When “normal” Blood Sugar Isn’t Normal (part 2)
In the last article I explained the three primary markers we use to track blood sugar: fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and hemoglobin A1c (A1c). We also looked at what the medical establishment considers as normal for these markers. The table below summarizes those values. In this article, we’re going to look at just how “normal” those normal levels are — according to the scientific literature. We’ll also consider which of these three markers is most important in preventing diabetes and cardiovascular disease. Marker Normal Pre-diabetes Diabetes Fasting blood glucose (mg/dL) <99 100-125 >126 OGGT / post-meal (mg/dL after 2 hours) <140 140-199 >200 Hemoglobin A1c (%) <6 6-6.4 >6.4 But before we do that, I’d like to make an important point: context is everything. In my work with patients, I never use any single marker alone to determine whether someone has a blood sugar issue. I run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid and triglycerides (along with other lipids), and I also have them do post-meal testing at home over a period of 3 days with a range of foods. If they have a few post-meal spikes and all other markers or normal, I’m not concerned. If their fasting BG, A1c and fructosamine are all elevated, and they’re having spikes, then I’m concerned and I will investigate further. On a similar note, I’ve written that A1c is not a reliable marker for individuals because of context: there are many non-blood sugar-related conditions that can make A1c appear high or low. So if someone is normal on all of the other blood sugar markers, but has high A1c, I’m usually not concerned. With all of that said, let’s take a look at some of the research. Fasting blood sugar According to cont Continue reading >>
Why You Should Test Your Blood Sugar – Even If You’re Not Diabetic!
I’m pretty excited about Robb Wolf’s new book, Wired to Eat, and have just released a podcast where he and I chat about lentils, blood sugar, and “why” (I’ll get to that later in the post, or you can listen to the show). Before I talk more about the book, I thought I’d give you a little context on why I’m such a huge advocate of it… (and if you’re not interested in my story, skip down to “The Basic Gist of the Book”) I’ve always had blood sugar control issues. I think it goes back to being an undiagnosed Celiac as a kid, and constantly being hungry. I mean, I was starving ALL THE TIME. I could have eaten a full Thanksgiving dinner at any point during the day, and then some. I was really underweight as a kid, but always had a little belly. I also had a host of other issues like low muscle tone, hyper mobile joints, reading and attention problems, and had such low blood pressure that I’d sometimes randomly pass out. My small town, egocentric pediatrician declared I had lactose intolerance, and so he told my mother to give me diluted soy formula instead of milk. My daily meals looked something like this: Frosted Flakes with soy milk and orange juice plus banana for breakfast, canned chicken noodle soup for lunch, and Hamburger Helper for dinner. Rarely did we have fresh vegetables or a “from scratch” meal. My mom worked, and thought that homemaking was not for “modern women,” so my kitchen was stocked with Hungry Man dinners (you know, the ones in the tin foil) and Ritz crackers, “cheese spread” and the occasional bag of frozen string beans. During my 20’s, I went nearly vegetarian in college. I loved my deep fried tofu, lentils, and deep bowls of soba noodles. I never fully made it to completely plant-based, purely because my body c Continue reading >>
Common Questions About Blood Sugar
How often should I test my blood sugar? This is a very common question, and the answer isn't the same for everyone. In general, you should test as often as you need to get helpful information. There's no point in testing if the information you get doesn't help you manage your diabetes. If you've been told to test at certain times, but you don't know why or what to do with the test results, then testing won't seem very meaningful. Here are some general guidelines for deciding how often to test: If you can only test once a day, then do it before breakfast. Keep a written record so that you can see the pattern of the numbers. If you control your blood sugar by diet and exercise only, this once-a-day test might be enough. If you take medicine (diabetes pills or insulin), you will probably want to know how well that medicine is working. The general rule is to test before meals and keep a record. If you want to know how your meals affect your blood sugar, testing about 2 hours after eating can be helpful. Test whenever you feel your blood sugar is either too high or too low. Testing will give you important information about what you need to do to raise or lower your blood sugar. If you take more than 2 insulin shots a day or use an insulin pump, you should test 4 to 6 times a day. You should test more often if you're having unusually high or low readings, if you're sick, under more stress than usual, or are pregnant. If you change your schedule or travel, you should also test your blood sugar more often than usual. Talk to a member of your health care team about how often to test based on your personal care plan. What should my test numbers be? There isn't one blood sugar target that's right for everyone with diabetes. It's important to work with your health care team to set Continue reading >>
What Does Preprandial Blood Sugars Mean?
