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Hypos and hypers

The key to controlling diabetes is to balance insulin injections with food and activity. But it’s not
always easy and, when the balance isn’t right, hypoglycaemia (hypo – when blood glucose drops
too low) or hyperglycaemia (hyper – when blood glucose rises too high) can result.

Hypos

Hypoglycaemia (or hypo) means low blood glucose levels, i.e. when the blood glucose level drops
below 4mmol/l*. In people without diabetes, low blood glucose levels trigger the body to stop
producing insulin and to release stored glucose to keep the body going. But, in people with Type 1
diabetes, while this mechanism still works, it’s not so effective because the insulin they have
injected can’t be ‘switched off’. So it will continue to work, even though blood glucose is too low.
Spotting the symptoms

Hypos can come on quickly and your child will tend to develop symptoms that warn them their
blood glucose levels are dropping too low. Everyone has different symptoms, but common ones
are:

feeling shaky
sweating
hunger
tiredness
blurred vision
lack of concentration
headaches
feeling tearful, stroppy or moody
going pale

*Millimoles per litre: a measurement of the concentration of a substance in a specific amount of
liquid.

Why do hypos happen?

There’s no hard and fast rule why they happen, but some things can mean it’s more likely that your
child has a hypo:

too much insulin
a delayed or missed meal or snack
not enough carbohydrate food
unplanned physical activity
if they are old enough, drinking large quantities of alcohol or alcohol without food
and sometimes there just is no obvious cause.

The main types of insulin

There are seven main types of insulin:

Rapid-acting analogues should ideally be injected just before food and have a peak action at
between 0 and three hours. They tend to last between two and five hours and only last long
enough for the meal at which they are taken. They are clear in appearance.

They don't need to be taken with food because they have a peak action. heart (cardiovascular disease). Mixed insulin – a combination of medium. Read through the links and get to know the 15 healthcare essentials to find out more about complications. kidneys. kidneys (nephropathy).and short-term complications can impact on a wide variety of parts of the body including eyes.and short-acting insulin. heart (cardiovascular disease). Very long-acting analogues are mainly used by people who are unable to inject themselves as they can provide background insulin for up to 42 hours. When that balance isn’t right. Their peak activity is between four and 12 hours and can last up to 30 hours. They are clear in appearance. blood pressure and blood fat levels under control will greatly help to reduce the risk of developing complications. Short-term complications include hypoglycaemia diabetic ketoacidosis (DKA). and hyperosmolar hyperglycaemic state (HHS). They are clear in appearance. Diabetes complications People living with diabetes may have to deal with short-term or long-term complications as a result of their condition. one of two . keeping blood glucose. They have a peak action of two–six hours and can last for up to eight hours. Medium. Although they can be injected once every 42 hours (three days). They are clear in appearance. Impact on overall health Long.and long-acting insulins are taken once or twice a day to provide background insulin or in combination with short-acting insulins/rapid-acting analogues. Long-term complications include how diabetes affects your eyes (retinopathy). Mixed analogue – a combination of medium-acting insulin and rapid-acting analogue. and hyperosmolar hyperglycaemic state (HHS). kidneys (nephropathy). they are usually injected once a day. Short-acting insulins should be injected 15–30 minutes before a meal to cover the rise in blood glucose levels that occurs after eating. They are cloudy in appearance. Short-term complications include hypoglycaemia diabetic ketoacidosis (DKA). Hypos and hypers Diabetes is a manageable condition. and how to reduce the risk of developing them. They don't need to be taken with food because they don't have a peak action. and nerves and feet (neuropathy). Long-acting analogues tend to be injected once or twice a day to provide background insulin lasting approximately 24 hours. Regular check-ups are essential to help manage the condition. People living with diabetes may have to deal with short-term or long-term complications as a result of their condition. and nerves and feet (neuropathy). heart. nerves and feet. Long-term complications include how diabetes affects your eyes (retinopathy). With all complications. but key to successfully living with diabetes is balancing medication and insulin injections with food and activity.

