Blood Glucose DiaryThis Blood Glucose Diary 2. Blood glucose meter 2 KNOW THE NUMBERS Every child and young person with Type 1 diabetes has to manage their condition to live a healthy,

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Blood Glucose Diary

Visit our website: www.nhsaaa.net

All our publications are available in other formats

Find us on Facebook at www.facebook.com/nhsaaa

Follow us on Twitter @NHSaaa

Name:

Call these numbers to contact the Children’s Diabetes Team:

• For Diabetes Specialist Nurse: 9am-5pm Monday to Saturday 01563 826010

• For Dietitians, : 01563 827141

• Out of hours or urgent: Ward 1A, Crosshouse 01563 827831

Please remember to always bring the following items to Clinic:

1. This Blood Glucose Diary

2. Blood glucose meter

2

KNOW THE NUMBERS

Every child and young person with Type 1 diabetes has to manage theircondition to live a healthy, happy life. This quick guide shows the blood

glucose readings that you and your family should be aiming for.

BLOOD GLUCOSE GUIDANCE FOR TYPE 1 DIABETES

HbA1C(SHOWS CONTROL OVER 3 MONTHS)

7 DAY AVERAGE(OF DAILY BLOOD GLUCOSE CHECKS)

Less than

58MMOL/MOL

Aim for

8MMOL/L

BEFORE MEALS(INCLUDING BREAKFAST)

BEDTIME2 HRS AFTER MEALS

4-7MMOL/L

5-9MMOL/L

4-7MMOL/L

WHAT TO AIM FOR DURING THE DAY

TOP 3 TIPS FOR MANAGING BLOOD GLUCOSE

Give insulin minutes before meal times

1 Check your blood at least times a day

2 Improve your carb counting skills....

3

5 1... 2... 35-15

Remember, a lot of things can a�ect your blood glucose readingssuch as exercise, illness and worry. Do you or your family need

a li�le help? Is there something you’re struggling with?Talk to your Diabetes Team who will be happy to help you.

PAED

IATR

IC GU

IDAN

CE 2

016

3

7.0 7.8 8.6 9.4 10.2 11.0 11.8 12.6 13.3 14.9 16.5 18.1AVERAGE BLOOD GLUCOSE

HbA1c mmol/mol

NATIONAL TARGET RANGE

You’re doing really great!

Need a li�le bit of help?

It’s time to make changes

At this level there is a serious risk of DKA!

Things to remember:Your HbA1c is a measure of your blood glucose over the last 8–12 weeks.The target HbA1c is less than 58mmol/mol (ideally 48mmol/mol) without frequent hypos.High blood glucose levels a�ect mood, growth, energy and concentration.Very high blood glucose levels can cause ketones to be produced and increase the risk of life threatening Diabetic Ketoacidosis.Lowering your HbA1c by just 10mmol/mol reduces your risk of complications by 20%.

Date:

Discussions:

Current HbA1c: Last HbA1c:

Next steps:

YOUR HbA1c CHART

42 48 53 58 64 69 75 80 86 97 108 119

IN TARGET ABOVE TARGET HIGH

KNOW THE NUMBERS

Every child and young person with Type 1 diabetes has to manage theircondition to live a healthy, happy life. This quick guide shows the blood

glucose readings that you and your family should be aiming for.

BLOOD GLUCOSE GUIDANCE FOR TYPE 1 DIABETES

HbA1C(SHOWS CONTROL OVER 3 MONTHS)

7 DAY AVERAGE(OF DAILY BLOOD GLUCOSE CHECKS)

Less than

58MMOL/MOL

Aim for

8MMOL/L

BEFORE MEALS(INCLUDING BREAKFAST)

BEDTIME2 HRS AFTER MEALS

4-7MMOL/L

5-9MMOL/L

4-7MMOL/L

WHAT TO AIM FOR DURING THE DAY

TOP 3 TIPS FOR MANAGING BLOOD GLUCOSE

Give insulin minutes before meal times

1 Check your blood at least times a day

2 Improve your carb counting skills....

3

5 1... 2... 35-15

Remember, a lot of things can a�ect your blood glucose readingssuch as exercise, illness and worry. Do you or your family need

a li�le help? Is there something you’re struggling with?Talk to your Diabetes Team who will be happy to help you.

