Question about blood sugar levels

[RN2Bn2006]

I am a 3rd semester nursing student, and I have a questions concerning my Papaw. He's 87, has been a diabetic for many years, but never took any medicine or insulin. He also never did regular blood sugar checks (I have no idea why - Dr did not order it) Anyway, so it was more or less diet controlled.

He now has a glucometer at home, and my aunt, who helps care for him "occasionally" checks his blood sugar. He has had two episodes where his first morning capillary glucose level is in the 30's. From what I understand this is pretty serious. My aunt is also diabetic, so she gives him orange juice or something similar. He doesn't eat just a whole lot, so we told him to eat something right before he goes to bed to raise his blood sugar. The doctor told him to drink OJ right before bed, but this morning his BS was again in the 30's. Would drinking OJ by itself cause spikes in his sugar (causing it to drop low). Is there something that would work better to keep his sugar up through the night. I don't understand if he's been supposedly "diabetic" all these years - why is his blood sugar so low - he's not taking insulin.

Maybe I'm missing something - just wanted to know if any of you had experienced this before.

[rogramjet]

I would not suggest OJ before bed. I woould look into either Glucerna shakes or bars. These have slower absorbing carbs in them. I don't know why he is dropping so low if he's not on diabetic meds. Could be a number of things. Is his doc a GP? You may want to take him to an Internist or an Endo to have some tests run.

[babynurselsa, RN]

I would recommend a slightly more substantial bedtime snack. a small glass of milk and a peanut butter sandwick is going to allow for a more level blood sugar than a glass of oj. Oj is going to quickly raise the blood sugar and then it will be gone.

http://www.diabetes.org here is the link to the American Diabetic Association for more info.

[purplemania, BSN, RN]

When was the last time the glucometer was calibrated? What is his Hgb A1C and how long ago was that done? What was his fasting blood sugar at the MD's office? If all these are in normal ranges I would think his MD needs to address hypoglycemia. He may need a nutritional supplement or certain carbs before retiring. It seems strange to me that he even wakes up with a BS in the 30's. I would check the meter first, then call MD for advice. Also, check the dates on the strips and be sure the sample size is adequate.

[RN2Bn2006]

I would not suggest OJ before bed. I woould look into either Glucerna shakes or bars. These have slower absorbing carbs in them. I don't know why he is dropping so low if he's not on diabetic meds. Could be a number of things. Is his doc a GP? You may want to take him to an Internist or an Endo to have some tests run.

Yes his doc is a GP. He was recently in the hospital due to a severe bladder infection caused by retention due to enlarged prostate. I guess I should have my aunt inquire as to what his BS were during that time. We might need to see someone else. I will check into the Glucerna. Thanks for the suggestion.

[CoffeeRTC, BSN, RN]

Great advice. Since he isn't eating much you should look for things that he might like that pack in the nutrients in a small serving. Definatly include a protein in the snack and make sure he is getting something at bed time.

[RN2Bn2006]

I would recommend a slightly more substantial bedtime snack. a small glass of milk and a peanut butter sandwick is going to allow for a more level blood sugar than a glass of oj. Oj is going to quickly raise the blood sugar and then it will be gone.

www.diabetes.org here is the link to the American Diabetic Association for more info.

Thanks - that kind of what I thought, but I don't know enough about it yet to know for sure.

Thanks for the link. I will do some research there.

[RN2Bn2006]

When was the last time the glucometer was calibrated? What is his Hgb A1C and how long ago was that done? What was his fasting blood sugar at the MD's office? If all these are in normal ranges I would think his MD needs to address hypoglycemia. He may need a nutritional supplement or certain carbs before retiring. It seems strange to me that he even wakes up with a BS in the 30's. I would check the meter first, then call MD for advice. Also, check the dates on the strips and be sure the sample size is adequate.

Well, I don't know - they just recently got the glucometer - DR finally ordered one, because my grannie has having BS problems too. He was diagnosed probably 20-30 years ago, so I have no idea when the last time he had his Hgb A1C tested. Is that the test where it can tell what you blood sugar has been for the past several days? Sorry I can't remember.

Will check dates on strips though.

Thanks for your thoughts and suggestions.

[SweetieRN]

We give our diabetic patient's 1/2 turkey sandwich on whole wheat and skim milk before bed. That seems to help.