but some things make it more likely: excess insulin. blurred vision. you are likely to experience some hypos or hypers. but key to successfully living with diabetes is balancing medication and insulin injections with food and activity. Sometimes there just is no obvious cause. not enough carbs. Hypoglycaemia (hypo) Hypoglycaemia means ‘low blood glucose levels’ – less than 4 mmol/l*. and drinking large quantities of alcohol or alcohol without food. if your diabetes is treated. Symptoms Hypos can come on quickly and everyone has different symptoms. unplanned physical activity. headaches. sweating. or blood glucose rises too high and hyperglycaemia (a hyper) occurs. When that balance isn’t right. you are likely to experience some hypos or hypers. stroppy or moody. Symptoms Hypos can come on quickly and everyone has different symptoms. No matter how much you know about diabetes or how careful you are. This is too low to provide enough energy for your body’s activities. hunger. but common ones are: feeling shaky. or blood glucose rises too high and hyperglycaemia (a hyper) occurs. Treating a hypo If you become unconscious Severe hypos Preventing a hypo Blood glucose and hypos Hypers Hypoglycaemia (hypo) Hypoglycaemia means ‘low blood glucose levels’ – less than 4 mmol/l*. and drinking large quantities of alcohol or alcohol without food.things will happen: either blood glucose drops too low and hypoglycaemia (a hypo) results. Sometimes there just is no obvious cause. but common ones are: feeling shaky. but some things make it more likely: excess insulin. stroppy or moody. tiredness. unplanned physical activity. feeling tearful. if your diabetes is treated. Check with your diabetes healthcare team if you are not sure if the treatment you are on is likely to cause hypos or hypers. This is too low to provide enough energy for your body’s activities. delayed or missed meal or snack. going pale. hunger. tiredness. delayed or missed meal or snack. No matter how much you know about diabetes or how careful you are. Diabetes is a manageable condition. Why do hypos happen? There’s no rule as to why they happen. going pale. headaches. feeling tearful. Why do hypos happen? There’s no rule as to why they happen. Check with your diabetes healthcare team if you are not sure if the treatment you are on is likely to cause hypos or hypers. lack of concentration. sweating. not enough carbs. blurred vision. lack of concentration. one of two things will happen: either blood glucose drops too low and hypoglycaemia (a hypo) results. .

Should I keep my blood glucose levels high to avoid hypos? . such as jelly babies Small carton of pure fruit juice Glucose gel. Eat enough carbohydrate. Eat extra carbohydrate if you are more active than normal.How to prevent a hypo Don’t miss a meal. They will need to: Put you into the recovery position (on your side with your head tilted back and knees bent) Give you a glucagon injection . Note: Make sure your family and friends are aware that they mustn’t give you anything by mouth if you are unconscious or unable to swallow. It’s recommended that you retest your blood glucose levels after 15–20 minutes and re-treat if your blood glucose levels are still less than 4mmol/l. How to recognise and treat a hypo Glucose gel may be used if you are feeling drowsy and someone can help you. This snack could be a sandwich. treat your hypo immediately with 15–20g of fast-acting carbohydrate: Small glass of sugary (non-diet) drink At least three glucose tablets Five sweets. If no one is trained to give a glucagon injection an ambulance should be called immediately. if it’s due. Treating a hypo If you are conscious. If you become unconscious If you have a severe hypo and become unconscious you will need help from someone to treat the hypo.some people with insulin treated diabetes are prescribed glucagon injections. Some people may need to follow this treatment with a snack of 15–20g of slower-acting carbohydrate to prevent their blood glucose levels getting low again. Always tell your diabetes healthcare team if you have a severe hypo. The choice of hypo treatment is up to you. Ask your diabetes healthcare team if you need one Call an ambulance if you don’t have a glucagon kit available or you have not recovered within ten minutes of receiving the glucagon injection. Glucose gel is available on prescription if you are treated with insulin. Take your tablets and/or insulin injections correctly. cereal or some biscuits and milk – or even your next meal. piece of fruit. Don’t drink alcohol on an empty stomach or drink too much alcohol. but it should not be used if you are unconscious. so you’ll need to decide how much and which treatment works best for you. Note: Don’t treat your hypo with foods that are high in fat such as chocolate and biscuits because the fat will delay the absorption of the glucose and won’t treat the hypo quickly enough.

