improve your sleep habits. If you often feel sleepy during the day, you may have obstructive sleep apnea , a condition in which your breathing briefly stops many times during the night.
Sleep apnea is common in people who have diabetes. Talk with your health care team if you think you have a sleep problem. This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK , part of the National Institutes of Health.
NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.
Home Health Information Diabetes Diabetes Overview Managing Diabetes. English English Español. Diabetes Overview What Is Diabetes? Show child pages. Risk Factors for Type 2 Diabetes Show child pages.
Preventing Type 2 Diabetes Show child pages. Preventing Diabetes Problems Show child pages. How can I manage my diabetes? Your self-care plan may include these steps: Manage your diabetes ABCs Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol.
A for the A1C test The A1C test shows your average blood glucose level over the past 3 months. C for Cholesterol You have two kinds of cholesterol in your blood: LDL and HDL.
S for Stop smoking Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels.
If you quit smoking you will lower your risk for heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and amputation your cholesterol and blood pressure levels may improve your blood circulation will improve you may have an easier time being physically active If you smoke or use other tobacco products, stop.
Follow your diabetes meal plan Make a diabetes meal plan with help from your health care team. Make physical activity part of your daily routine Set a goal to be more physically active.
Swimming or water walking is a good way to move more. Take your medicine Take your medicines for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals.
Check your blood glucose levels For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes.
Checking and recording your blood glucose level is an important part of managing diabetes.
Your blood sugar target is guidnace range guidancw try guidancr reach as much as Blood sugar management guidance. Antiviral medicinal plants about Monitoring Your Blood Sugar and All About Your A1C. Staying guidanxe Blood sugar management guidance managemeng range can also help improve your energy and mood. Find answers below to common questions about blood sugar for people with diabetes. Use a blood sugar meter also called a glucometer or a continuous glucose monitor CGM to check your blood sugar. A blood sugar meter measures the amount of sugar in a small sample of blood, usually from your fingertip.Contributor Disclosures. Please read the DIY cramp relief techniques at the end of Bloor page.
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In addition, glucose monitoring should be continued so that appropriate action may be taken. Importantly, in Blood sugar management guidance with diabetes or hyperglycemia who are eating, the blood suugar monitoring should occur just amnagement the meal.
In those who are receiving nothing by mouth, or receiving continuous tube feeds or total parenteral nutritionthe blood glucose monitoring should occur at regular, fixed intervals, usually every six hours. Although continuous glucose monitoring CGM is not generally recommended for the inpatient or critical care setting, it has been used in inpatient locations more frequently since the onset of the coronavirus COVID pandemic.
See "COVID Issues related to diabetes mellitus in adults". Clinical trial data generally have shown small and perhaps not clinically meaningful glycemic benefits with CGM compared with traditional glucose monitoring [ 14,15 ]. The same study showed a small reduction in hypoglycemia reoccurrence with CGM compared with conventional monitoring, but the overall rates were very low [ 14 ].
CGM may be useful in selected inpatients, such as those for whom close contact with inpatient providers should be minimized eg, COVID or other highly transmissible infection or possibly, in patients at high risk for hypoglycemia [ 14,16 ].
Hospitals that use these devices routinely must provide proper personnel training and resources for safe application of CGM [ 17 ]. It is certainly reasonable for patients using CGM at home to continue wearing these devices while hospitalized, as long as they maintain the required dexterity, vision, and cognitive capacity to safely implement such technology [ 17 ].
Any concerning glycemic data should be shared with the health care team for both confirmation and potential intervention. Most hospitals, however, have policies that forbid use of a patient's personal CGM data as the sole tool for glucose monitoring or to guide glucose management strategies, such as insulin administration.
Insulin delivery. Basal-bolus or basal-nutritional insulin regimens — Although most patients will have type 2 diabetes, many will require at least temporary insulin therapy during inpatient admissions. In such patients, insulin may be given subcutaneously with an intermediate-acting insulin, such as neutral protamine hagedorn human NPHor a long-acting basal insulin analog, such as glargine, detemir, or degludec combined with a pre-meal rapid-acting insulin analog lispro, aspart, glulisine in patients who are eating regular meals ie, a so-called "basal-bolus" regimen algorithm 1 and algorithm 2.
Short-acting human regular has fallen out of favor for meal-time dosing in the hospital, although there are no good studies comparing its efficacy or safety to the more costly rapid acting analogs.
