Glucose is the main sugar used by the body. It is the principal source of energy for the cells of the body and is carried to each cell by the bloodstream. Insulin helps the glucose cross from the blood stream into the cells. Two of the main goals for diabetes management are to achieve blood sugar control as close to normal levels as possible and to prevent dangerously low and high blood sugar levels. According to the National Institutes of Health, the ideal blood glucose values for most people with diabetes are: on waking up, 80 to 120 milligrams per deciliter; before meals, 80-120 mg/dl; 2 hours after meals, 180 mg/dl or less; at bedtime, 100-140 mg/dl. Low blood sugar, called hypoglycemia or insulin reaction, is present when your blood glucose falls below 60 milligrams per deciliter. Hypoglycemia can happen to you if your meals are too small, delayed or skipped so that there is insufficient sugar available to be absorbed into the blood stream; if you take too much insulin or oral glucose-lowering medication and glucose is removed too quickly from the blood stream; if you exercise or are more physically active than usual and you do not compensate for this extra burst of energy by increasing your carbohydrate intake or reducing your insulin dose; if you drink alcohol unwisely, more than one or two drinks per day, particularly on an empty stomach. With your understanding of the causes of a low blood glucose, it is clear that the best prevention of this problem is to be consistent with your daily plans for medications, food, exercise and monitoring alcohol wisely. Symptoms of mild hypoglycemia that you may feel are: shakiness, palpitations, hunger, sweating and headache. Symptoms of moderate hypoglycemia are headache, dizziness, decreased concentration, mood changes and drowsiness. If the earlier symptoms of hypoglycemia are not recognized, the patient can go on to have seizures, loss of consciousness and progress into coma. If you suspect that your blood sugar is low, immediately check your blood glucose. If this confirms hypoglycemia, a reading of 70 milligrams per deciliter or below, or if testing is not available, follow the ÒRule of 15Ó program. Immediately eat or drink 15 grams of rapidly absorbed carbohydrate. This can be either half a cup of fruit juice or non diet soda, or a cup of milk, or 4 or five pieces of hard candy, or 3 packets or 1 tablespoon of sugar, or 3 glucose tablets. Recheck your blood glucose reading after 15 minutes. After 15 minutes, if your blood sugar is still below 70 mg/dl, repeat the treatment of 15 grams of carbohydrate. Recheck your blood sugar after another 15 minutes. When your blood sugar reaches more than 70 mg/dl, have your regular meal, or if this is not available, have a snack of complex carbohydrate and protein, for example peanut butter crackers, to provide 30 grams of carbohydrate. If the patient is having seizures or is unconscious, always call 911 so at the patient can be taken to an emergency department. When you have had an episode of hypoglycemia, analyze why it happened and discuss with your nurse or doctor your insulin dosages, the timing of your meals, your physical activity, use of alcohol and the frequency with which you need to monitor your blood glucose. High blood sugar-hyperglycemia- is present when your blood sugar is above 250 milligrams per deciliter. Hyperglycemia can occur when you have missed a dose of insulin or pills or have not taken enough; if you have gone off your recommended diet and indulged too freely; or if you have an illness or infection; or excessive stress. There may be no symptoms and signs of hyperglycemia or they can include: weakness and fatigue, thirst, and frequent urination. When you notice any of these symptoms, check your blood glucose. If the blood glucose is above 250 milligram per deciliter, you will need to adjust your diet, medication and exercise program. Hyperglycemia happens to everyone with diabetes at some time. Even if you feel well, but your blood sugar is consistently high, it needs attention to prevent long-term complications. You should consult your medical team. If your blood sugar stays over 250 milligram per deciliter, you can progress into diabetic ketoacidosis, particularly if you have Type 1 diabetes. The symptoms and signs of this are: excessive urination and thirst; nausea and vomiting; fruity breath and ketones in your urine Treatment for diabetic ketoacidosis is to call your doctor or nurse or go to the emergency room immediately. It is important to develop a sick day plan before you get sick. If you have symptoms such as fever, cough, head congestion, nausea or vomiting, do not stop taking your diabetes medications. Test and record your blood glucose every two hours. If you cannot eat your usual meal plan, try to take 15 grams of carbohydrate every 1-2 hours while awake. Foods which contain 15 grams of carbohydrates include: 1 cup chicken soup, 1/2 cup fruit juice, 1/2 cup ginger ale or Coke (not diet), 1/2 cup regular Jell- O, 1/2 cup vanilla ice cream, 1/2 cup cooked cereal. Check in with your doctor or nurse if: you have vomiting or diarrhea for more than 6 hours; if your illness is not improving after 2 days; if your blood glucose stays above 240 milligrams per deciliter; if you are not sure what to do.