kidney disease and lower limb amputations.No. The rise may happen because you felt incredibly hungry during the hypo and ate to correct this. Call an ambulance if you don't have a glucagon kit available. people are aware that you have diabetes and can help. your blood glucose level may actually rise. While this is not common. prolonged high blood glucose levels can lead to complications such as blindess. In the long term. stroke. you may need to alter your diabetes treatment with the help of your diabetes healthcare team. if someone you are with has a severe hypo there are some key things to remember: Never give food or drink by mouth because there is a danger of choking. heart attack. Severe hypos If a hypo is untreated there is a risk of losing consciousness and/or having a fit. People who’ve had diabetes for a long time may also lose their hypo warnings signs. Will hypos affect my quality of life? Hypos should not be frequent or severe. This means that your blood glucose level may drop further and the . How do hypos affect my blood glucose levels? After you’ve had a hypo. Why do some people have severe hypos without any warnings? Research suggests that people who keep their diabetes very tightly controlled may have problems in recognising hypo warnings. and some people with diabetes may not be woken by the mild symptoms of a hypo. If there is. If you are on insulin. We recommend that all parents of children with diabetes should have glucagon and be trained how to use it. It can be harmful for you if you try to run your blood glucose levels consistently very high. go to the toilet frequently and feel tired. don’t be tempted to increase your dose. inject it as you have been instructed. You may start to feel thirsty. they’re more likely to have repeated episodes. If you’re having problems. they can often regain them by adjusting their diabetes treatment. Night-time hypos Low blood glucose levels do happen at night. test your glucose levels before you go to bed and during the night – ask your healthcare team about the best times to test. phone an ambulance. talk them through with your diabetes healthcare team. Things to remember: hypos Keep hypo treatments with you at all times. Make sure you carry some form of identification – such as an identity card. Try to build a picture of any hypos you have to see if there are any trends and patterns. Place them in the recovery position (on their side with their head tilted back). contact your diabetes healthcare team. If they are. or the person with diabetes has not recovered within 10 minutes of giving the glucagon injection. however. Your levels may also rise because hypos cause the body to mobilise its own glucose stores. bracelet or necklace – so that if you ever become unwell and are unable to communicate. and that if they have one severe hypo without warning. If not. If you have been given a glucagon injection and shown how to use it. If you’re having night-time hypos.

How to prevent a hyper Be aware of your carbohydrate portions and how they may be affecting your blood glucose levels. This happens when your blood glucose levels are too high – usually above 7mmol/l before a meal and above 8. You may need more medication – discuss this with your diabetes healthcare team. If a night-time blood test appears to shows night-time hypos your insulin dose may need to be adjusted. It may be that you: Have missed a dose of your medication Have eaten more carbohydrate than your body and/or medication can cope with Are stressed Are unwell from an infection Or from over-treating a hypo. If they are a regular occurrence. Remember to take your insulin and diabetes medication. But if it stays high you need to take action: Drink plenty of sugar-free fluids. But if it stays high you need to take action to avoid developing diabetic ketoacidosis. If you are on insulin. If the hypo hasn’t woken you. continue taking your diabetes medication even if you aren’t eating. Treatment If your blood glucose level is high for just a short time. If you are feeling unwell. you must contact your diabetes healthcare team for advice. you may need to take extra insulin. or have a headache (a bit like a hangover). There are several reasons why this may happen.5mmol/l two hours after a meal. contact your diabetes healthcare team for a review of your medications and/or lifestyle. . Symptoms may include: Passing more urine than normal. you may feel very tired the next morning. and always take them correctly. If your blood glucose level is high for a short time. and contact your diabetes healthcare team if you need more information. especially if you are vomiting. emergency treatment won’t be necessary. When you are ill. Hyperglycaemia (hyper) At the other end of the scale is hyperglycaemia or hypers. especially at night Being very thirsty Headaches Tiredness and lethargy. emergency treatment won’t be necessary. The best way to confirm if night-time hypos are happening is to do a blood test during the course of the night. Be as active as possible.hypo may become more severe. Treating hyperglycaemia Treatment of hypers will depend on what caused them.