Sliding-scale insulin — We do not endorse the routine use of regular insulin "sliding scales," particularly when prolonged over the course of a hospitalization. It has no role when used alone in those with type 1 diabetes, who always require basal insulin, even when receiving nothing by mouth.
In type 2 diabetes patients who are very insulin deficient typically insulin-treated older individuals, often but not always lean, with longstanding disease and a history of labile glucosesthe same recommendations apply.
However, in the usual patient with type 2 diabetes managed with oral agents or injectable glucagon-like peptide 1 GLP-1 -based therapies, and whose glucose management on admission appears at goal, the temporary use of a sliding scale is reasonable for just one to two days as the trajectory of the patient's glycemia becomes apparent see 'Correction insulin' below.
However, after this period of time, a decision should be made about the need for a more physiological glucose management strategy for the remainder of the hospitalization algorithm 1 and algorithm 2. The widespread use of sliding scales for insulin administration for hospitalized patients began during the era of urine glucose testing, and it increased after the introduction of rapid capillary blood glucose testing in the last two to three decades.
However, there are few data to support its benefit and some evidence of potential harm when such treatment is applied in a rote fashion, that is, when all patients receive the same orders and, importantly, when the sole form of insulin administered is rapid-acting insulin every four to six hours without underlying provision of basal insulin.
This was illustrated in an observational study of patients with diabetes who were admitted to a university hospital, of whom 76 percent were placed on a sliding-scale insulin regimen [ 18 ].
Sliding-scale insulin regimens when administered alone were associated with a threefold higher risk of hyperglycemic episodes as compared with no therapy relative risk [RR] 2. Thus, in this observational study, the use of sliding-scale insulin alone provided no benefit.
Correction insulin — Varying doses of rapid-acting insulin can be added to usual pre-meal rapid-acting insulin in patients on basal-bolus regimens to correct pre-meal glucose excursions. In this setting, the additional insulin is referred to as "correction insulin" algorithm 1 and algorithm 2which differs from a sliding scale because it is added to planned mealtime doses to correct for pre-meal hyperglycemia.
The dose of correction insulin should be individualized based upon relevant patient characteristics, such as previous glycemia, previous insulin requirements, and, if possible, the carbohydrate content of meals.
When administered prior to meals, the type of correction insulin eg, short acting or rapid acting should be the same as the usual pre-meal insulin. Meal-time correction insulin alone is sometimes used in place of a fixed mealtime dose, usually when risk of hypoglycemia is high, dietary intake is uncertain, or other clinical circumstance that warrants a conservative approach to glycemic management.
Correction insulin alone may also be used as initial insulin therapy or as a dose-finding strategy in hyperglycemic patients with type 2 diabetes previously treated at home with diet or non-insulin agents who will not be eating regularly during the hospitalization.
This use of correction insulin is essentially a "sliding scale. Rapid-acting insulin analogs can also be used but may require more frequent dosing up to every four hours and do not have clear advantage over regular insulin in fasting patients.
Insulin infusion — Most patients with type 1 or type 2 diabetes admitted to the general medical wards can be treated with subcutaneous insulin.
There are little data showing that intravenous insulin is superior to subcutaneous insulin. The key point is that the patient should have at least a small amount of insulin circulating at all times, which will significantly increase the likelihood of successfully managing blood glucose levels during illness.
In addition, the safe implementation of insulin infusion protocols requires frequent monitoring of blood glucose, which is not typically available on a general medical ward. Practical considerations including skill and availability of the nursing staff may impact the choice of delivery; complex intravenous regimens may be dangerous where nurses are short staffed or inexperienced.
Thus, insulin infusions are typically used in critically ill intensive care unit ICU patients, rather than in patients on the general medical wards of the hospital.
There is a lack of consensus on how to best deliver intravenous insulin infusions, and individual patients may require different strategies. The best protocols take into account not only the prevailing blood glucose, but also its rate of change and the current insulin infusion rate.
Several published insulin infusion protocols appear to be both safe and effective, with low rates of hypoglycemia, although most have been validated only in the ICU setting, where the nurse-to-patient ratio is higher than on the general medical and surgical wards [ 13,19,20 ].
There are few published reports on such protocols outside of the critical care setting. In the course of giving an intravenous regular insulin infusion, we recommend starting with approximately half the patient's usual total daily insulin dose, divided into hourly increments until the trend of blood glucose values is known, and then adjusting the dose accordingly.
