Hypoglycemia usually means having a blood sugar level below 70mg/dl. However, in some diabetic patients, symptoms of hypoglycemia may happen when blood sugar rapidly decreases, even if it is above 70mg/dl.

• Hypoglycemia may occur in the following events：
  1. Inappropriate dosing of insulin or oral medication
  2. Skipping a meal, eating a small meal, or eating later than usual
  3. Eating a meal with mostly simple sugars
  4. Drink alcohol without eating
  5. Too much energy consumption without snacking, such as strenuous or prolonged exercising
  6. Diarrhea
• Symptoms of low blood sugar：
  1. Early on when hypoglycemia has just begun, there might be hunger, shivering, cold sweating, palpitation or rapid heart rate, weakness, dizziness, or lip numbness.
  2. In severe conditions, patients may develop disturbances in consciousness, seizure, or pass out.
• If the patient is clear and may cooperate, eat or drink 15 grams of a fast-acting carbohydrate every 15 minutes until symptoms improve or if tested blood sugar is over 70mg/dL. Try：
  1. Juice or soft drink (about 120mL)
  2. Milk (about 240mL)
  3. Hard candy (about 3 sugar cubes)
  4. Honey (1 tbsp under the tongue)
     *If symptoms persist for over 30min, please go to the ER immediately.
• Once symptoms improve, have an earlier meal if anticipating to eat within the hour, or have a piece of toast or 3 pieces of saltine crackers if at least anther hour until the expecting meal.
• For the unconscious patient
  Carefully apply 1 tbsp of syrup or honey into the pocket between the patient’s lip and gums, then gently rub the cheeks. Repeat every 15 minutes. Bring patient to the hospital immediately.
• Prevention：
  1. Learn to spot symptoms of hypoglycemia.
  2. Inject insulin or take oral diabetic medication in appropriate doses
  3. Eat at a regular scheduled meal time in appropriate proportions and amount.
  4. Check blood sugar before and after exercise. Have a snack if the sugar level is below 180 mg/dl.
  5. Carry candy or biscuit everywhere in case of hypoglycemic episode.
• When feeling sick or having poor appetite, call your doctor or nutritionist for medication adjustment.

• Hyperglycemia develops when your body does not produce enough insulin or does not respond well to insulin. Without enough insulin, your body begins to use fat as fuel instead of sugar. Sugar level increases while metabolic products of fatty acids called ketones buildup.
  When left untreated, hyperglycemia may lead to a serious condition called diabetic ketoacidosis.
  Hyperglycemic hyperosmolar syndrome is another serious condition that may develop when blood sugar is over 600mg/dl and blood osmolarity is over 320mosm/mL with no ketones in blood.
• Early symptoms of high blood sugar：
  1. Increased thirst
  2. Frequent peeing
  3. Nausea or vomiting, abdominal pain
  4. Weight loss
  5. Dry skin and dry mouth
  6. Sunken eyes
• Symptoms of ongoing or serious complications of hyperglycemia：
  1. Fruity smelling breath and shortness of breath in ketoacidosis
  2. Long and slow deep breaths in hyperglycemic hyperosmolar syndrome
  3. Rapid heart rate
  4. Postural hypotension or rapid drop in blood pressure when standing
  5. Change or loss of consciousness
     *If suspect a hyperglycemic event, drink lots of water, stop all ongoing activities, and go to the ER.
• Preventing hyperglycemic complications：
  1. Take medication as instructed and follow-up as scheduled.
  2. Follow the suggested diet plan of the nutritionist.
  3. Regularly check and record blood sugar.
  4. Regular exercises.
  5. Understand your own body’s limitations and learn to recognize symptoms of increasing blood sugar.

• High blood pressure or hypertension is a subtle chronic disease often with mild or no symptoms at all. However, it should not be overlooked just because there is minimal or no discomfort.
• Medication should be taken as instructed even if there is no discomfort.
• Monitor blood pressure on a regular basis. Return to the cardiology outpatient department regularly.
• Limit salt intake. Avoid adding excess salt, MSG, or soy sauce on food.
• Eat fewer processed or packaged foods such as canned, pickled, or instant foods. Make a habit of reading packaging labels. Opt for lower-sodium options at restaurants and airplanes.
• Limit or stop drinking caffeinated drinks such as coffee, cocoa, tea, etc.
• Quit smoking.
• Watch your weight. Lose weight if necessary.
• Avoid anxious or stressful situations such as staying up late working or getting in an argument. Do not stress eat or binge drink.
• Avoid overworking and take time to relax.
• Return to the emergency department as soon as possible if there are following symptoms：
  1. Chest pain or chest tightness
  2. Severe headache with vomiting
  3. Limb weakness, speech difficulties, or unsteady gait

• Hypokalemia is a metabolic imbalance characterized by extremely low potassium levels in the blood. It is a symptom of another disease or condition, or a side effect of diuretic drugs.
• Patients with hypokalemia are encouraged to eat more bananas, oranges, guavas, hard persimmons, melons, tomatoes, dark green vegetables, chicken soup, or broth.
• Patients with a history of hypokalemia should go to the ER if there is persistent diarrhea, vomiting, worsening muscle weakness, or other recently managed symptoms showing no improvements.
• For further treatment and tests, please follow up at the nephrology or endocrinology outpatient department as scheduled.