Make sure you drink plenty of sugar-free fluids. Over time. Make sure people close to you know what your hypo symptoms are and how to treat a hypo or hyper. Cardiovascular disease Damage to the heart and blood vessels is collectively known as cardiovascular disease and people with diabetes have a higher chance of developing it. *Millimoles per litre: a measure of the concentration of a substance in a specified amount of liquid. The force of the blood being pumped from the heart can make the clot break away from the artery wall and travel through the system until it reaches a section too narrow to pass through. If the plaque ruptures the artery walls. This is the cause of heart attack or strokes (affecting the brain). Cardiovascular problems Your major blood vessels consist of arteries which carry blood away from your heart. stroke and all other diseases of the heart and circulation. This is called peripheral vascular disease (PVD). This can contribute to the development of high blood pressure or hypertension. If you have ketones and are unwell. Damage to these vessels is referred to as macrovascular disease. blood cells (called platelets) try to repair the damage. the walls of the blood vessels lose their elasticity. When damage occurs to these vessels it’s referred to as microvascular disease. Narrowing of the blood vessels can affect other parts of the body. you must contact your diabetes team for advice. Keep something to treat a hypo or hyper with you at all times. If this happens the narrow section will become partially or completely blocked. furring up the artery and reducing the space for blood to flow. If left untreated. The term cardiovascular disease (CVD) includes heart disease. If ketones are present it is likely that you do not have enough insulin in your body. Carry diabetes ID to alert people to your diabetes and help them to help you if you are having a hypo. When fatty materials such as cholesterol form deposits on the walls of the vessels (known as plaque). amputation of the limb may eventually be necessary. so you may need to increase the dose or give an extra dose. Talk to your diabetes team about how to do this. such as the arms or legs. this is described as arteriosclerosis or atherosclerosis. especially if you are vomiting. and even more closely if: you have not eaten as well as expected you have done a lot of physical activity you are unwell there has been any change in the routine that might upset your diabetes management. Note: The best way to avoid hypos and hypers is by checking your blood glucose level regularly.Check your blood or urine for ketones if your blood glucose level is 15mmol/l or more. What causes cardiovascular disease? . PVD may produce intermittent claudication (pain in the calf muscle). and veins which return it. Capillaries are the tiny vessels where the exchange of oxygen and carbon dioxide takes place. but this will cause a clot to form. Blockage of an artery leads to the part of the body it supplies being starved of the oxygen and nutrients it needs. which can cause more damage to the blood vessels.