A reasonable regimen usually involves a continuous insulin infusion at a rate of 1 to 5 units of regular insulin per hour; within this range, the dose of insulin is increased or decreased based on frequently measured glucose concentrations, ideally through the use of an approved protocol.
In patients who are not eating, concomitant glucose infusion is necessary to provide some calories, reduce protein loss, and decrease the risk of hypoglycemia; separate infusions allow for more flexible management. When the patient receiving intravenous insulin is more stable and the intercurrent event has passed, the prior insulin regimen can be resumed, assuming that it was effective in achieving glycemic goals.
Because of the short half-life of intravenous regular insulinthe first dose of subcutaneous insulin must be given before discontinuation of the intravenous insulin infusion. If intermediate- or long-acting insulin is used, it should be given two to three hours prior to discontinuation, whereas short- or rapid-acting insulin should be given one to two hours prior to stopping the infusion.
Patients with type 2 diabetes — The treatment of patients with type 2 diabetes depends upon previous therapy and the prevailing blood glucose concentrations. Any patient who takes insulin before hospitalization should receive insulin throughout the admission algorithm 1 and algorithm 2 [ 13 ].
If the patient is unable to eat normally, oral agents or injectable GLPbased therapies should be discontinued. In patients who are eating and who do not have contraindications to their oral agent, oral agents or injectable GLPbased therapies may be cautiously continued if they are on the hospital's formulary see 'Patients treated with oral agents or injectable GLPbased therapies' below.
Therapy should be returned to the patient's previous regimen assuming that it had been effective as soon as possible after the acute episode, usually as soon as the patient has resumed eating his or her usual diet. In those with elevated A1C upon admission, the discharge regimen should be modified to improve glycemic management, or at the very least, the patient should be evaluated by the clinician managing his or her diabetes soon within several weeks after discharge.
Diet-treated patients — Patients with type 2 diabetes treated by diet alone who are to have minor surgery or an imaging procedure, or who have a noncritical acute illness that is expected to be short lived, will typically need no specific antihyperglycemic therapy.
Nevertheless, regular blood glucose monitoring is warranted to identify serious hyperglycemia, especially if steroid therapy is administered. The measurement system used should be standardized to ensure reasonable accuracy and precision.
See 'Blood glucose monitoring' above. Correction insulin with rapid-acting analogs can also be used, but the dosing frequency may need to be every four hours, so the more cost-effective regular insulin is preferred.
If substantial doses are required, adding basal insulin will improve glycemia and allow reduced the doses of regular insulin. Insulin requirements can be estimated based upon a patient's body weight algorithm 1.
: Blood sugar management guidance| Initial management of hyperglycemia in adults with type 2 diabetes mellitus - UpToDate | Also talk with your healthcare professional about your blood sugar testing needs. In practice, given the high cost of this class of medications, formulary coverage often determines the choice of the first medication within the class. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes? Diabetes mellitus: Diagnosis, classification and pathophysiology. Find out more about DKA. |
| Monitoring Your Blood Sugar | When Blood sugar management guidance see your doctor, review your diabetes self-care plan and blood glucose chart. Gestational diabetes can Bloov during managemebt. A tube connects the reservoir of insulin to a tube catheter that's inserted under the skin of your abdomen. Snacking between meals could keep your blood sugar levels from spiking or plummeting throughout the day. Prelipcean, MD. |
| Manage Blood Sugar | Similarly, patients without severely increased albuminuria have some benefit, but the absolute benefits are greater among those with severely increased albuminuria. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Sulfonylureas'. But this procedure's long-term risks and benefits for type 2 diabetes aren't yet known. In addition, the safe implementation of insulin infusion protocols requires frequent monitoring of blood glucose, which is not typically available on a general medical ward. MNT may be customized to achieve body weight reduction and is reviewed in detail elsewhere. Resistance training may be particularly important for individuals with type 2 diabetes who do not have overweight or obesity, in whom relative sarcopenia may contribute to diabetes pathophysiology [ 26 ]. That said, some of the biggest improvements have to do with your dietary choices. |