PAED

IATR

IC GU

IDAN

CE 2

016

4

Correction Doses (for people without a bolus calculating meter)

You can work out a correction dose using your ISF (Insulin Sensitivity Factor), also known as the “correction factor (CF). The ISF is how much the blood glucose will drop if you take 1 unit of insulin. The diabetes team will help you work this out and make a note of it in this diary. Work out how much your blood glucose needs to come down to get into the target range (aim for 5.5mmol/l). Then divide that number by your ISF to get the number of units you need to take.

Ask the diabetes team for advice if you are unsure.

Suggested Ratios

Time Blocks

ICR(Carb ratios)

ISF / CF

Target

5

How to use Blood Glucose Charts Insu-

lin Type

ICR (U/10g)

Mon Tue Wed Thu Fri Sat Sun 12/10 13/10 14/10 15/10 16/10 17/10 18/10

B Lev 10 10 10 10 10 10 10

B Nov 8 8+1.5 8+3 8+2 8 8 8

L Nov 7.5 7.5 9 7.5 6 7.5 7.5

T Nov 10 10+1.5 12 12 10 8 10+4

T Lev 12 12 12 14 14 14 14

S Nov +2

7.1 Early morning

B Over 7 12.6 16.2 14.3

R 4 - 7 6.9 6.7 5.7 4.8

E Under 4

2h after 4.5

L Over 7 8.4

U 4 - 7 5.6 6.2 6.2 4.9

N Under 4 3.8

2h after 8.9

E Over 7 13.9 18.7

M 4 - 7 6.9 5.9 6.4 5.2

Under 4 3.2

2h after 7.8

S Over 7 12.5 14.6

U 4 - 7 6.3 4.9 5.4 6.7 5.8

P Under 4

2h after

Overnight result 6.5

3 high results in a row have been corrected, so basal

dose must also be increased

Additional correction

bolus Bolus for

Carbs eaten

Correction bolus given at supper

Low & high glucose results are recorded in highlighted rows

Day used to check “paired” readings of before & after meal blood glucose results(once or twice each month)

3 low or high results at sam

e time of day m

eans change is needed

NO

W.

Test for ketones if glucose over 14

Different insulin types recorded

6

Daily Blood Glucose Results

Daily Blood Glucose Results Daily Blood Glucose Results

Date Comments

Insulin Mon Tue Wed Thu Fri Sat Sun

L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result

Use Correction Dose if glucose over 7 (check ketones if over 14)

Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth

7



Have you checked overnight Glucose results recently? Use Correction Dose if glucose over 7 (check ketones if over 14)

3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result

14 day Ave BG:

8



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal Overnight result


Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result

14 day Ave BG: __mmol/l

14 day Ave BG =__mmol/l

9


14 day Ave BG:

10



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



11


14 day Ave BG:

12



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



13


14 day Ave BG:

14



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



15


14 day Ave BG:

16



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



17


14 day Ave BG:

18



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



19


14 day Ave BG:

20



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



21


14 day Ave BG:

22



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



23


14 day Ave BG:

24



Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under



Reco

rd b

lood

glu

cose

res

ults

, E

VER

Y d

ay, a

nd “

paire

d” g

luco

se r

eadi

ngs

once

or

twic

e ea

ch m

onth



3 low or high

results at sam

e time of day m

eans chan

ge is needed

NO

W.

Date Comments


L.A.

BF

LUN

EM

L.A.

SUP

Early morning

B Over

R 4 - 7

E Under

2h after meal

L Over

U 4 - 7

N Under

2h after meal

E Over

M 4 - 7

Under

2h after meal

S Over

U 4 - 7

P Under

2h after meal

Overnight result



25


14 day Ave BG:

26

Advice for EmergenciesThe next few pages contain advice on these emergency situations:

Hypoglycaemia (“Hypos”)

Illnesses (“Sick Day Advice”)

Diabetic Ketoacidosis (DKA)

HypoglycaemiaHypoglycaemia is commonly known as having a ‘hypo’. This is when blood glucose levels fall below 4mmols/l, with or without symptoms.

