50 Things You Need to Know about Diabetes. Kathleen Stanley

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will be handled after your visit. A follow-up will give you the opportunity to discuss real-life experiences you’ve encountered with your meal plan, what things work, and what may need some more planning. The RD can provide a source of support and encouragement for whatever your goals are, so use your resources and stay in touch. Once you’ve established a meal plan, it may help to touch base with your RD annually to discuss new food choices and any new information that may help you improve your plan.

       MORE RESOURCES TO EXPLORE

       WEBSITES

      American Diabetes Association Website …. WWW.DIABETES.ORG

      American Dietetic Association…… WWW.EATRIGHT.ORG

      American Association of Diabetes Educators…… www.DIABETESEDUCATOR.ORG

4 How to call your doctor for help

      There will be days with unexpected troubles, days when you need to get some advice from your health care team about your diabetes care. The doctor’s office is the place for getting accurate medical advice. It may be easier to ask friends or neighbors (or the Internet) for health advice, but they may unknowingly provide you with misinformation, or worse yet, provide dangerous suggestions, which could cause further problems. Here is some good advice for when you need some help.

       DISCUSS THE GROUND RULES

      Ideally, as part of your initial visit, you should have been given information from your health care team about when to contact them, your responsibilities when doing so, and when interventions are up to them. If you have not received this information, plan to ask these questions at your next visit:

      

At what levels do you want me to treat high or low blood glucose on my own?

      

What number should I call when my blood glucose gets really high (for example, higher than 350 mg/dl)?

      

What number should I call for help when my blood glucose gets really low (for example, lower than 50 mg/dl)?

      

When should I call other health care professionals instead of you?

      

Should I call you if I experience any hypoglycemia, or just moderate to severe episodes?

      

Should I have a glucagon emergency kit?

      

Should I check for ketones? If yes, when?

      

What steps should I take if I have positive ketones?

      

What steps should I take if I can’t take my diabetes medication (going to have a dental procedure, employment physical, having vomiting, etc.)?

      

What steps should I take if I run out of medication?

      

What steps should I take if I can’t reach your office for a diabetes problem?

      

Who will be taking my after-hour calls? What are his or her professional qualifications? Do they have access to my medical history if needed?

      

When should I go to the hospital if I can’t manage my blood glucoses on my own?

      

To which hospital should I go if I need emergency help?

       WHEN TO CALL

      Typically, you will want to notify your health care provider at once if:

      

You run out of medication

      

You are running a fever (for more than 8 hours)

      

You are unable to eat (nausea, vomiting, diarrhea, other) for more than 6 hours

      

You have missed more than one dose of diabetes medication

      

You are spilling moderate (or greater) ketones, or cannot clear trace/small ketones

      

You have symptoms of diabetic ketoacidosis (DKA) if you have type 1 diabetes

      

You are having “runaway” high blood glucose levels for a few hours (starting at 200, then moving up to 300, then going to 400. Do I hear 450?)

       EMERGENCY SITUATIONS—TAKE ACTION

      If you are experiencing symptoms of a serious health problem, such as a serious injury, possible heart attack or stroke, or possible DKA, do not call your doctor’s office. Have someone take you to the nearest hospital or call your local emergency response center immediately.

       HOW TO CALL

      Find out what phone number to use for office hours and after hours. Some offices have a “triage” system where phone emergencies are called in and someone is appointed to call you back. Some offices have an automatic voice messaging/prompt system, which allows you to access someone by selecting a certain choice, even in emergencies.

       DON’T WAIT

      If you have been experiencing problems with your blood glucose for a couple of days, don’t wait until Friday night to call the after-hours support person. You may end up being connected to someone who is not familiar with your history and not associated with your regular crew. Don’t get mad if they require additional information (asking question upon question)

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