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Having diabetes means that you will be prone to higher than normal blood glucose levels. Popular wisdom to the contrary, diabetes does not, in fact, cause low blood glucose; rather, it is certain drugs used to treat diabetes that sometimes leads to this. In this section, we look at how high or low blood glucose levels can make you feel.

High blood glucose

High blood glucose is not an “all or none,” yes or no kind of thing. Rather, elevated blood glucose levels run a continuum ranging from only slightly higher than normal to up into the stratosphere. A person without diabetes seldom has blood glucose levels higher than 8mmol/L or so, and symptoms of high blood glucose develop only if blood glucose is higher than 10mmol/L or so.

Looking at the symptoms of high blood glucose

These are the most common symptoms of high blood glucose:

✔ Frequent urination

✔ Increased thirst

✔ Blurred vision

✔ Fatigue

✔ Hunger

✔ Weight loss

✔ Persistent vaginal infections

Not everyone with high blood glucose experiences all these symptoms. Indeed, many people have only one or two of these symptoms and some people have none at all. Also, the severity of the symptoms can vary widely. Some people have profound thirst, are running to the bathroom 24/7, and lose many pounds, whereas other people feel slightly tired and that’s it.

The fact that symptoms can be minimal or nonexistent partly explains why so many people with diabetes don’t know they have it. After all, if you feel perfectly fine it only makes sense you won’t suspect you’ve got a problem and thus won’t be knocking on your doctor’s door to get checked out.

Because people can have diabetes yet feel perfectly well and therefore not know they have the condition, the Canadian Diabetes Association recommends all people 40 years of age or over be tested periodically for diabetes. You should have the test sooner if you have an increased risk of diabetes (for example, if you have a parent with type 2 diabetes).

Considering the complications of high blood glucose

Having high blood glucose can do two main things: It can cause symptoms like those we discuss in the previous section, and, if severe or if longstanding, it can damage the body.

If you have very high blood glucose levels (more than 15 to 20mmol/L or so) and you are feeling very unwell, then this may be an emergency and you should seek immediate medical attention.

If your blood glucose levels exceed target year after year, you will be at risk of a number of different types of complications. But if you keep most of your blood glucose levels within target you can dramatically reduce your risk of running into problems. In other words, diabetes complications are not inevitable!

Chronically elevated blood glucose levels can lead to complications like these:

✔ Eye damage (retinopathy), which, if severe, can lead to blindness

✔ Kidney damage (nephropathy), which, if severe, can lead to kidney failure and the need for dialysis

✔ Nerve damage (neuropathy), including abnormal or loss of sensation in the feet, which can be a factor leading to amputation

The role of high blood glucose in causing heart attacks and strokes is more complicated, but it likely plays an important role. Your risk of a heart attack or stroke is much higher if you are overweight, sedentary, smoke, have inadequately controlled high blood pressure, or if you have elevated LDL cholesterol. See a common denominator? We do. These are all things that, working with your diabetes team, you can control! In Chapter 4, we look at the ways healthy eating can help you control your blood pressure and your cholesterol.

Low blood glucose

Low blood glucose (hypoglycemia) is defined as a blood glucose level below 4.0mmol/L. As we mention earlier in this chapter, diabetes, per se, does not cause low blood glucose; rather, it is certain drugs – such as insulin or glyburide – used to treat diabetes that can lead to this condition.

Looking at the symptoms of low blood glucose

These are the common symptoms of low blood glucose:

✔ Anxiety

✔ Hunger

✔ Sweating

✔ Palpitations (noticing a rapid or excessively forceful heartbeat)

✔ Trembling of the hands

If hypoglycemia is severe, it can lead to other symptoms, including confusion, difficulty concentrating, difficulty speaking, and even loss of consciousness. Fortunately, the great majority of the time when people with diabetes experience hypoglycemia they will quickly recognize its symptoms and ingest some sugar-containing food, which will quickly bring their blood glucose level back to normal.

Treating low blood glucose

If ever you have low blood glucose, you need to treat it quickly in order to return your blood glucose to a safe level.

As recommended by the Canadian Diabetes Association, these are the steps you should take if you have low blood glucose:

1. Eat or drink 15 grams of a fast-acting carbohydrate such as

● Four 4-gram glucose tablets (for example, Dex4 tablets; this totals 16 grams)

● ³/₄ cup (175ml) of juice or regular (not diet or sugar-free) pop (but see the warning following this list)

● 3 tsp (15ml) honey or maple syrup; or 3 tsp (15ml) of table sugar dissolved in water

● Seven jelly beans

2. Wait 15 minutes, and then retest your blood.

If your blood glucose level is still less than 4mmol/L, ingest another 15 grams of fast-acting carbohydrate (as listed in the previous step).

3. If your next meal is more than one hour away, or you are going to be physically active, eat a snack, such as half a sandwich or cheese and crackers.

The snack should contain 15 grams of carbohydrate and a source of protein.

If you have low blood glucose and you’re about to eat a meal, you must instead first treat your hypoglycemia with the measures we just described. Only when your blood glucose is back to normal (above 4mmol/L) should you then eat your meal.