light must be able to pass from the front of the eye through to the retina. is to achieve these agreed targets. The capillaries (small blood vessels) in the retina become blocked. they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates). being focused by the lens. If you have any chest pain. taking part in regular activity. impotence or signs of a stroke. you should contact your doctor as soon as possible. Retinopathy is the most common cause of blindness among people of working age in the UK. Background retinopathy The earliest visible change to the retina is known as background retinopathy. high blood pressure. but it needs to be carefully monitored. ask for help to stop. Risks to your eyes Persistent high levels of glucose can lead to damage in your eyes. if you do smoke. So. Maculopathy . Eyes (retinopathy) Diabetic retinopathy or ‘retinopathy’ is damage to the retina (the 'seeing' part at the back of the eye) and is a complication that can affect people with diabetes. try to get down to a healthy weight. These signals are sent to your brain through the optic nerve and your brain interprets them to produce the images that you see. which should be agreed by you and your healthcare team. Eat a healthy. with a healthy lifestyle. it is important for people with diabetes to manage these levels by making lifestyle changes such as eating a healthy diet. Take your medication as prescribed. It converts the light into electrical signals. Any weight loss will be of benefit. reducing weight if you are overweight and stopping smoking. balanced diet. If you are overweight. What causes retinopathy? To see. stopping will be extremely helpful. Types of retinopathy There are different types of retinopathy: background retinopathy. blood pressure and blood cholesterol checked at least once a year and aim to keep to the target agreed with your healthcare team. smoking or high levels of cholesterol. A delicate network of blood vessels supplies the retina with blood. blood glucose. intermittent pain when walking. such as facial or arm weakness or slurred speech. Get your blood glucose levels. leaky or grow haphazardly. Smoking also plays a major part in eye damage so.Blood vessels are damaged by high blood glucose levels. blood pressure and blood fats need to be kept within a target range. The aim of your diabetes treatment. This will not affect your eyesight. The retina is the light-sensitive layer of cells at the back of the eye – the ‘seeing’ part of the eye. Be more physically active. To reduce the risk of eye problems. maculopathy and proliferative retinopathy. When those blood vessels become blocked. the retina becomes damaged and is unable to work properly. Steps you can take to help prevent CVD If you smoke. Retinopathy is damage to the retina.

These appear during the first stages of kidney disease. As kidney disease progresses. Kidney disease in diabetes develops very slowly. At this stage. This happens as a result of the build up of waste products in the blood. It is also very important to keep blood pressure controlled. especially in the feet and ankles. Beams of bright laser light make tiny burns to stop the leaking and to stop the growth of new blood vessels. Kidney disease can be a very serious condition. In the very early stages there are usually no symptoms and you may not feel unwell. About one in three people with diabetes might go on to develop kidney disease. in some cases. This can lead to some loss of vision. Kidney disease (or nephropathy to give it its proper name) is when the kidneys start to fail. The bleeding (haemorrhage) causes scar tissue that starts to shrink and pull on the retina. What is kidney disease? The kidneys regulate the amount of fluid and various salts in the body. These growing blood vessels are very delicate and bleed easily. as if you are looking through a layer of fluid not quite as clear as water. particularly for reading and seeing fine details. If the kidneys start to fail they cannot carry out their jobs so well. this can mean there are changes in blood pressure and in the fluid balance of the body. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications. helping to control blood pressure. as the kidneys become 'leaky' and lose protein. although. Why are people with diabetes more at risk? Kidney disease is caused by damage to small blood vessels. It provides our central vision and is essential for clear. and everything may appear blurred. This can lead to swelling. Once the retinopathy has reached this stage it will be treated with laser therapy. detailed vision. Proliferative retinopathy Proliferative retinopathy occurs as background retinopathy develops and large areas of the retina are deprived of a proper blood supply because of blocked and damaged blood vessels. It is most common in people who have had the condition for over 20 years. Kidneys (nephropathy) Kidney disease can happen to anyone but it is much more common in people with diabetes and people with high blood pressure. This stimulates the growth of new blood vessels to replace the blocked ones. If fluid leaks from the enlarged blood vessels it can build up and causes swelling (oedema). as treatments improve. the kidneys become less and less efficient and the person can become very ill. leading to it becoming detached and possibly causing vision loss or blindness. How does my doctor check for kidney disease? As part of your annual health care review you should have a blood and urine test.Maculopathy is when the background retinopathy (see above) is at or around the macula. to stop working. kidney disease can . which the body cannot get rid of. fewer people are affected. The macula is the most used area of the retina. over many years. making the kidneys work less efficiently. This damage can cause the vessels to become leaky or. Your urine will be checked for tiny particles of protein. called 'microalbumin'. They also release several hormones.

