Glucose Bad 1

Diabetes Self-Management Education Made Easy
with Mnemonic (GLUCOSE BAD)

MAY 31, 2016
Because diabetes can affect many parts of the body, there’s a lot to remember
for self-management. Fortunately, diabetes self-management education can be
made easy.
Given that glucose isn’t good for patients with diabetes, here’s a mnemonic I
learned in pharmacy school that can help health providers and patients recall
what’s needed for diabetes self-management: “GLUCOSE BAD.”
G: Glycemic control
To ensure effective glycemic control, keep a daily log. Be sure to wash hands
with soap and warm water and dry them prior to using a glucometer.
According to the American Diabetes Association, targets for most non-pregnant

adults with diabetes are:
● A1C <7%
● Blood glucose 80-130 mg/dL pre-meal

● Blood glucose <180 mg/dL 1-2 hours post-meal
Some signs and symptoms of hypoglycemia (<70 mg/dL) include shakiness,
sweating, dizziness, or fatigue. Treat hypoglycemia with 15-20 g of glucose or
simple carbohydrates, such as a half cup of juice or 2 tablespoons of raisins.
Then, recheck blood glucose after 15 minutes. Repeat treatment and recheck
until blood glucose is no longer low.
Hypoglycemia left untreated may lead to a seizure or passing out, so a

prescribed glucagon injection will be needed to stimulate the liver to release
stored glucose into the bloodstream.
L: Lipids
Low-density lipoprotein cholesterol (LDL-C) should be <100 mg/dL. Adult
patients not taking a statin should obtain a lipid profile at diabetes diagnosis,
initial medical evaluation, and every 3-5 years thereafter if the patient’s LDL-C is
<100 mg/dL. Adult patients with abnormal lipids taking a statin should obtain a
lipid panel at initiation of statin therapy and annually thereafter.
Some lifestyle changes for lipid management include losing weight if the patient
is overweight; reducing intake of saturated fat, trans fat, and cholesterol;
increasing intake of omega-3 fatty acids, viscous fiber, and plant stanols/sterols;
and increasing physical activity.
U: Urine screening
Patients with type 1 diabetes for at least 5 years, patients with type 2 diabetes
starting at diagnosis, and all patients with hypertension should get their urine
screened annually for albumin and estimated glomerular filtration rate.
C: Cigarettes
Patients who smoke should be encouraged to quit, as smoking affects small
blood vessels, which consequently decreases blood flow to the feet and makes
wounds heal slowly.
O: Ophthalmic exams
Patients with diabetes are at a higher risk of blindness. With regular checkups,
health care providers and patients can keep minor eye disorders from
progressing or treat major problems right away when available treatment options
are still effective.
Patients with type 1 diabetes should get an initial dilated and comprehensive eye
exam within 5 years of diabetes onset, while patients with type 2 diabetes should
get an initial dilated and comprehensive eye exam at time of diabetes diagnosis.
If there’s no evidence of retinopathy during 1 or more annual eye exams, exams

every 2 years can be considered. Otherwise, more frequent dilated retinal exams
are recommended. For pregnant patients, eye exams should occur before
pregnancy or in the first trimester and monitored every trimester and for 1 year
postpartum.
S: Sexual dysfunction
Patients should be asked about sexual dysfunction. Treatment options include
phosphodiesterase type 5 inhibitors such as sildenafil or tadalafil.
E: Extremities
Annual comprehensive foot exams should be conducted to look for risk factors
predictive of ulcers and amputations. Patients should be provided foot self-care
education such as:
● Checking the feet every day for red spots, cuts, swelling, and blisters
● Keeping toe nails trimmed

● Protecting the feet by wearing socks and shoes at all times
● Keeping the feet clean and dry
● Keeping the skin soft and smooth by rubbing a thin coat of lotion over the top and
bottom of feet
● Keeping the blood flowing to the feet by avoiding smoking and wiggling the toes
and moving the ankles up and down
B: Blood pressure (BP)

BP should be measured at every patient visit, and elevated BP should be
confirmed on a different day. The goal is typically <140/90, but it’s <130/80 if the
patent is younger, has albuminuria, and/or has hypertension with 1 or more
additional atherosclerotic cardiovascular disease (ASCVD) risk factor. A pregnant
patient’s BP goal is 110-129/65-79.
Patients with BP >120/80 should modify their lifestyle through weight loss,
reducing sodium intake to <2300 mg/day, increasing potassium intake,
increasing fruit and vegetable intake to 8-10 servings/day, and increasing
physical activity. Patients should consult their primary care provider before
modifying their lifestyle. Because of other diabetes complications that a patient
may have such as retinopathy, autonomic neuropathy, and peripheral
neuropathy, increasing physical activity or engaging in weight-bearing activity
may not be options.
Patients with BP >140/90 should be initiated on pharmacologic therapy.
A: Aspirin
Consider daily aspirin therapy (75-162 mg/day) as primary prevention for type 1
or 2 diabetes patients who are at increased ASCVD risk (10-year risk >10%) and
not at risk of bleeding. Aspirin therapy should also be considered for secondary
prevention for diabetes patients with a history of ASCVD. If the patient has an
aspirin allergy, clopidogrel 75 mg/day can be used instead.
D: Dental exams
Twice-yearly dental exams are recommended.

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Glucose Bad 1

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Diabetes Self-Management Education Made Easy

with Mnemonic (GLUCOSE BAD)

According to the American Diabetes Association, targets for most non-pregnant

● Blood glucose 80-130 mg/dL pre-meal

Hypoglycemia left untreated may lead to a seizure or passing out, so a

If there’s no evidence of retinopathy during 1 or more annual eye exams, exams

● Keeping toe nails trimmed

B: Blood pressure (BP)

Patients with BP >140/90 should be initiated on pharmacologic therapy.

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