Preprandial means "before a meal." You might have heard the word in the context of preprandial plasma glucose. This refers to your blood sugar levels before a meal. It may also be known as the fasting blood glucose level (if you haven't eaten in at least eight hours). Postprandial blood glucose, on the other hand, refers to your blood sugar levels one to two hours after eating. What Are Normal Preprandial Glucose Levels? For healthy adults, normal preprandial glucose levels are 70 - 99 mg/dl. A preprandial glucose reading of 100 - 125 mg/dl indicates prediabetes. For adults with diabetes, the American Diabetes Association recommends a preprandial glucose target of 80–130 mg/dl. The American Association of Clinical Endocrinologists suggests a preprandial glucose goal of <110mg/dl for people with diabetes. However, depending on your personal health condition, your doctor may set preprandial glucose readings that are different than these guidelines, so make sure you know what numbers you're shooting for. Why Do Preprandial Plasma Glucose Readings Matter? Your preprandial plasma glucose readings tell you the amount of glucose in your bloodstream when you haven't eaten. When you eat, the carbohydrates (and a small amount of the protein) that you've ingested change into glucose, which gets absorbed into your bloodstream. In response, your pancreas releases insulin, which helps move glucose out of the bloodstream and into cells where it can be used as energy. In a healthy state, your body regulates the amount of insulin that's released, resulting in optimal blood sugar readings--ones that are neither too high (hyperglycemic) or too low (hypoglycemic). In diabetes, this balance of insulin and glucose is disrupted. In type 1 diabetes, that's because the pancreas stops making i Continue reading >>
A Simple Trick To Lower Morning Blood Sugar
If you’re type 2 diabetic, you may be wondering why your blood sugar is so high in the morning. Every other time you test, your levels seem to be within range… But those morning levels, sometimes they are sky high and it puts you in a panic, questioning what on earth you may be doing wrong. Firstly, stop panicking — morning rises are a common occurrence in diabetics. However, it is important to understand why it happens and what you can do about it… The dawn phenomenon Logically you’d think that your blood sugar reading should be at it’s lowest in the morning. After all, you’ve eaten nothing and done nothing but sleep. But regardless of whether you eat, glucose production continues anyway… The reason for this is your body’s cells need fuel for your heart to beat, your brain to work and your organs to keep functioning. When you don’t eat, or when you’re asleep, the body can break down stores of available glucose (glycogenolysis) or enter a process called gluconeogenesis — a process that can use non-carbohydrate stores such as amino acids to produce glucose. Various hormones such as glucagon, growth hormone and cortisol, are also involved in raising glucose levels. To wake you up every morning, your body naturally activates these hormones from around 3 am onwards, which explains why it’s called the dawn phenomenon. In people without diabetes, insulin would normally counteract these hormones to prevent excessive glucose production. But since the insulin response and insulin sensitivity are altered in diabetes, your body may not compensate effectively. The Somogyi effect There is another phenomenon called the “Somogyi effect” or “rebound hyperglycemia.” This is when your body’s glucose levels decrease during the night (nocturnal hypoglyce Continue reading >>
Why Do I Have High Blood Sugar Levels In The Morning?
Some people experience very high blood sugar levels in the morning. But what implications does this have for a person's health? There are two main causes of high blood sugar in the morning, the dawn phenomenon and the Somogyi effect This article explores these two causes of high blood sugar levels in the morning. It also discusses what risk factors may cause people to experience them and gives practical advice around how to better manage blood sugar levels. Contents of this article: The dawn phenomenon The dawn phenomenon has to do with natural body changes that occur during the sleep cycle: Midnight - 3 a.m. While most people are sleeping, their body has little need for insulin. During this period, however, any insulin that may have been taken during the evening causes the blood sugar levels to drop off drastically. Between 3 - 8 a.m. The body automatically begins to dish out stored sugar (glucose) in preparation for the upcoming day. In addition, hormones that actively reduce the body's sensitivity to insulin are also being released. During this time period, counter-regulatory hormones are being released. This can interfere with insulin, which may lead to a rise in blood sugar. These include growth hormones, such as: cortisol glucagon epinephrine These events are all happening simultaneously as bedtime levels of insulin are beginning to taper off. Each of these events ultimately plays a part in causing blood sugar levels to rise at "dawn" or in the morning. Who the dawn phenomenon affects Although people with diabetes are generally more aware of the dawn phenomenon, it actually happens to everyone. However, it affects people with or without diabetes differently. Typically, people who do not have diabetes tend not to notice these high blood sugar levels in the morning. Continue reading >>