| 14 Easy Ways to Lower Blood Sugar Levels Naturally | See "Susceptibility to infections in persons with diabetes mellitus", section on 'Risk of infection'. Glycemic targets — Although there are adequate experimental and observational data to recommend avoidance of marked hyperglycemia in patients with or at risk for infection, the precise glycemic target or threshold for noncritically ill or critically ill patients with preexisting diabetes mellitus has not been firmly established [ ]. In the absence of data from clinical trials, the optimal blood glucose goal for hospitalized patients can only be approximate. The ADA has not stipulated any differences in target glucose values based on the timing of the measurements, such as preprandial versus postprandial. More stringent goals may be appropriate for stable patients with previous good glycemic management, and the goal should be set somewhat higher for older patients and those with severe comorbidities where the heightened risk of hypoglycemia may outweigh any potential benefit. The data supporting these glycemic goals are presented separately. Acute MI — There is increasing evidence that suboptimal glycemic management in patients with diabetes or stress-induced hyperglycemia in patients without diabetes is associated with worse outcomes after acute myocardial infarction MI and that better glycemic management may be beneficial in some individuals. In the absence of large controlled clinical trials regarding how best to manage the inpatient with diabetes, the management approach outlined below is based primarily upon clinical expertise. Blood glucose monitoring — At the time of admission or before an outpatient procedure or treatment, blood glucose should be measured and the result known. In addition, glucose monitoring should be continued so that appropriate action may be taken. Importantly, in patients with diabetes or hyperglycemia who are eating, the blood glucose monitoring should occur just before the meal. In those who are receiving nothing by mouth, or receiving continuous tube feeds or total parenteral nutrition , the blood glucose monitoring should occur at regular, fixed intervals, usually every six hours. Although continuous glucose monitoring CGM is not generally recommended for the inpatient or critical care setting, it has been used in inpatient locations more frequently since the onset of the coronavirus COVID pandemic. See "COVID Issues related to diabetes mellitus in adults". Clinical trial data generally have shown small and perhaps not clinically meaningful glycemic benefits with CGM compared with traditional glucose monitoring [ 14,15 ]. The same study showed a small reduction in hypoglycemia reoccurrence with CGM compared with conventional monitoring, but the overall rates were very low [ 14 ]. CGM may be useful in selected inpatients, such as those for whom close contact with inpatient providers should be minimized eg, COVID or other highly transmissible infection or possibly, in patients at high risk for hypoglycemia [ 14,16 ]. Hospitals that use these devices routinely must provide proper personnel training and resources for safe application of CGM [ 17 ]. It is certainly reasonable for patients using CGM at home to continue wearing these devices while hospitalized, as long as they maintain the required dexterity, vision, and cognitive capacity to safely implement such technology [ 17 ]. Any concerning glycemic data should be shared with the health care team for both confirmation and potential intervention. Most hospitals, however, have policies that forbid use of a patient's personal CGM data as the sole tool for glucose monitoring or to guide glucose management strategies, such as insulin administration. Insulin delivery. Basal-bolus or basal-nutritional insulin regimens — Although most patients will have type 2 diabetes, many will require at least temporary insulin therapy during inpatient admissions. In such patients, insulin may be given subcutaneously with an intermediate-acting insulin, such as neutral protamine hagedorn human NPH , or a long-acting basal insulin analog, such as glargine, detemir, or degludec combined with a pre-meal rapid-acting insulin analog lispro, aspart, glulisine in patients who are eating regular meals ie, a so-called "basal-bolus" regimen algorithm 1 and algorithm 2. Short-acting human regular has fallen out of favor for meal-time dosing in the hospital, although there are no good studies comparing its efficacy or safety to the more costly rapid acting analogs. Sliding-scale insulin — We do not endorse the routine use of regular insulin "sliding scales," particularly when prolonged over the course of a hospitalization. It has no role when used alone in those with type 1 diabetes, who always require basal insulin, even when receiving nothing by mouth. In type 2 diabetes patients who are very insulin deficient typically insulin-treated older individuals, often but not always lean, with longstanding disease and a history of labile glucoses , the same recommendations apply. However, in the usual patient with type 2 diabetes managed with oral agents or injectable glucagon-like peptide 1 GLP-1 -based therapies, and whose glucose management on admission appears at goal, the temporary use of a sliding scale is reasonable for just one to two days as the trajectory of the patient's glycemia becomes apparent see 'Correction insulin' below. However, after this period of time, a decision should be made about the need for a more physiological glucose management strategy for the remainder of the hospitalization algorithm 1 and algorithm 2. The widespread use of sliding scales for insulin administration for hospitalized patients began during the era of urine glucose testing, and it increased after the introduction of rapid capillary blood glucose testing in the last two to three decades. However, there are few data to support its benefit and some evidence of potential harm when such treatment is applied in a rote fashion, that is, when all patients receive the same orders and, importantly, when the sole form of insulin administered