I had protein in my urine but now the test is negative. the filtering and cleaning of the blood cannot be done normally. Attend all your medical appointments. You may need to limit certain foods in your diet. Keeping blood pressure under control is extremely important. so this test is very important. An increasingly common form of treatment for people with diabetes is ACE inhibitor or angiotensin II receptor antagonists (AIIRAs). Get help to stop smoking. In some cases. In some cases. People with poorly controlled diabetes can be more prone to urinary tract infections because glucose in the urine provides a breeding ground for bacteria. phosphate or sodium. and tablets for lowering blood pressure are often used. due to their protective effect on the kidneys. If you need to make any changes to your diet. the diet can be quite complicated to follow. and estimated glomerular function (eGFR) showing how well the kidneys are working. Keep your blood glucose levels and blood pressure levels within your target range. If the kidneys have been damaged. This might need treatment with antibiotics. These medications are sometimes used in people who have normal blood pressure. These are particularly successful as they not only lower blood pressure but also help protect the kidneys from further damage. explaining what it does and how it will help. How can this happen? Kidney disease is not the only reason for protein to appear in the urine.often be treated successfully. such as blood pressure. the type of diabetes and other factors. Have your urine tested for protein and a blood test to measure kidney function at least once a year. Controlling blood pressure is also very important. Your doctor should discuss any treatment with you before starting you on it. so it is very important for people with diabetes to visit their doctor if they develop a urinary tract infection. The blood test will measure urea. There are various types of dialysis. it can cause damage to the kidneys. you should receive detailed advice from a registered dietitian. This aims to prevent waste products building up in your body. What if kidney disease gets worse? There are many ways of treating kidney disease if the kidneys are no longer able to function properly. and your doctor will discuss with you which one would be best for you. if the infection persists. If you have a urinary tract infection (UTI) this can lead to protein being passed out in the urine. As there may be a number of different things to consider. dialysis might be needed to do this job for the kidneys. What sort of treatment might be recommended? This depends on the individual. Eat healthily and keep active. such as protein foods or foods high in potassium. . What can I do to look after my kidneys? Taking care of your kidneys is an essential part of managing your diabetes. creatine.

people controlling their diabetes with diet or tablets have been known to develop DKA when severely ill. vomiting Breathing changes (deep sighing breaths) Smell of ketones on breath (likened to smell of pear drops) Collapse/unconsciousness. If you are unable to eat. You may need to take extra insulin. Drink plenty of unsweetened fluid. During a growth spurt/puberty. (Some people who do not realise they have Type 1 diabetes do not get diagnosed until they are very unwell with DKA.) When you are ill. DKA is a life-threatening emergency Although most common in people with Type1 diabetes. DKA can be fatal. DKA usually develops over 24 hours but can develop faster particularly in young children. What to do if you have symptoms of DKA If you have high blood glucose levels and any signs of DKA you must contact your diabetes team immediately. and the body starts to break down other body tissue as an alternative energy source. Ketones in the blood/urine.g. You may need to test your blood glucose and ketone levels frequently (e. Treatment involves closely monitored intravenous fluids. Left untreated. If you have not taken your insulin for any reason. This happens when a severe lack of insulin means the body cannot use glucose for energy. Ketones are the by-product of this process. nausea. Ketones are poisonous chemicals which build up and. In exceptionally rare cases. if left unchecked. If picked up early. Ketones are easily detected by a simple urine or blood test. DKA prevention . every two hours). glucose and fluid. replace meals with snacks and drinks containing carbohydrate to provide energy (e. sips of sugary drinks. Frequently passing urine Thirst Feeling tired and lethargic Blurry vision Abdominal pain. Hospital admission and treatment is essential to correct the life-threatening acidosis. and will cause the body to become acidic – hence the name 'acidosis'.Diabetic ketoacidosis (DKA) Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). How to recognise DKA: High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. insulin and glucose.g. If your levels are consistently above 15mmol/l you should check for ketones. Make sure you check for ketones if your blood glucose is over 15mmol/l. The most likely times for DKA to occur are: At diagnosis. it can be treated with extra insulin. sucking boiled sweets). using strips available on prescription. anyone who depends on insulin could develop diabetic ketoacidosis.