Questions And Answers - Blood Sugar
Use the chart below to help understand how different test results can indicate pre-diabetes or diabetes Fasting Blood Glucose Oral Glucose Tolerance Test (OGTT) Random Blood Sugar (taken any time of day with or without fasting) A1C Ideal Result Less than 100mg/dl Less than 140 mg/dl Less than 140 (even after eating a large meal) Less than 5.7% Pre-diabetes 100-125mg/dl 140-199mg/dl 140-200 5.7% to 6.4% Diabetes 126mg/dl and greater 200 mg/dl and greater 200 or greater 6.5% or more Q: I have been told that I have diabetes, or "pre-diabetes", or that I am in the "honeymoon period" . My readings are all over the place: sometimes in the 120's, others in the 90's, sometimes, but rarely in the 150-170's. My doctor does not want to put me on medication yet. I exercise regularly and am not overweight though my diet is variable. I certainly like sweets, pizza, and pasta. What is the long term effect of these continued high blood sugar levels? A: Firstly, kudos for your physician for giving diet/lifestyle changes a chance to work. Reduction of body fat often is the first best start. This may or may not be true in your case but certainly sweets, pizza, etc. are affecting your numbers. If you can discipline yourself at this time to eat unrefined foods and be more active, your beta cells that produce insulin may get the rest they need to become efficient again. Our diabetes management booklet has many referenced foods/supplements that may help to stabilize your glucose levels. In time, your favorite foods may be reintroduced in moderate amounts. You appear to be more in the pre-diabetes range at this time. Complications are a long process. If your daytime levels stay under 120-140, that is good. Fasting levels are higher due to hormonal activity nighttime; these levels are a much sl Continue reading >>
The Dawn Phenomenon – T2d 8
The occurrence of high blood sugars after a period of fasting is often puzzling to those not familiar with the Dawn Phenomenon. Why are blood sugars elevated if you haven’t eaten overnight? This effect is also seen during fasting, even during prolonged fasting. There are two main effects – the Somogyi Effect and the Dawn Phenomenon. Somogyi Effect The Somogyi effect is also called reactive hyperglycaemia and happens in type 2 diabetic patients. The blood sugar sometimes drops in reaction to the night time dose of medication. This low blood sugar is dangerous, and in response, the body tries to raise it. Since the patient is asleep, he/she does not feel the hypoglycaemic symptoms of shakiness or tremors or confusion. By the time the patient awakens, the sugar is elevated without a good explanation. The high blood sugar occurs in reaction to the preceding low. This can be diagnosed by checking the blood sugar at 2am or 3am. If it is very low, then this is diagnostic of the Somogy Effect. Dawn Phenomenon The Dawn Effect, sometimes also called the Dawn Phenomenon (DP) was first described about 30 years ago. It is estimated to occur in up to 75% of T2D patients although severity varies widely. It occurs both in those treated with insulin and those that are not. The circadian rhythm creates this DP. Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP. These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver Continue reading >>
Even after a long period of stability, your dog or cat's insulin requirements may change as a result of: Change in exercise regimen This is why it's important to continually monitor your pet's progress and consult your veterinarian if there are sudden changes or if anything unusual happens. Monitoring your dog's or cat's glucose level Monitoring your pet's glucose level is an important part of the overall therapy for diabetes and can be done in 2 ways: Checking your pet's urine for the presence of glucose and ketones (a chemical produced by the body when it burns fat for energy). This is not as accurate as measuring glucose in the blood, but can be done at home easily. Measuring glucose level in your pet's blood. This is the most accurate method and is done either by your veterinarian in the clinic or at home with a portable glucometer and blood test strips. If your pet has significant weight gain or loss, talk to your veterinarian about how this may affect diabetes treatment. Monitoring glucose and ketones in your pet's urine Immediately following diagnosis, your veterinarian may ask you to check your pet's urine glucose, 1 to 3 times a day: FOR DOGS Early in the morning, just prior to the time of the Vetsulin injection and first meal. Late in the afternoon, before the second meal. Late in the evening. As your pet's management progresses, less frequent testing will be needed. Regular examinations remain important though, because your pet's insulin needs can change. What you need Clean containers for collecting urine. Urine dipsticks from your veterinarian. A place to record results. Collecting urine For dogs: take your dog out for a walk on a leash. Keep your dog on a leash so that it will be within reach when it urinates. For cats: place your cat in its litter box.* H Continue reading >>
Why Your “normal” Blood Sugar Isn’t Normal (part 2)