• Target patients：those with hyperlipidemia, cholecystitis, gall bladder stone, severe diarrhea, and coronary artery disease.
• Goal：
  1. To decrease the absorption of fat from food.
  2. To decrease the work and stress on the following organs：pancreas, intestines, gall bladder, coronary artery.
• Suggested foods：
  1. More plant foods：whole-grain products, fruits, non-fried soy products, beans and peas, and vegetables.
  2. Moderate amount of lean and low-fat, meat and dairy products：low-fat or skim milk and yogurt, low-fat cheese, lean meat, liver, heart, kidney, eggs, oysters, shrimp, eel, abalone, octopus, sardines, scallops, squid ….
• Low-fat cooking：steamed, boiled, braised, stewed, roasted, braised without oil. Try adding non-irritating condiments such as lemon juice, herbs, and spices on cooked vegetables instead of using cheese, butter, or cream-based sauces.

• Hyperkalemia is a condition of abnormally high potassium levels in the blood. The concentration of potassium in the body is regulated by kidneys and hormones, and balance is maintained through excretion in urine. Abnormally high levels of potassium in the blood or urine suggest the presence of another underlying medical condition. Because potassium helps to regulate muscle activity, including the activity of heart muscle, hyperkalemia needs to be taken seriously, especially in patients with known hyperkalemia history and kidney diseases.
• Potassium ions are stored in various types of foods and are easily soluble in water. Cutting vegetables into small pieces then blanching them in hot water can reduce the intake of potassium as most of the potassium will be left in the cooking water. Don’t drink the cooking water and avoid drinking soup.
• Drink less animal based soup (including chicken, beef, fish, pork soup, hot pot soup, and stock). Avoid soaking rice or noodles in vegetable soup or broth.
• Tomatoes should not be eaten raw or try eating it after it has been blanched or cooked and had the tomato juice strained.
• Starfruit is strongly discouraged as it contains neurotoxins which uremic patients cannot metabolize. Consequences include persistent hiccups or other uncomfortable symptoms to severe convulsions or coma.
• Eating fruits is still encouraged for their fiber and prevention of constipation. Eat whole fruits (not just the pulp or juice) up to portions of no more than 2 fist size per day.
• Avoid chocolate, kiwi and bananas because they are high in potassium, which may cause the arrhythmia.
• Do not use low-sodium soy sauce as they are actually high in potassium from substituting sodium for potassium.

• Target patients：Patients with osteoporosis, calcium deficiency, or those who have had a recent bone fracture and need to increase the intake of calcium.
• Suggested foods：
  1. Dairy：milk, yogurt, cheese
  2. Legumes：soybeans, bean curd, almonds, peanuts, black sesame
  3. Seafood：shrimp, seaweed, kelp, milkfish, oysters, shrimp, Salmon and sardines canned with their soft bones
  4. Mushrooms and fungi
  5. Green leafy vegetables：broccoli, collards, kale, mustard greens, turnip greens, and bok choy or Chinese cabbage, Thai basil, cabbage
• When making bone soup or fish soup, adding some vinegar or lemon can help release the calcium from the bones. Eating vitamin C rich fruits after meals (such as oranges and guavas) can also help with calcium absorption.
• Talk to a nutritionist or health care provider for possible need of supplements. Too much calcium may cause bloating, gas, and constipation. Very high doses of calcium can also cause kidney stones. Any supplement should be checked with your doctor if you are taking prescription drugs.

• Target patients：Those with chronic anemia or iron deficiency anemia.
  1. About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body.
• Suggested foods (iron-rich foods)：
  1. Proteins：Beef or chicken liver, pork and pork loin, sausage, beef, sardines, oyster, egg yolk, soybeans.
  2. Fruits & vegetables：Raisins, spinach, cherries, parsley, beans, lentils, peas, dates, apples, pumpkin, sesame, or squash seeds.
  3. Carbohydrates：Brown rice, oatmeal, wheat germ.
• Increasing vitamin C rich foods such as oranges and guavas, can also help promote the absorption of iron.
• Limit the amount of coffee, tea or calcium-rich foods which may hinder iron absorption.
• Talk to a nutritionist or health care provider for possible need of supplements. Although iron toxicity from food sources is rare, deadly overdoses are possible with supplements.

• A bland diet is a diet consisting of foods that are generally soft, low in dietary fiber, cooked rather than raw, and not spicy.
• Target patients：those with gastric ulcer, duodenal ulcer, gastritis, ulcerative colitis, and diarrhea or irritable bowel.
• Principle eating habit：regular meals, frequent small meals, chew thoroughly and swallow slowly.
• Suggested foods：milk and dairy products, soft tender meat free of tendons and sinews, animal internal organs, seafood, soy products, low-fiber vegetables and fruits, peeled and seeded fruit that are less sweet, rice and oat products, saltine crackers, bland toast … etc.
• Fried and fatty foods, strong cheeses, whole grains (rich in fiber), and the medications aspirin and ibuprofen should be avoided while on this diet.