Several situations can cause blood glucose levels to nose-dive or skyrocket. Being prepared for them when and if they occur is the best way to avoid the possible highs and lows.

Sick Days

As you've learned, being ill is a big risk factor for high blood glucose levels. If your doctor hasn't discussed it with you already, you should ask him about a sick-day plan. A sick-day plan is simply a course of action to take if you develop the flu or another mild illness. Here are some typical guidelines to follow when you are sick:

• Keep eating and drinking. Have plenty of nonperishable food and drinks on hand that are easy on the tummy, including Jell-O, broth soups, saltine crackers, fruit juice, and pudding. Drink plenty of water and fluids to avoid dehydration.

• Stock up the medicine cabinet. In addition to your glucose meter, you should always have ketone-testing supplies on hand, and basics like a thermometer and medications to treat diarrhea and vomiting. Talk to your doctor about recommendations for the latter.

• Stay in touch. Discuss guidelines with your doctor about when you should call (e.g., if your blood glucose reaches a certain landmark, or if you can't keep food down, or if you exhibit specific symptoms). When in doubt, always pick up the phone.

• Test often. Stating the obvious — you'll need to test frequently to pick up dangerous highs early.

• Don't skip your meds. Keep taking both insulin and oral medications, and if they aren't bringing down your glucose adequately, call your doctor to discuss increasing the dose.

Drinking Alcohol

When you drink, your liver decides to shut down its regular glycogen storage and glucose production operation, opting instead to concentrate on clearing the alcohol from your body. The result can be hypoglycemia, either while you're drinking or hours afterward while your liver continues to clear alcohol from the bloodstream. For this reason, you should always eat when you drink, and be on the lookout for symptoms of a low.

If you choose to drink alcohol, it is absolutely essential that you have a non-drinking friend with you who knows how to recognize the symptoms of hypoglycemia and treat them appropriately. Because alcohol can so easily impair judgment, this should be someone you can trust not to drink.

Always eat something when you drink to keep glucose levels up, and be sure to assess any mixed drinks for “hidden” calories and sugar from fruit juices or mixes (and work them into your overall meal plan). A snack before bed is also important if you've indulged to ward off overnight lows. And when you've been drinking, it's always a good idea to set your alarm to awaken you for a middle-of-the-night blood test for the same reason.

Even if you choose to abstain or have only one drink, but attend a function where the alcohol is flowing freely, it's important to have a designated non-drinking buddy who knows what to look out for. Some of the symptoms of a low — confusion, mood swings, and incoherence — can easily be mistaken for intoxication by others (especially if they've had a few themselves) and not treated appropriately.

Medications

Certain medications can cause highs or lows. Whenever you get a new prescription, ask your doctor about its potential to affect your blood glucose levels and what adjustments you can make to your treatment to avoid a blood sugar emergency. And for the same reason, never take supplements or herbal remedies without running them by your doctor first.

Make sure you are never caught without your diabetes medication. Always get your insulin and oral drug prescriptions filled well before you run out. If you ever find yourself in the position of not being able to afford your medication, call your doctor and explain your circumstances. In many cases, she may be able to offer you drug samples to get you through a particularly difficult time. She may also be able to prescribe a less-expensive generic or alternative drug.