When To Call The Doctor
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Tuesday, March 28, 2006 |
Q: "I always read about target goals, but they don’t say when to call the doctor. What is really too low or too high? Although I am often under 130 before meals, sometimes I’m not; yet I can’t imagine that I would call every time I’m above 130."
A: You ask an important and frequently asked question. I have always said that monitoring is only valuable if you know how to interpret and act on the results.
However, unfortunately giving you a definite answer is impossible because of the many factors that can affect your target goals and “take action” points:
- Your age: Very young children or the elderly may have slightly different targets, based on their ability to recognize and act on signs and symptoms.
- Pregnancy: Pregnant women have stricter glucose goals, and often different testing times.
- History of severe or frequent hypoglycemia or hypoglycemia unawareness: With these conditions, it is usually necessary to set higher goals to prevent hypoglycemia and coma.
- Whether or not you take diabetes medication: If you are diet controlled only, then technically you cannot get too low, so you would only need to know your upper level target.
- Presence of other medical conditions: Depending on your individual situation, your doctor may decide that managing your other medical condition may need to be a temporary priority, and thus your glucose goals may be somewhat relaxed.
- Newly diagnosed: It takes time to learn all the details of diabetes, and to adopt healthy habits. Your doctor may want to allow some time for you to work with your diabetes team, to modify your meal plan, and develop an exercise program-and to see what effects diabetes education and lifestyle changes have on your blood glucose. For example, if you are trying to lose weight, and your glucose is not at target but not above 180, your doctor might want to wait 3 months to see if weight loss and exercise can get you to your target goals. On the other hand, if your glucose is very high, your doctor may decide that is too long to wait.
- Recent change in your diabetes regimen (meal or activity plan, or diabetes medication dosage): It takes awhile to see the effect of any change, so your doctor may need to provide you with specific guidelines, such as “call in one week and weekly thereafter (or two weeks or one month, etc.) if your glucose is not yet at your target level.”
- Sick day guidelines vary even in the literature: As mentioned in the sick day guidelines, the ADA recommends calling if you are over 240 more than 24 hours, or if you vomit more than 6 hours. But if you were a pump user, you might be advised to recheck any glucose over 250 (or 300, depending on your team's advice) within an hour or two, take extra insulin, and call your healthcare team if your glucose didn't come down. But some clinics might advise you to call immediately if you vomit more than once, or if you have ketones.
- Knowing the cause of the high glucose: Many clinics might tell you to call only if you have “unexplained high glucose,” meaning that if you know you overate at lunch, then it is no surprise that the glucose is higher before dinner that day. You might lower it with exercise, or extra medication (if you have been told how to do this), or by cutting back on the next meal, or you may simply ignore it since it will eventually come back down. But I have seen instances where the person didn't call to report the persistently high glucose over a 2 week period because “I knew I was eating more than I should.” In this case, yes, the person knew the cause, but 2 weeks is generally too long to have high glucose levels.
What you can do:
- Keep good records and look for causes/trends: For example, if you notice that your bedtime readings are often too high, you can first assess your dinnertime meal content, as well as determine if you have decreased your exercise recently. Or if all your readings are suddenly running higher than usual, you can first recheck your monitoring technique (as well as your strips, expiration date, and proper coding of your meter).
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Ask your healthcare team: Despite all the above variables,
everyone with diabetes should be able to obtain specific advice from their
healthcare team. So the questions you should ask your healthcare team are:
- What are my target goals? Is there a lower and upper limit?
- Is there an “ideal target” for me, as well as an “acceptable target” until I can make some changes in my lifestyle?
- If I'm not at my goal, how long do I wait before I contact you?
- If you just changed my medication, how long do I wait before I call again if I'm still not at my target goal?
- Regarding illness: Do I need to test ketones, and if so, do I call as soon as I show ketones? How long can my glucose be up before I call? When do I call if I'm vomiting? How high should my fever be for me to report it?
As you can now understand, there are many circumstances that can affect your individual target goals and take action points. But armed with the above information, you should be able to discuss this with your healthcare team and obtain specific goals to meet your needs.
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Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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