Hi, I just found this site and would like to participate. I will give my numbers, etc. First, my last A1c was 6.1, the doc said it was Pre-diabetes in January of 2014, OK, I get it that part, but what confuses me is that at home, on my glucometer, all my fastings were “Normal” however, back then, I had not checked after meals, so maybe they were the culprits. Now, I am checking all the time and driving myself crazy. In the morning sometimes fasting is 95 and other times 85, it varies day to day. Usually, after a low carb meal, it drops to the 80’s the first hour and lower the second. On some days, when I am naughty and eat wrong, my b/s sugar is still low, and on other days, I can eat the same thing, and it goes sky high, again, not consistent. Normally, however, since February, my fbs is 90, 1 hour after, 120, 2nd hour, back to 90, but, that changes as well. In February, of 2014, on the 5th, it was horrible. I think I had eaten Lasagne, well, before, my sugars did not change much, but that night, WHAM-O I started at 80 before the meal, I forgot to take it at the one and two hour mark, but did at the 3 hour mark, it was 175, then at four hours, down to 160, then at 5 hours, back to 175. I went to bed, because by that time, it was 2 AM, but when I woke up at 8:00 and took it, it was back to 89!!!! This horrible ordeal has only happened once, but, I have gone up to 178 since, but come down to normal in 2 hours. I don’t know if I was extra stressed that day or what, I am under tons of it, my marriage is not good, my dear dad died 2 years ago and my very best friend died 7 months ago, I live in a strange country, I am from America, but moved to New Zealand last year, and I am soooo unhappy. Anyway, what does confuse me is why the daily differences, even though I may Continue reading >>
Tests For Blood Sugar (glucose) And Hba1c
Blood sugar (glucose) measurements are used to diagnose diabetes. They are also used to monitor glucose control for those people who are already known to have diabetes. Play VideoPlayMute0:00/0:00Loaded: 0%Progress: 0%Stream TypeLIVE0:00Playback Rate1xChapters Chapters Descriptions descriptions off, selected Subtitles undefined settings, opens undefined settings dialog captions and subtitles off, selected Audio TrackFullscreen This is a modal window. Beginning of dialog window. Escape will cancel and close the window. TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaqueFont Size50%75%100%125%150%175%200%300%400%Text Edge StyleNoneRaisedDepressedUniformDropshadowFont FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall CapsReset restore all settings to the default valuesDoneClose Modal Dialog End of dialog window. If your glucose level remains high then you have diabetes. If the level goes too low then it is called hypoglycaemia. The main tests for measuring the amount of glucose in the blood are: Random blood glucose level. Fasting blood glucose level. The HbA1c blood test. Oral glucose tolerance test. Capillary blood glucose (home monitoring). Urine test for blood sugar (glucose). Blood tests for blood sugar (glucose) Random blood glucose level A sample of blood taken at any time can be a useful test if diabetes is suspected. A level of 11.1 mmol/L or more in the blood sample indicates that you have diabetes. A fasting blood glucose test may be done to confirm the diagnosis. Fasting blood glucose level Continue reading >>
- Tiny sensor placed under the skin to replace finger prick tests for diabetes: Smartphone app will alert patients if their blood sugar level drops or is too high
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
- Lower Blood Sugar Naturally to Prevent High Blood Sugar from Leading to Diabetes
How To Maintain Normal Blood Sugar
If you are one of the millions of people who has prediabetes, diabetes, metabolic syndrome or any other form of “insulin resistance,” maintaining normal blood sugar levels can be challenging. Over the past several decades, these chronic disorders have swept through the U.S. and many other nations, reaching epidemic proportions and causing serious, but often preventable, side effects like nerve damage, fatigue, loss of vision, arterial damage and weight gain. Elevated blood sugar levels maintained for an extended period of time can push someone who is “prediabetic” into having full-blown diabetes (which now affects about one in every three adults in the U.S.). (1) Even for people who aren’t necessarily at a high risk for developing diabetes or heart complications, poorly managed blood sugar can lead to common complications, including fatigue, weight gain and sugar cravings. In extreme cases, elevated blood sugar can even contribute to strokes, amputations, coma and death in people with a history of insulin resistance. Blood sugar is raised by glucose, which is the sugar we get from eating many different types of foods that contain carbohydrates. Although we usually think of normal blood sugar as being strictly reliant upon how many carbohydrates and added sugar someone eats, other factors also play a role. For example, stress can elevate cortisol levels, which interferes with how insulin is used, and the timing of meals can also affect how the body manages blood sugar. (2) What can you do to help avoid dangerous blood sugar swings and lower diabetes symptoms? As you’ll learn, normal blood sugar levels are sustained through a combination of eating a balanced, low-processed diet, getting regular exercise and managing the body’s most important hormones in othe Continue reading >>
What Is A Normal Blood Sugar Level?
