American Diabetes Association Complete Guide to Diabetes. American Diabetes Association

strips that come in a vial all spoil at the same time, probably 6 months after you open them.

      Pharmacies

      Some pharmacies offer a smaller selection of equipment, so check the aisles to see how your pharmacy stacks up. If you have a good relationship with your pharmacist, you may be able to ask him or her to order what you want. Although small pharmacies can be more expensive, establishing a good working relationship with your pharmacist can save you a lot of running around. Pharmacists can often give you information about the ins and outs of different products and models. Local pharmacists will know the products they sell and will be able to spend time training you to use the purchase. This is often a real, convenient advantage.

      Most grocery store and chain pharmacies carry diabetes supplies, which might be convenient if you are shopping for other items.

      Diabetes Supply Stores

      Another shopping option is to visit a diabetes specialty store. To find one near you, call your local American Diabetes Association office or check in the phonebook under “Diabetes” or “Medical Supplies.” If you are lucky enough to have one nearby, you may be able to get many nonprescription items along with diabetes information and support in one easy stop. You may also find a selection of healthy foods, books, and information on local diabetes events and organizations. Many diabetes shops have knowledgeable staff who can help you compare models, answer questions, and provide training on new tools.

      Mail Order

      Purchasing your diabetes supplies, such as test strips, through a mail-order supplier can save you money. However, you’ll also have to calculate the extra time it will cost to ship supplies and perhaps the extra time to deal with insurance coverage.

      Buying Supplies Online

      When purchasing supplies online, make sure to look for an Internet site that is secure and reputable. The FDA recommends purchasing from websites that are located in the United States and provide clear ways to contact the company with questions or concerns.

      Making Mail Order Work for You

      • Pay extra attention to timing. Some orders will ship automatically, whereas others will take up to 2 weeks. Order your supplies far enough in advance that your current supply won’t run out before the new ones arrive.

      • The mail-order company should confirm your insurance coverage before filling out your first order. If you use Medicare to help pay for supplies, note that the prices shown in advertisements or quoted over the phone may differ from the amount that Medicare will reimburse for that item.

      • If you live in a warm climate or order during the summer, ask how perishable items will be shipped. Strips can spoil in excessive heat, so overnight shipping is best for these items.

      • Compare prices by shopping around. Most mail-order firms have toll-free numbers and websites.

      • Always keep copies of any orders you send through the mail. If you call in an order, be sure to write down when you placed the order and what you ordered.

      • Check the expiration date on each item that arrives. If you’ll need the item in 6 months, make sure it doesn’t expire in 2 months. Send back all items with expiration dates that are just around the corner.

CHAPTER 8

      Blood Glucose Emergencies

      • Hypoglycemia

      • Hyperglycemia

      • Illness

      Dealing with high and low blood glucose levels is a fact of life with diabetes, so you should be aware of possible emergencies that can occur. Emergencies include blood glucose levels that are too high or too low.

      It is important that you learn to recognize the warning signs and have a plan for dealing with them. Discuss with your health care team what you should be on the lookout for and what you should do if you suspect an emergency situation may be developing. Also, talk to your family, friends, and coworkers about what to do in an emergency. If you are in danger, you may not always be able to handle the situation yourself.

      Being prepared is your best bet, and frequent monitoring of blood glucose will alert you in time to prevent most emergencies.

Hypoglycemia

      The most common emergency is low blood sugar, which is called hypoglycemia. It can be a problem for people who take insulin or certain diabetes pills, including chlorpropamide, glipizide, glyburide, glimepiride, repaglinide, and nateglinide. Hypoglycemia occurs when blood glucose levels get too low. At the beginning of a hypoglycemic reaction, you might feel dizzy, sweaty, shaky, or faint. If untreated, you could lose consciousness or have seizures.

      Hypoglycemia is usually caused by insulin doing its job too well. In people without diabetes, the body stops releasing insulin before glucose levels fall too low. But if you inject insulin, your body has no way to shut it off. Another interesting, if frustrating, fact about diabetes is that the body uses insulin inconsistently. Even if you always give yourself the same dose of insulin or other diabetes medication, you could end up with more than enough insulin to handle the glucose in your blood. This can happen even when you are doing everything (including eating) the same as usual.

      It’s impossible to control everything you do to manage your diabetes, no matter how hard you try. Insulin will do its job of clearing glucose from the blood even if it means that blood glucose levels fall too low. Hypoglycemia usually occurs just before meals, during or after strenuous exercise, or when you have too much insulin in your body. Sometimes you may even get hypoglycemia during the night when you are sleeping.

      Causes of Hypoglycemia

      • Too much insulin

      • Too little food

      • Too much exercise

      • A delayed meal

      • Alcohol on an empty stomach

      Symptoms of Low Blood Glucose

      It’s important that you learn your own signs of hypoglycemia. Different people may have different feelings, so it’s important to know what signals your body gives during a low glucose reaction. Hypoglycemia can occur at any time. The only sure way to know whether you have hypoglycemia is to check your blood glucose.

      Symptoms of Hypoglycemia

      • Shakiness

      • Nervousness or anxiety

      • Sweating

      • Irritability or impatience

      • Chills and clamminess

      • Rapid heartbeat

      • Lightheadedness

      • Hunger

      • Sleepiness

      • Anger, stubbornness, or sadness

      • Lack of coordination

      • Blurred vision

      • Nausea

      • Tingling or numbness in the lips or tongue

      • Nightmares or crying out during sleep

      • Headaches

      • Strange behavior, including delirium, confusion, or personality change

      • Seizures

      • Unconsciousness

      Each person’s reaction to low blood glucose can cause a different set of symptoms. It is unlikely that you will have them all or that you will have the same ones each time.

      Hypoglycemic symptoms can serve as important clues to whether