thirst nausea dry skin disorientation and. containing carbohydrate. Because people with Type 2 diabetes may still be producing some insulin. which is why it was previously referred to as HONK (hyperglycaemic hyperosmolar non- ketotic coma). as occurs in diabetic ketoacidosis (DKA). ketones may not be created. drowsiness and a gradual loss of consciousness. Stopping diabetes medication during illness (e. Food choices In some cases dietary advice for the older person with diabetes may differ from general recommendations. Ketones develop when the blood glucose level is high due to lack of insulin which is needed to allow glucose to enter the cells for energyy. Symptoms can frequently include: urination. Older people and diabetes Most areas of care in diabetes are relevant to all age groups but there are some specific changes due to growing older which might affect your diabetes. HHS is a potentially life-threatening emergency Hospital treatment for HHS aims to correct dehydration and bring blood glucose down to an acceptable level by giving replacement fluid and insulin by an intravenous drip It does not usually lead to the presence of ketones in the urine.g. What you can do: Always take your diabetes medication. in later stages. even if you feel unwell and can’t eat If you monitor your blood glucose. It can develop over a course of weeks through a combination of illness (e. Older people in care homes are often more likely to be underweight than . Because of swallowing difficulties or nausea) can contribute. Making sure you always take your insulin in the right amounts for your food and activity patterns. keeping a good check on your blood glucose levels and consulting your healthcare team appropriately will help you to avoid episodes which are both life-disrupting and life-threatening.DKA is usually avoidable. but blood glucose often rises despite the usual diabetes medication due to the effect of other hormones the body produces during illness. replace meals with snacks and drinks.g. you may need to test more frequently Contact your healthcare team if your blood glucose levels remain high (>15mmol/l) Drink plenty of unsweetened fluids If you can’t eat.infection) and dehydration. Hyperosmolar Hyperglycaemic State (HHS) Hyperosmolar Hyperglycaemic State (HHS) occurs in people with Type 2 diabetes who experience very high blood glucose levels (often over 40mmol/l).

Person having a healthcheck with GP Nutritional assessment and diet should form part of your individual care plan if you live in a care home. People at risk should have a nutritional assessment and individual advice from a dietitian to address areas of concern such as needing extra calories. Personal food preferences are important in any diet plan and older people with diabetes should be able to continue to enjoy a wide variety of foods. particularly during bouts of illness. It may not always be appropriate to reduce the fat. Exercise to build limb strength and flexibility for those who are housebound and confined to a bed or chair can be taught by a physiotherapist and supported by carers. You can aim to be as active as you are able. including those with frailty. It can help you to continue to self-care. Older people may have added risk factors which can lead to hypo: being prescribed five or more medications chronic kidney problems poor food intake having other illnesses or conditions. meal supplements and replacements. Remember to check with your GP before starting any new exercise. Poor or irregular eating can often be a cause of hypos. limited mobility. dexterity or vision can all cause discomfort associated with eating. maintain mobility and balance and improves insulin sensitivity. This may mean that the first signs noticed by a carer are: inability to concentrate personality change morning headaches sleep disturbance. effects of some drugs on the digestive system. Poor oral health. can improve your mental well- being and prevent falls.overweight and there is a high rate of undernutrition. Keeping active Keeping active in later life helps to strengthen muscles. salt and sugar for every older person with diabetes. Hypos Hypoglycaemia or hypo occurs at blood glucose levels of less than 4mmols/l. and some have no symptoms at all. Fluid intake is often lower in older people which can cause dehydration. Hypos which go unnoticed can cause very unpleasant symptoms: confusion speech and self-care difficulties poor appetite aggressive behavior unsteadiness and falls losing consciousness cognitive damage . Older people. low salt diet or manageable foods. have been shown to benefit from light resistance and balance training. weight reduction. Staff. Many older people find their hypo warning symptoms become less obvious. including catering staff in older people's care homes. should have training to give them an understanding of the specific needs of individuals with diabetes.