Common causes of hypo:

Not eating enough carbohydrate; Having a late meal, or missing a meal or snack; Doing extra exercise or being more active than normal; Taking too much insulin or taking it at the wrong time; Being ill (such as diarrhoea or vomiting)

27

Severity is based on how bad the symptoms are, not how low the blood glucose is:

Symptoms TreatmentMild or moderate hypo:

• Child able to swallow and co-operative

• Shaky • Hungry • Pale • Headache• Stomach Ache • Mood Swings • “Jelly”/Tired Legs• Lack of Concentration

Give 10g fast-acting carbohydrate:• For example, 3 Glucose tablets OR

60 ml Lucozade® Original OR 100 ml non-diet cola or similar

Wait 10-15 mins and then retest blood. If blood glucose still under 4 mmol/l:• repeat fast-acting carbohydrate &

retest blood glucose in further 10 mins

If blood glucose now 4 mmol/l or higher:• give STARCHY CARBOHYDRATE

such as: digestive biscuit, small sandwich Snack, fruit or meal (if due)

If child is uncooperative, refusing tablets or liquid, try to give Glucose gel into mouth.

Severe Hypo: Child unconscious, unable to swallow:

May be fitting Unresponsive, Confused, Coma

1. glucagon injection (“GlucaGen” - from orange box) into the large, front-facing muscle of the thigh.

2. Call 999

28

Sick Day AdviceThe next few pages outline what to do on days when your child is unwell, referred to as “Sick Days”.

Important points:

Illness may cause high or low blood glucose levels:

• Fever usually causes high blood glucose levels.

• Gastroenteritis (diarrhoea and vomiting) can cause low blood glucose levels.

Treat the illness. Your child’s illness must be diagnosed and treated in the same way as a child who doesn’t have diabetes. Contact your family doctor (GP) if concerned. State that your child has diabetes and request a same day or urgent appointment.

Vomiting may be caused by a lack of insulin. Make sure you check your child’s blood glucose and blood ketones. If it is high you need to give them extra insulin.

Your child could become very sick with diabetic ketoacidosis (DKA) if high blood glucose levels are not treated.

29

What do I need for sick days?1. Rapid acting insulin - for example Novorapid or

Humalog. You may need extra doses of rapid acting insulin to get your child’s blood glucose down from a high level.

2. Blood ketone meter. Make sure you know how to use it and that you always have spare strips.

3. Hypoglycaemia remedy. For example, glucogel, glucose tablets, Lucozade.

When your child is unwell, please refer to these six “Sick day rules”:

Rule 1: Monitor your child’s blood glucose level. Check the blood glucose level more often: every hour, if necessary.

Rule 2: Test for ketones. Check for ketones if the blood glucose is above 14mmol/l (up to every 2 hours). Levels above 0.6mmol/l can mean that the diabetes is getting out of control. If in doubt, phone us for advice.

Rule 3: Drink plenty. Encourage your child to drink more fluids. High blood glucose readings lead to dehydration as a result of passing more urine. Extra fluids help clear ketones. Try to get your child to drink 1/2 to one cup of fluid per hour in small amounts (avoid carbonated drinks).

30

1. If blood glucose is more than 7mmol/l, drink sugar-free drinks or water.

2. If blood glucose is less than 7mmol/l, also drink liquids containing carbohydrates (milk or sugary juice).

Rule 4: Keep taking carbohydrates. Try to make sure your child eats as normal a diet as possible. Telephone us for advice if you are finding this difficult.

What if my child has a poor appetite?Try offering small and frequent snacks of food and drinks containing carbohydrates. Keep monitoring your child’s blood glucose .

What if my child is refusing to eat?

If your child can drink, give them frequent sips of sugary drinks and keep watching their blood glucose.

