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How Do You Assess For Somogyi Phenomenon?

Frequently Asked Questions

Frequently Asked Questions

The Dumbest & Smartest Things A Doctor Ever Told Me I eat a low fat diet, so why is my cholesterol level still high? Why are my blood sugars higher in the morning than when I go to bed the night before? This typically occurs due to the dawn phenomenon. The dawn phenomenon is the rise in blood glucose levels in the dawn (that is, the morning) due to excessive release of glucose from the liver into the blood. Here is a graph of a person’s blood glucose readings measured with a device (a “continuous glucose monitor”) that automatically measures the body’s glucose level about 300 times per day (each colour represents a different day): As you can see in the preceding graph, every day starting at about 3am this person’s glucose levels started to go up. This individual, like so very many others living with diabetes who have high blood glucose levels first thing in the morning, blamed themselves and attributed their elevated morning blood glucose to having overeaten or snacked the night before. Not so! What they (and you) eat at bedtime (or suppertime) seldom is a significant factor in leading to high blood glucose levels the next morning; heck, the food you ate the night before is long since digested, absorbed into the body, and metabolized well before the following morning’s breakfast. This graph nicely illustrates that point. One colourful term for the liver’s tendency to release glucose into the blood overnight is a liver leak. How much sugar (glucose) gets released from the liver if you have the dawn phenomenon? How about this: Almost as much as is contained in TWO CANS OF COLA! If you have the dawn phenomenon this is something that is not simply to be accepted. Rather, your therapy should be adjusted to fight it so that your blood glucose levels are kept w Continue reading >>

Somygi Phenomenon

Somygi Phenomenon

in Pets with Diabetes Mellitus. There was a very good article that was found at this link which seems to not be working at this time so here is the page that was originally found there. Somogyi Below is a blood glucose curve depicting the Somogyi phenomenon. In this scenario, the positive urine glucoses prompted continued escalation in the insulin dose administered. The subsequent insulin toxicity (and concomitant hypoglycemia –or low blood glucose) resulted in initiation of protective compensatory mechanisms which caused massive transient rises in blood sugar. In this case, urine dipsticks for glucose were checked twice daily and were always positive, prompting the owners to incrementally increase the insulin dose. This graph depicts in days what usually happens over weeks when well-meaning concerned pet owners try to use urine dipsticks to determine insulin dosing. Fortunately, the body is able to release several hormones which increase the amount of circulating glucose and which “shield” the tissues from the effects of insulin. Over time, even as the body is experiencing dramatic fluctuations in blood sugar levels, the tissues develop a resistance to insulin which may require weeks of insulin withdrawal to resolve. The best way to avoid Somogyi is to base insulin dose adjustments on blood, not urine glucose levels. Your veterinarian can do this by using a glucometer with just a drop of blood acquired every 2-3 hours for 12-24 hours, depending on how often insulin is administered. From the Pet Diabetes Dictionary Somogyi effect: A condition in which the blood glucose level increases if too much insulin is given. It occurs when insulin causes the blood glucose level to go so low it stimulates the production of other hormones in the body such as epinephrine which Continue reading >>

Nclex-rn: Medicalsurgical Nursing

Nclex-rn: Medicalsurgical Nursing

MedicalSurgical Nursing: Endocrine System MedicalSurgical Nursing: Pancreas Disorders MedicalSurgical Nursing: Diabetes Mellitus (Types 1 and 2) Definition: A group of disorders that have a variety of genetic causes, but have glucose intolerance as a common thread. Type 1insulin-dependent diabetes mellitus with beta cell destruction or defect in function affects about 5% of all diabetics. a. Immune mediatedpresence of islet cell or insulin antibodies that identify the autoimmune process leading to beta cell destruction. b. Idiopathicno evidence of autoimmunity. Type 2noninsulin-dependent diabetes mellitus is the most common. Results when body produces insufficient insulin or there is insulin resistance with relative insulin deficiency. Affects 90% of all diabetics. Twenty-one million Americans have type 2 and 41 million are prediabetic. a. Type 2 accounts for half of all cases in young people. b. Incidence in young has risen dramatically last 10 years. Type 3Gestational (GDM)increased blood glucose levels during pregnancy. Type 4Other specific typesgenetic defects of beta-cell function or insulin action, pancreatic diseases, endocrinopathies, or drug- or chemical-induced diabetes. a. Rapid onsetrequires insulin due to absence of circulating insulin. c. Presence of anti-islet cell antibodies. Type 2 (noninsulin-dependent), formerly adult-onset type. a. Gradual onsetmay be controlled by diet. b. Ninety percent of diabetes cases are this type. c. Impaired beta-cell response to glucose (client usually nonobese). d. Tissues insensitive to insulin (client usually obese). (2) Normal or high levels of circulating insulin. C. Somogyi phenomenon. Hypoglycemia usually at night followed by compensatory rebound hyperglycemia in the morning (lasts 1272 hours). Usually caused by too Continue reading >>