it is helpful to have regular mealtimes and snacks containing carbohydrate and to be aware of hypo symptoms and what to look out for in individuals who may be at risk. Mental health and well-being Depression is more common in people with long-term conditions but may go unnoticed in older people with complex health problems. foot ulceration and adverse effects of medication can all contribute to depression. a sandwich or the next meal. screening on admission and annually is recommended. Anything which affects your mental well-being may affect your ability to successfully manage your own diabetes. Extra monitoring and medication may be required and carers may need to give you extra support. particularly those living in care homes may be more likely to be admitted to hospital when they are unwell. such as a sugary (non-hot. Painful neuropathy. The risk of dementia also increases with age. Managing self-care . Living with Diabetes and Dementia is a helpful guide with practical tips. This is because diabetes can have an additional effect on the illness and the illness can impact on the diabetes. This is something to discuss with the GP. For older people in care homes a personal hypo box with hypo treatments and instructions for treatment can be kept at hand. particularly in older people who are dehydrated. If you do have to go to hospital it is very helpful to take a copy of the care plan with you so that staff can easily see your diabetes medical history and current treatment. diabetes care plans for individuals and diabetes skills training for staff. Treatment A hypo should be treated immediately in a conscious person with fast-acting glucose. If you are living with diabetes and dementia. Residential settings providing care for people with diabetes should have a diabetes policy which includes management and prevention of hypos. If someone is unconscious. Simple tests are available from your GP to screen for depression or dementia. call for medical help or an ambulance. heart attack or stroke. Blood glucose can rise quickly during illness. non-milky) drink or some glucose tablets and followed up with something starchy like biscuits. Recognizing these issues at an early stage can help limit their longer term impact. For older people living in care homes. It is important that there is guidance for carers in your personal care plan. This should also show very clearly when medical attention must be sought. Target levels for blood glucose control should not be too tight and medication must be right for the individual. Prevention To prevent hypos. Blood glucose monitoring can help to identify older people who may be at risk of hypos but must always be looked at together with longer term blood results like HbA1c to give a clear picture. Illness and hospital admission Older people with diabetes.

Physical changes as you grow older may affect your ability to self-care. meaning early problem signs are missed. It is easy to assume that symptoms are simply due to the ageing process or because you have diabetes.Physical changes as you grow older may affect your ability to self-care. Failing eyesight and reduced mobility may lead to a reduced level of daily foot care. Failing eyesight and reduced mobility may lead to a reduced level of daily foot care. However. it is important to seek advice for any new symptoms and to ask for support where self-care and monitoring has become difficult for you. Urinary incontinence can be a symptom of many conditions. Age is the most significant factor for common eye conditions like glaucoma. Failing eyesight and reduced mobility may lead to a reduced level of daily foot care. It is easy to assume that symptoms are simply due to the ageing process or because you have diabetes. As changes can occur at any time they may also indicate that something should be investigated as you may need a change of medication. it is important to seek advice for any new symptoms and to ask for support where self-care and monitoring has become difficult for you. cataract and macular degeneration. meaning early problem signs are missed. Physical changes as you grow older may affect your ability to self-care. including poorly controlled diabetes and changes in kidney function. However. meaning early problem signs are missed. . However. including poorly controlled diabetes and changes in kidney function. including poorly controlled diabetes and changes in kidney function. As changes can occur at any time they may also indicate that something should be investigated as you may need a change of medication. Urinary incontinence can be a symptom of many conditions. Physical changes as you grow older may affect your ability to self-care. Age is the most significant factor for common eye conditions like glaucoma. it is important to seek advice for any new symptoms and to ask for support where self-care and monitoring has become difficult for you. Age is the most significant factor for common eye conditions like glaucoma. As changes can occur at any time they may also indicate that something should be investigated as you may need a change of medication. cataract and macular degeneration. cataract and macular degeneration. As changes can occur at any time they may also indicate that something should be investigated as you may need a change of medication. Urinary incontinence can be a symptom of many conditions. It is easy to assume that symptoms are simply due to the ageing process or because you have diabetes.