The aim of diabetes treatment is to bring blood sugar (“glucose”) as close to normal as possible. What is a normal blood sugar level? And how can you achieve normal blood sugar? First, what is the difference between “sugar” and “glucose”? Sugar is the general name for sweet carbohydrates that dissolve in water. “Carbohydrate” means a food made only of carbon, oxygen, and hydrogen. There are various different kinds of sugars. The one our body uses most is called “glucose.” Other sugars we eat, like fructose from fruit or lactose from milk, are converted into glucose in our bodies. Then we can use them for energy. Our bodies also break down starches, which are sugars stuck together, into glucose. When people talk about “blood sugar,” they mean “blood glucose.” The two terms mean the same thing. In the U.S., blood sugar is normally measured in milligrams of glucose per deciliter of blood (mg/dl). A milligram is very little, about 0.00018 of a teaspoon. A deciliter is about 3 1/3 ounces. In Canada and the United Kingdom, blood sugar is reported in millimoles/liter (mmol/L). You can convert Canadian or British glucose levels to American numbers if you multiply them by 18. This is useful to know if you’re reading comments or studies from England or Canada. If someone reports that their fasting blood glucose was 7, you can multiply that by 18 and get their U.S. glucose level of 126 mg/dl. What are normal glucose numbers? They vary throughout the day. (Click here for a blood sugar chart.) For someone without diabetes, a fasting blood sugar on awakening should be under 100 mg/dl. Before-meal normal sugars are 70–99 mg/dl. “Postprandial” sugars taken two hours after meals should be less than 140 mg/dl. Those are the normal numbers for someone w Continue reading >>
How To Lower Morning Blood Sugar
It seems strange to be able to keep blood sugar levels in control throughout the day and have morning blood sugar high, right? I mean, it doesn't seem logical. After all, you haven't eaten anything so it should be lower shouldn't it? It's a common assumption and it would seem logical, but it is common for people with type 2 diabetes to have high blood sugar in the morning. Why? Because your body continues to produce glucose even when you don't eat. It's called gluconeogenesis. This is a natural process for all of us. But in diabetes many people have increased gluconeogensis. Another reason is that cortisol (our stress hormone) is the hormone that slowly increases in levels from around 3 am onwards to reach it’s peak early in the morning. Cortisol has a direct influence on blood sugar levels too – elevating them. Still, there are practical things you can do to lower morning blood sugar levels, here's how… How to Lower Morning Blood Sugar Lowering morning highs has a lot to do with your overall health, diet, and lifestyle and usually incorporates a number of different factors. Put some of the following things into practice, give it some time, and no doubt you will start seeing an improvement. Just remember, the number you're aiming for with fasting blood sugar is between 90-110 (5-6.1). Try Apple Cider Vinegar & Cheese Before Bed One small study found that having 2 tablespoons of apple cider vinegar with 1 oz (28 g) cheese (which is just 1 slice cheese) before bed reduced morning glucose by 4% compared to 2% when the participants only had cheese and water. People that had a typical fasting glucose above 130 mg/dl or 7.2 mmol/l had an even better result of 6% decrease in morning blood sugar levels. It’s not fully understood why vinegar has such a beneficial effect Continue reading >>
Are You Non-diabetic? Your After-meal Blood Sugar Spikes May Be Killing You Softly
Something millions of people don’t realize is that non-diabetics do experience blood glucose spikes after meals. Yes, non-diabetics get blood sugar highs believe it or not. They just don’t know it and this phenomenon has implications for your health. Your doctor won’t tell you how important your blood glucose control is as a non-diabetic. I will. The reason your doctor fails to tell you this is mainly because it is generally thought that until a diagnosis of diabetes is made, you are assumed to be metabolically competent. But that is not always the case. In actual fact, this is the reason why a lot of prediabetes cases are missed. Prediabetes is the abnormal metabolic stage before type 2 diabetes actually bites. And before the prediabetes stage, you also develop insulin resistance which is largely silent as well. Doctors don’t pay attention to metabolic health in a run-of-the-mill consultation even if the consultation is for a wellness overview. There are so many individuals with insulin resistance, prediabetes and frank type 2 diabetes walking around totally unaware they have any of those conditions. If only we paid just a little attention to our metabolic health, we could prevent millions of cases of type 2 diabetes raging around the globe like a wild summer forest fire. Do non-diabetics have blood sugar spikes? I often get asked about whether non diabetics have blood sugar highs i.e blood sugar spikes. The short answer is they do but there is a caveat there. Not every non diabetic does. It all depends on what I call metabolic competence along with other variables. Before I talk about the variables involved, let me draw your attention to this study carried in Ulm University in Germany. They recruited 24 healthy volunteers into the study and made them eat simil Continue reading >>