[NRSKarenRN, BSN, RN]

sounds like diabetic education is sorely needed here for both patient and caregivers. i'm assuming he's homebound as your aunt is caring for him. call his doctor and request a visiting nurse for diabetic education first thing tomorrow. many homecare agencies have specific diabetes programs often taught by certified rn diabetic educators (cde).

recent infection is often what causes diet controlled diabetics blood sugars to go out of control due to additional stress on the body. despite his previously not being on meds/performing glucometer testing, both he and his wife are having diabetes affect their way of life so most likely will be willing to accept instruction now.

symptoms of hypoglycemia include:

• hunger
  
• nervousness and shakiness
  
• perspiration
  
• dizziness or light-headedness
  
• sleepiness
  
• confusion
  
• difficulty speaking
  
• feeling anxious or weak

hypoglycemia can also happen while sleeping. one might

• cry out or have nightmares
  
• find that your pajamas or sheets are damp from perspiration
  
• feel tired, irritable, or confused when you wake up

recommended evening snack serving size 1500 cal diet:

1 starch/bread

1 milk or 1 meat

1 fruit

links will take you to nutrition guide with food exchange lists and amount food per serving from univ. of mass. diabetes cookbook:

http://www.umassmed.edu/diabeteshandbook/chap06.htm

bedtime snack ideas:

1 slice bread with 1 tbsp peanut butter; 1/c cup applesauce.

1 cup milk, 1/2 cup cheerios, 1/2 sliced banana

6 graham crackers, 1 cup milk, 1 small apple

1/2 cup ice cream with strawberries

15 honey bear cookies, 1 cup milk, 7 dried apricots

another site with snack ideas: http://www.diabetic-lifestyle.com/articles/may98_cooki_1.htm

professional link re understanding hypoglycemia: http://www.bbdc.org/diabetesmanagement/link12.htm

thanks for being a caring granddaughter. hope your papaw gets the instruction he needs to empower him to control his diabetes to minimize affects on his health and keep him going for many years!

[rogramjet]

I am a diabetes educator, and if i had a pt with severe hypoglycemia who was not on insulin, sulfonylureas, or meglinitinides, I would first check the meter, but would want to know why these numbers are so low. This is not normal for a type 2 who is not on any meds. If he were my relative I would want him looked at by an Internal Med Doc or an Endo. It may be nothing, but I would want to be sure. Infection usually drives BG up not down. Get a second opinion.

[RN2Bn2006]

sounds like diabetic education is sorely needed here for both patient and caregivers. i'm assuming he's homebound as your aunt is caring for him. call his doctor and request a visiting nurse for diabetic education first thing tomorrow. many homecare agencies have specific diabetes programs often taught by certified rn diabetic educators (cde).

recent infection is often what causes diet controlled diabetics blood sugars to go out of control due to additional stress on the body. despite his previously not being on meds/performing glucometer testing, both he and his wife are having diabetes affect their way of life so most likely will be willing to accept instruction now.

symptoms of hypoglycemia include:

• hunger
  
• nervousness and shakiness
  
• perspiration
  
• dizziness or light-headedness
  
• sleepiness
  
• confusion
  
• difficulty speaking
  
• feeling anxious or weak

hypoglycemia can also happen while sleeping. one might

• cry out or have nightmares
  
• find that your pajamas or sheets are damp from perspiration
  
• feel tired, irritable, or confused when you wake up

recommended evening snack serving size 1500 cal diet:

1 starch/bread

1 milk or 1 meat

1 fruit

links will take you to nutrition guide with food exchange lists and amount food per serving from univ. of mass. diabetes cookbook:

http://www.umassmed.edu/diabeteshandbook/chap06.htm

bedtime snack ideas:

1 slice bread with 1 tbsp peanut butter; 1/c cup applesauce.

1 cup milk, 1/2 cup cheerios, 1/2 sliced banana

6 graham crackers, 1 cup milk, 1 small apple

1/2 cup ice cream with strawberries

15 honey bear cookies, 1 cup milk, 7 dried apricots

another site with snack ideas: http://www.diabetic-lifestyle.com/articles/may98_cooki_1.htm

professional link re understanding hypoglycemia: http://www.bbdc.org/diabetesmanagement/link12.htm

thanks for being a caring granddaughter. hope your papaw gets the instruction he needs to empower him to control his diabetes to minimize affects on his health and keep him going for many years!

wow thank you. i will print this off to get started, and refer to your links. thank you !!