Dawn Phenomenon And Somogyi Effect In Iddm

Dawn Phenomenon And Somogyi Effect In Iddm

We examined the clinical relevance of a rise in fasting blood glucose (BG) between 0300 and 0600 in 97 patients with insulin-dependent diabetes mellitus (IDDM) receiving sequentially conventional (CT) and basal-bolus (BBIT) insulin therapies and assessed the impact of one potential causal factor, i.e., posthypoglycemic hyperglycemia, with 231 BG profiles (97 during CT, 134 during BBIT) in which BG was measured every 3 h over a 24-h period. A rise in BG between 0300 and 0600 occurred in 157 of 231 (68%) profiles. The mean magnitude of this rise was 56 ±39 mg/dl and was lower (P < .05) during BBIT (48 ± 35 mg/dl, n = 97) than CT (62±43 mg/dl, n = 97). A dawn rise (between 0300 and 0600) >50 mg/dl occurred in 40 of 97 (41%) profiles during CT and 26 of 97 (27%) during BBIT (P < .05). When all profiles were grouped according to the magnitude of this rise in BG, the mean daytime BG (from 0900 to 1800) was higher (P < .05) after an 0300–0600 BG rise >50 mg/dl compared with groups of profiles showing either a fall in BG or a rise <50 mg/dl; a rise in BG between 0300 and 0600 correlated (r = .38, P < .0001) with the subsequent mean daytime BG. Nocturnal hypoglycemia (BG <60 mg/dl) recorded at 2400 and/or 0300 occurred in 57 of 231 (25%) profiles. After nocturnal hypoglycemia, the highest BG recorded before breakfast was only 215 mg/dl, and the mean BG at 0600 was considerably lower (P < .0001) in profiles showing at least one episode of nocturnal hypoglycemia (116 ± 45 mg/dl, n = 57) compared with all profiles in which no nocturnal hypoglycemia was detected (174 ± 85 mg/dl, n = 174). In addition, postbreakfast BG levels at 0900 were lower (P < .0001) after nocturnal hypoglycemia (171 ± 87 mg/dl, n = 57) than when no nocturnal hypoglycemia was detected (211 ± 91 mg/dl, Continue reading >>

Diabetes And The Somogyi Effect

Diabetes And The Somogyi Effect

I have had some interesting diabetic cases in the last month. Both cases were diagnosed with diabetes at other clinics and found their way to Four Lakes Veterinary Clinic. Generally, the diagnosis of diabetes is pretty straightforward. A dog or cat will be brought to the clinic because it is eating a lot, but losing weight, drinking a lot and possibly having urine accidents in the house, or looks skinny and is having problems walking or jumping. Blood and urine samples are taken to look for possible causes and, if diabetic, the blood glucose will be very high (often above 500, when the normal range is 80-120) and there will be glucose in the urine. If the pet is really sick, there may be ketones in the urine, too. In a diabetic animal, the body isn't producing enough insulin. Insulin is the substance produced by the pancreas (an organ near the stomach) that helps glucose, a simple sugar, get into the cells of the body. Without insulin to "unlock" the door into the cell, the sugar molecules go right by. Now the body thinks it is starving, so it starts breaking down protein and fat to provide the body with glucose. But without insulin, the cells still think they are starving, even though there is now a lot of glucose in the blood stream. Extra glucose is excreted in the urine. So the blood and urine glucose levels from an untreated diabetic animal will be very high. Once we diagnose diabetes, we start the pet on insulin injections. This insulin allows the cells to take in glucose again. Insulin produced by our pancreas is continuous and dependent on how much glucose is circulating in our blood. After a meal, more insulin is released to get the extra glucose into the cells; once the blood glucose level is normal, then no more insulin is released. But with insulin injection Continue reading >>