is rapid-acting insulin every four to six hours without underlying provision of basal insulin. This was illustrated in an observational study of patients with diabetes who were admitted to a university hospital, of whom 76 percent were placed on a sliding-scale insulin regimen [ 18 ]. Sliding-scale insulin regimens when administered alone were associated with a threefold higher risk of hyperglycemic episodes as compared with no therapy relative risk [RR] 2. Thus, in this observational study, the use of sliding-scale insulin alone provided no benefit. Correction insulin — Varying doses of rapid-acting insulin can be added to usual pre-meal rapid-acting insulin in patients on basal-bolus regimens to correct pre-meal glucose excursions. In this setting, the additional insulin is referred to as "correction insulin" algorithm 1 and algorithm 2 , which differs from a sliding scale because it is added to planned mealtime doses to correct for pre-meal hyperglycemia. The dose of correction insulin should be individualized based upon relevant patient characteristics, such as previous glycemia, previous insulin requirements, and, if possible, the carbohydrate content of meals. When administered prior to meals, the type of correction insulin eg, short acting or rapid acting should be the same as the usual pre-meal insulin. Meal-time correction insulin alone is sometimes used in place of a fixed mealtime dose, usually when risk of hypoglycemia is high, dietary intake is uncertain, or other clinical circumstance that warrants a conservative approach to glycemic management. Correction insulin alone may also be used as initial insulin therapy or as a dose-finding strategy in hyperglycemic patients with type 2 diabetes previously treated at home with diet or non-insulin agents who will not be eating regularly during the hospitalization. This use of correction insulin is essentially a "sliding scale. Rapid-acting insulin analogs can also be used but may require more frequent dosing up to every four hours and do not have clear advantage over regular insulin in fasting patients. Insulin infusion — Most patients with type 1 or type 2 diabetes admitted to the general medical wards can be treated with subcutaneous insulin. There are little data showing that intravenous insulin is superior to subcutaneous insulin. The key point is that the patient should have at least a small amount of insulin circulating at all times, which will significantly increase the likelihood of successfully managing blood glucose levels during illness. In addition, the safe implementation of insulin infusion protocols requires frequent monitoring of blood glucose, which is not typically available on a general medical ward. Practical considerations including skill and availability of the nursing staff may impact the choice of delivery; complex intravenous regimens may be dangerous where nurses are short staffed or inexperienced. Thus, insulin infusions are typically used in critically ill intensive care unit ICU patients, rather than in patients on the general medical wards of the hospital. There is a lack of consensus on how to best deliver intravenous insulin infusions, and individual patients may require different strategies. The best protocols take into account not only the prevailing blood glucose, but also its rate of change and the current insulin infusion rate. Several published insulin infusion protocols appear to be both safe and effective, with low rates of hypoglycemia, although most have been validated only in the ICU setting, where the nurse-to-patient ratio is higher than on the general medical and surgical wards [ 13,19,20 ]. There are few published reports on such protocols outside of the critical care setting. In the course of giving an intravenous regular insulin infusion, we recommend starting with approximately half the patient's usual total daily insulin dose, divided into hourly increments until the trend of blood glucose values is known, and then adjusting the dose accordingly. A reasonable regimen usually involves a continuous insulin infusion at a rate of 1 to 5 units of regular insulin per hour; within this range, the dose of insulin is increased or decreased based on frequently measured glucose concentrations, ideally through the use of an approved protocol. In patients who are not eating, concomitant glucose infusion is necessary to provide some calories, reduce protein loss, and decrease the risk of hypoglycemia; separate infusions allow for more flexible management. When the patient receiving intravenous insulin is more stable and the intercurrent event has passed, the prior insulin regimen can be resumed, assuming that it was effective in achieving glycemic goals. Because of the short half-life of intravenous regular insulin , the first dose of subcutaneous insulin must be given before discontinuation of the intravenous insulin infusion. If intermediate- or long-acting insulin is used, it should be given two to three hours prior to discontinuation, whereas short- or rapid-acting insulin should be given one to two hours prior to stopping the infusion. Patients with type 2 diabetes — The treatment of patients with type 2 diabetes depends upon previous therapy and the prevailing blood glucose concentrations. Any patient who takes insulin before hospitalization should receive insulin throughout the admission algorithm 1 and algorithm 2 [ 13 ]. If the patient is unable to eat normally, oral agents or injectable GLPbased therapies should be discontinued. In patients who are eating and who do