What if my child is vomiting?Remember this may be a symptom of DKA so be sure to check your child’s ketones if blood glucose in above 14mmol/l. Your child may need extra insulin. If their glucose level is less than 4 and you can’t get your child to eat anything you will need to go to hospital.

31

Rule 5: Never stop insulin completely. Usually extra insulin is required. Some insulin is always required to ‘switch off’ ketones, however, if your child’s blood glucose levels are low, less insulin may be needed. If a meal is missed and no carbohydrates are taken, then no fast acting will be required at that point if the BG is in the target range. If in doubt, call us for help.

When should my child get their insulin and how much insulin?Use the table on the next page. Give your child their insulin at the usual times. Your child may also need to have extra doses of rapid acting insulin at other times depending on the blood glucose level. The best way to know how much insulin is needed is to keep records from a previous similar illness and to know what insulin dose worked then. You may need to give your child another rapid insulin dose later, but wait for at least three hours before doing this.

32

Sick day Advice continued...What to do with glucose and ketone results on sick days(Check every 2 hours while unwell)

Blood Glucose (mmol/l)

Ketones on blood test (mmol/l)

What to do

Less than 4mmol/L

Treat as a HYPO. Once blood glucose greater than 4mmol/L, give insulin as above. If unsure, phone for advice.

Between 4 and 7 (in target range)

Do not give extra insulin. If your child has a vomiting and/or diarrhoea illness, they may need a reduction in the normal insulin dose to be given. If unsure, phone for advice.

Between 7 and 14

Give the usual doses of insulin you are familiar with using on a day to day basis. Remember to give a correction dose in the usual way.

More than 14

Below 0.6 Give a Correction dose of rapid acting insulin (see box below).Based on your usual correction factor.

33

More than 14

Above 0.6 but below 1.5

Give a dose of rapid acting insulin.This should be 10% of your total daily dose (TDD).The TDD should be written at the bottom of this page (33).

Above 1.5 Give a dose of rapid acting insulin.This should be 20% of your rotal daily dose (TDD). The TDD should be written at the bottom of this page (33).If the ketone level stays above 1.5 for any longer than 2 hours you will need to bring your child to hospital (CONTACT THE DIABETES TEAM OR WARD 1A - see front cover for telephone numbers).

For Sick Days Clinic Date:Total Daily Dose of Insulin = UNITS 10% Total Daily Dose = UNITS 20% Total Daily Dose = UNITS

34

Rule 6: telephone for advice.

Please feel free to call us for advice at any time.

In particular, we would expect you to always call for advice, or go directly to hospital if:

• Vomiting persists;

• You have given 3 or more correction doses for high ketones;

• You are unable to keep blood glucose level above 4mmol/l;

• You are unable to get blood glucose below 14mmol/l despite extra insulin;

• Your child is becoming more unwell;

• You are worried or exhausted;

• Your child is very young;

• You are unable to get ketone levels below 1.5 mmol/l

• You don’t know what to do next

• Your child has any symptoms of DKA (see page 35).

Do not leave things too late before calling for help

35

Diabetic Ketoacidosis (DKA)What is DKA?This is a life threatening complication of diabetes which happens if the body runs out of insulin. It can happen if your child is unwell and has not had enough insulin. It can happen if your child has omitted or forgotten doses of insulin.

DKA is an emergency and needs to be treated in hospital urgently. Always telephone us for advice early, but if you are very concerned about your child dial 999.

What are the symptoms of DKA?• Vomiting• Abdominal pain• Deep heavy breathing• Drowsiness or even coma

How can I prevent DKA?Follow the sick day rules, Telephone for advice early. Ensure your child never misses any doses of insulin.

Last reviewed: November 2016 Leaflet reference: MIS16-179-GDPIL code: PIL16-0207

All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice.

0800 169 1441

Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh.

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Documents

Blood Glucose DiaryThis Blood Glucose Diary 2. Blood glucose meter 2 KNOW THE NUMBERS Every child and young person with Type 1 diabetes has to manage their condition to live a healthy,