Taming & Controlling Your Morning Blood Sugar

Taming & Controlling Your Morning Blood Sugar

Guest Blogger: Dr. Jody Stanislaw Naturopathic Doctor Jody Stanislaw has spent decades successfully helping clients dramatically improve their lives via her E.A.S.Y. Lifestyle Transformation Formula. She can teach you simple strategies for how to improve your: E.ating, A.ctivity, S.leep, and Y.ou (mental health). Each one of these Four Essential Pillars of Health is necessary for creating a life overflowing with well-being—and best of all, a life you enjoy! Dr. Jody Stanislaw is a Type 1 Diabetic since 1980. You can visit her on the web at: www.DrJodyND.com You go to bed and your blood sugar level is perfect….Ahhh. Then you wake up and it’s awful?! What happened?? My name is Dr. Jody Stanislaw and I’ve had type 1 since I was 7 years old. When I was diagnosed in 1980, blood glucose testing didn’t even exist. I had to pee in a cup twice a day and test how much sugar was in it, which only told me if I had been high over the past few hours. There was no way to ever know what my glucose level was in the moment…we’ve come a long way! Being able to know what your glucose level is at any time is a fabulous advancement that allows you to have better care. But more information can lead to new frustrations. Back then, if I woke up and didn’t feel low, all was good. Today, we can know exactly where our level is at anytime and if it’s in good range we’re happy and smiling! But if it’s not, we’re likely frowning and not feeling so hot. Over the years via my own trial and error and through working with many others who have diabetes, I have learned life-changing tools. I’ve learned that a key part of achieving healthy management is thorough understanding why blood sugar levels do what they do. So here you go… 4 Reasons Why Blood Sugar Can Be High in the Morn Continue reading >>

Can Fasting Glucose Levels Or Post-breakfast Glucose Fluctuations Predict The Occurrence Of Nocturnal Asymptomatic Hypoglycemia In Type 1 Diabetic Patients Receiving Basal-bolus Insulin Therapy With Long-acting Insulin?

Can Fasting Glucose Levels Or Post-breakfast Glucose Fluctuations Predict The Occurrence Of Nocturnal Asymptomatic Hypoglycemia In Type 1 Diabetic Patients Receiving Basal-bolus Insulin Therapy With Long-acting Insulin?

Abstract To investigate whether the occurrence of nocturnal asymptomatic hypoglycemia may be predicted based on fasting glucose levels and post-breakfast glucose fluctuations. The study subjects comprised type 1 diabetic patients who underwent CGM assessments and received basal-bolus insulin therapy with long-acting insulin. The subjects were evaluated for I) fasting glucose levels and II) the range of post-breakfast glucose elevation (from fasting glucose levels to postprandial 1- and 2-hour glucose levels). The patients were divided into those with asymptomatic hypoglycemia during nighttime and those without for comparison. Optimal cut-off values were also determined for relevant parameters that could predict nighttime hypoglycemia by using ROC analysis. Results 64 patients (mean HbA1c 8.7 ± 1.8%) were available for analysis. Nocturnal asymptomatic hypoglycemia occurred in 23 patients (35.9%). Fasting glucose levels (I) were significantly lower in those with hypoglycemia than those without (118 ± 35 mg/dL vs. 179 ± 65 mg/dL; P < 0.001). The range of post-breakfast glucose elevation (II) was significantly greater in those with hypoglycemia than in those without (postprandial 1-h, P = 0.003; postprandial 2-h, P = 0.005). The cut-off values determined for relevant factors were as follows: (I) fasting glucose level < 135 mg/dL (sensitivity 0.73/specificity 0.83/AUC 0.79, P < 0.001); and (II) 1-h postprandial elevation > 54 mg/dL (0.65/0.61/0.71, P = 0.006), 2-h postprandial elevation > 78 mg/dL (0.65/0.73/0.71, P = 0.005). Nocturnal asymptomatic hypoglycemia was associated with increases in post-breakfast glucose levels in type 1 diabetes. Study findings also suggest that fasting glucose levels and the range of post-breakfast glucose elevation could help predict the oc Continue reading >>

Somogyi Effect (rebound Hyperglycaemia)

Somogyi Effect (rebound Hyperglycaemia)

An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycaemia. This can also be produced if blood glucose concentrations fall too rapidly. The body attempts to counteract the decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly or approaches hypoglycaemia (blood glucose concentrations of less than 5 mmol/l (90 mg/dl)) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the CNS, adrenaline and subsequently cortisol, glucagon and growth hormone are released. These hormones bring about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen and increased peripheral resistance to insulin). The resultant hyperglycaemia produces polyuria and polydipsia. This can easily be misinterpreted as a result of an inadequate insulin dose. If the morning polyuria is thought to be the result of an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms become exhausted resulting in severe hypoglycaemia. Hyperglycaemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycaemic episode. As a result blood glucose concentrations do not always normalise within a few days of lowering the insulin dose. If the Somogyi effect is suspected, an alternative approach is to decrease the dose by 20% and closely observe the clinical signs. If signs of polyuria or polydipsia worsen a few days following the dose adjustment, it is unlikely that the Somogyi effect was the cause of the regulat Continue reading >>