not have contraindications to their oral agent, oral agents or injectable GLPbased therapies may be cautiously continued if they are on the hospital's formulary see 'Patients treated with oral agents or injectable GLPbased therapies' below. Therapy should be returned to the patient's previous regimen assuming that it had been effective as soon as possible after the acute episode, usually as soon as the patient has resumed eating his or her usual diet. In those with elevated A1C upon admission, the discharge regimen should be modified to improve glycemic management, or at the very least, the patient should be evaluated by the clinician managing his or her diabetes soon within several weeks after discharge. Diet-treated patients — Patients with type 2 diabetes treated by diet alone who are to have minor surgery or an imaging procedure, or who have a noncritical acute illness that is expected to be short lived, will typically need no specific antihyperglycemic therapy. Nevertheless, regular blood glucose monitoring is warranted to identify serious hyperglycemia, especially if steroid therapy is administered. The measurement system used should be standardized to ensure reasonable accuracy and precision. See 'Blood glucose monitoring' above. Correction insulin with rapid-acting analogs can also be used, but the dosing frequency may need to be every four hours, so the more cost-effective regular insulin is preferred. If substantial doses are required, adding basal insulin will improve glycemia and allow reduced the doses of regular insulin. Insulin requirements can be estimated based upon a patient's body weight algorithm 1. Alternatively, requirements can be based upon the total number of units of correction insulin administered over the course of a hospital day. Approximately 50 percent of the total daily dose can be given as basal insulin, and the remaining approximately 50 percent can be given in equally divided doses prior to meals one-third prior to each meal. Patients treated with oral agents or injectable GLPbased therapies — In general, insulin is the preferred treatment for hyperglycemia in hospitalized patients previously treated with oral agents or injectable glucagon-like peptide 1 [GLP-1]-based therapies. This approach stems from the fact that insulin doses can be rapidly adjusted and, therefore, can quickly correct worsening hyperglycemia. In addition, noninsulin diabetes therapies have not been widely tested in the hospital setting. However, there are some circumstances where insulin may not be necessary. As an example, in patients who are well managed on their outpatient regimen, who are eating, and in whom no change in their medical condition or nutritional intake is anticipated, oral agents may be continued, as long as new contraindications are neither present nor anticipated during the hospital admission, and as long as the medications or similar brands are on the hospital formulary. Of note, injectable GLPbased therapies are expensive and often not on hospital formularies; their use in the hospital setting is therefore uncommon. If a patient was previously eating but is unable to eat after the evening meal in preparation for a procedure the next morning, oral antihyperglycemic drugs should be omitted on the day of a procedure surgical or diagnostic. If procedures are arranged as early in the day as possible, antihyperglycemic therapy and food intake can simply then be shifted to later in the day. If the illness requiring admission is more severe eg, an infection requiring hospitalization , hyperglycemia is more likely, even when there is decreased food intake, and most acutely ill patients will need insulin. In this setting, oral agents should be discontinued. If eating, rapid-acting insulin is preferred, administered before meals. However, a more formal and comprehensive insulin regimen, including some form of basal insulin, is usually preferred when hyperglycemia persists algorithm 1 and algorithm 2. Oral agents should generally not be administered to patients who are not eating. In addition, many oral agents have specific contraindications that may emerge in hospitalized patients:. Examples include patients with acute cardiac or pulmonary decompensation, acute kidney injury, dehydration, sepsis, urinary obstruction, or in those undergoing surgery or radiocontrast studies. Given the typical case mix in most acute care hospitals, metformin should probably be discontinued at least temporarily in most patients. See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Contraindications'. As a result, they have an uncertain role in patients who are not eating. DPP-4 inhibitors have not been used or studied extensively in the acute care setting [ 23 ]. Two studies suggested that they may be reasonably effective in mildly hyperglycemic patients with type 2 diabetes who are eating [ 23,24 ]. We tend to continue them as they may modestly reduce hyperglycemia and decrease the need for insulin injections. They also have few contraindications or safety concerns, and DPP-4 inhibitors do not increase the risk of hypoglycemia. All DPP-4 inhibitors except linagliptin require dose reduction in the setting of impaired kidney function. See "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Dosing'. Although they may be continued during the hospitalization in stable patients who are expected to eat regularly, unexpected alterations in meal intake will increase the risk for hypoglycemia. On balance, sulfonylureas should usually be discontinued, at least temporarily, in the hospitalized patient. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'. As a result, these prandial-administered drugs may have a theoretical advantage in hospitalized patients but should also be used cautiously, including in those with acute ischemic heart disease events. Further limiting their inpatient use, meglitinides are typically not on hospital formularies. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus". As a result, their use should generally be avoided in the acute setting. They are also not usually included on most hospital formularies, in part due to high cost. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Introduction'. They increase calorie losses as well as risk of dehydration, volume contraction, and genitourinary tract infections. In addition, euglycemic diabetic ketoacidosis has been reported in patients with both type 1 during off-label use and, more rarely, type 2 diabetes who were taking SGLT2 inhibitors. These drugs should therefore generally not be used in the inpatient setting, particularly when patients are acutely ill, although they may be started just prior to discharge if compelling indications are present. For example, these agents may be used by cardiologists and especially heart failure specialists for the benefit of SGLT2 inhibitors in the setting of heart failure. See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Adverse effects' and "Primary pharmacologic therapy for heart failure with reduced ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors' and "Treatment and prognosis of heart failure with preserved ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors'. If the question of ventricular dysfunction is raised during a hospitalization, thiazolidinediones should be held until the situation is clarified. The antihyperglycemic effect of this drug class extends for several weeks after discontinuation as does the fluid-retaining effect , so that temporary interruption of therapy should have little effect on glycemia. See "Thiazolidinediones in the treatment of type 2 diabetes mellitus". Moreover, these inhibitors of intestinal carbohydrate absorption are only effective in patients who are eating and therefore have a limited role in this setting. See "Alpha-glucosidase inhibitors for treatment of diabetes mellitus". Patients treated with insulin — Insulin therapy should be continued in all patients already taking it to maintain a reasonably constant basal level of circulating insulin. Failing this, severe hyperglycemia or even ketoacidosis can occur, even in patients labeled as having type 2 diabetes but who have become significantly insulin deficient over a prolonged disease course. If the glucose was well managed with the outpatient insulin regimen, we typically reduce the dose by 25 to 50 percent because, in the more controlled environment of the hospital where the amount of food consumed may be less than at home and blood glucose levels are checked regularly , patients may need considerably less insulin than they were taking in the outpatient setting. However, clinicians should be ready to rapidly advance the dose if this reduction results in inadequate glycemic management. Different basal-bolus regimens are similarly effective in reducing A1C concentrations when insulin doses are titrated to achieve glycemic goals. These include skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or too much of a glucose-lowering medication that causes the pancreas to hold insulin. Low blood sugar is best treated with carbohydrates that your body can absorb quickly, such as fruit juice or glucose tablets. 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You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Diabetes is a serious disease. Following your diabetes treatment plan takes total commitment. Careful management of diabetes can lower your risk of serious or life-threatening complications. Make physical activity part of your daily routine. Regular physical activity can help prevent prediabetes and type 2 diabetes. It can also help those who already have diabetes to maintain better blood sugar control. A minimum of 30 minutes of moderate physical activity — such as brisk walking — most days of the week is recommended. Aim for at least minutes of moderate aerobic physical activity a week. Getting regular aerobic exercise along with getting at least two days a week of strength training exercises can help control blood sugar more effectively than does either type of exercise alone. Aerobic exercises can include walking, biking or dancing. Resistance training can include weight training and body weight exercises. Also try to spend less time sitting still. Try to get up and move around for a few minutes at least every 30 minutes or so when you're awake. Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year. Your provider may recommend the pneumonia and COVID vaccines, as well. The Centers for Disease Control and Prevention CDC also currently recommends hepatitis B vaccination if you haven't previously had it and you're an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines suggest vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have been diagnosed with diabetes, and haven't previously received the vaccine, talk to your provider about whether it's right for you. If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar. This depends on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation — one drink a day for women and up to two drinks a day for men — and always with food. Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed. Many substances have been shown to improve the body's ability to process insulin in some studies. Other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren't any alternative therapies that are currently recommended to help everyone to manage blood sugar. If you decide to try any type of alternative therapy, don't stop taking the drugs that your provider has prescribed. Be sure to discuss the use of any of these therapies with your provider. Make sure that they won't cause bad reactions or interact with your current therapy. Also, no treatments — alternative or conventional — can cure diabetes. If you're using insulin therapy for diabetes, never stop using insulin unless directed to do so by your provider. Living with diabetes can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan and you'll likely see a positive difference in your A1C when you visit your provider. Good diabetes management can take a great deal of time and feel overwhelming. Some people find that it helps to talk to someone. Your provider can probably recommend a mental health professional for you to speak with. Or you may want to try a support group. Sharing your frustrations and triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management. Your provider may know of a local support group. You can also call the American Diabetes Association at DIABETES or the Juvenile Diabetes Research Foundation at CURE You're likely to start by seeing your health care provider if you're having diabetes symptoms. If your child is having diabetes symptoms, you might see your child's health care provider. If blood sugar levels are very high, you'll likely be sent to the emergency room. If blood sugar levels aren't high enough to put you or your child immediately at risk, you may be referred to a provider trained in diagnosing and treating diabetes endocrinologist. Soon after diagnosis, you'll also likely meet with a diabetes educator and a registered dietitian to get more information on managing your diabetes. Preparing a list of questions can help you make the most of your time with your provider. For diabetes, some questions to ask include:. Diabetes care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version. Diagnosis Type 1 diabetes FAQs Endocrinologist Yogish Kudva, M. Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your diabetes-related health concerns Start Here. Enlarge image Close. Continuous glucose monitor and insulin pump A continuous glucose monitor, on the left, is a device that measures your blood sugar every few minutes using a sensor inserted under the skin. Request an appointment. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. By Mayo Clinic Staff. Show references Ferri FF. Diabetes mellitus. In: Ferri's Clinical Advisor Elsevier; Accessed May 7, Classification and diagnosis of diabetes: Standards of medical care in diabetes — Diabetes Care. Papadakis MA, et al. McGraw Hill; Accessed May 4, Diabetes risk factors. Centers for Disease Control and Prevention. Accessed June 2, Cunningham FG, et al. In: Williams Obstetrics. McGraw-Hill Education; Diabetes and DKA ketoacidosis. American Diabetes Association. Diabetes Canada Clinical Practice Guidelines Expert Committee. Complementary and alternative medicine for diabetes. Canadian Journal of Diabetes. Nimmagadda R. Allscripts EPSi. Mayo Clinic. June 16, Jameson JL, et al. Diabetes mellitus: Diagnosis, classification and pathophysiology. In: Harrison's Principles of Internal Medicine. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes — Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes — Call your provider if your blood sugar is too high or too low and you do not understand why. When your blood sugar is in your target range, you will feel better and your health will be better. Hyperglycemia - control; Hypoglycemia - control; Diabetes - blood sugar control; Blood glucose - managing. Atkinson MA, Mcgill DE, Dassau E, Laffel L. Type 1 diabetes. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; chap American Diabetes Association Professional Practice Committee; Draznin B, Aroda VR, et al. Glycemic Targets: Standards of Medical Care in Diabetes Diabetes Care. PMID: pubmed. Riddle MC, Ahmann AJ. Therapeutics of type 2 diabetes. Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. Editorial team. Managing your blood sugar. Take Control of Your Diabetes. Know how to: Recognize and treat low blood sugar hypoglycemia Recognize and treat high blood sugar hyperglycemia Plan healthy meals Monitor your blood sugar glucose Take care of yourself when you are sick Find, buy, and store diabetes supplies Get the checkups you need If you take insulin, you should also know how to: Give yourself insulin Adjust your insulin doses and the foods you eat to manage your blood sugar during exercise and on sick days You should also live a healthy lifestyle. Exercise at least 30 minutes a day, 5 days a week. Do muscle strengthening exercises 2 or more days a week. Avoid sitting for more than 30 minutes at a time. Try speed walking, swimming, or dancing. Pick an activity you enjoy. Always check with your health care provider before starting any new exercise plans. Follow your meal plan. Every meal is an opportunity to make a good choice for your diabetes management. Take your medicines the way your provider recommends. Check Your Blood Sugar Often. Not everyone with diabetes needs to check their blood sugar every day. But some people may need to check it many times a day. |
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