The Somogyi Effect

The Somogyi Effect

Go to site For Pet Owners An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual—it is a life-saving response. The body attempts to counteract the decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly, or approaches hypoglycemia (blood glucose concentrations of less than 65 mg/dL [2.8 mmol/L]) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the central nervous system, adrenaline and subsequently cortisol, glucagon, and growth hormone are released. These hormones bring about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen and increased peripheral resistance to insulin). The resultant hyperglycemia produces polyuria and polydipsia. This can easily be misinterpreted as caused by an inadequate insulin dose. If the morning polyuria is thought to be the result of an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms may become exhausted resulting in severe hypoglycemia. Hyperglycemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycemic episode. As a result, blood glucose concentrations do not always normalize within a few days after lowering the insulin dose. When to suspect a Somogyi overswing Minimal glycemia: <65 mg/dL or 3.6 mmol/L Maximum glycemia: 400–800 mg/dL or 22–44 mmol/L Persiste Continue reading >>

Blood Glucose Curves

Blood Glucose Curves

Blood glucose curves serve two very useful purposes that other monitoring parameters do not. They identify clinically undetectable hypoglycemia so that the insulin dose can be decreased before clinical signs of hypoglycemia develop. Thus, a periodic BGC is recommended for seemingly well-controlled patients. More importantly, although other techniques and clinical signs may suggest control is lacking, multiple reasons for poor control exist, including too low and too high an insulin dose. The only way to know how to appropriately change an insulin dose is to perform a BGC. There are several situations when a BGC should be performed: After the first dose of a new kind of insulin; At 714 days after an insulin dose change; At least q 3 mo even in well-controlled diabetics; At any time clinical signs recur in a controlled patient; and To construct a BGC, BG is generally measured q 2 hr for one interval between injections (i.e., for 12 hr if insulin is administered twice daily and for 24 hr if insulin is given once daily). When using glargine (Lantus) in cats, BG should be monitored every 34 hr. However, when BG is <150 mg/dL in both cats and dogs during any curve, BG should be measured hourly. The AlphaTrak 2 may be the most accurate BG meter (glucometer) for veterinary patients because it has been calibrated in dogs and cats.31,32,33 Although human glucometers are readily accessible to pet owners, the Task Force does not recommend their use due to inaccuracies when reading canine and feline blood. A normal insulin treatment and feeding schedule must be maintained as much as possible during the BGC. Unless patients eat their normal amount of the normal food at the normal time, a BGC should probably not be obtained. When first regulating a diabetic patient, assessment of own Continue reading >>

Ati Nutrition Practice A Flashcards - Cram.com

Ati Nutrition Practice A Flashcards - Cram.com

Age-related macular degeneration (AMD) nutritional change Found in foods : kale, spinach, collard greens and mustard TPN is empty, new bag not available - what should nurse infuse until new bag of TPN is available Dextrose 10% in water to prevent hypoglycemia Monitoring blood glucose levels at night. A fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime Nutritional teaching for toddler w/ failure to thrive - behavioral interventions 2.stop feeding when negative behavior exhibits Green leaf veggies and wheat flour wirh vitman B , Chicken liver Nutritional need for pt who has a new colostomy. Proteins - to promote healing of the incision Caloric range recommended for women lactating Increase your caloric intake by 300- 400 calories per day What age does bone loss typically begin in women Between 30-35 afterwards more bone is lost than gained Prealbumin is a sensitive indicator of nutritional status 30mg/dL Client has new prescription for eternal nutrition by intermittent tube feeding. What action should nurse plan of care include? Increase then volume of formula over the first 4-6 feedings until the prescribed volume is achieved What indicates an effective plan of care for pt w/type 2 diabetes mellitus Increase what foods if diagnosed with beriberi? Whole grains are a good source of vitamin B Which food allergy is a contraindication to the flu vaccine? Infant has cleft lip and palate - Which position should nurse use when bottle feeding infant? Upright with nipple directed to the side of her mouth to prevent the formula from entering the nasal passage Client undergoing radiation therapy for cancer and is experiencing stomatitis. Which food choices is appropriate? Soft and nonirritating to the oral mucosa..such as scrambled eg Continue reading >>

Ati Rn Nutrition Online Practice A

Ati Rn Nutrition Online Practice A

A nurse is planning care for a client who has a new prescription for enteral nutrition by intermittent tube feeding. Which of the following nursing actions should be included in the plan of care? increase the volume of formula over the first 4 to 6 feedings *increase until the prescribed volume is achieved A nurse in a clinic is reviewing the laboratory findings of a client who has type 2 diabetes mellitus. Which of the following findings indicates the clients plan of care is effective? A nurse in a clinic is reviewing dietary guidelines for a client who had gastric bypass surgery. Which of the follow-up guidelines should the nurse include? *the client should eat 5 small meals per day, stop eating when full, and take 30-60 min to eat each meal A nurse is providing teaching to a woman who is experiencing nausea during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? i will eat dry cereal before i get out of bed *carbs leave the stomach quickly and readily raise blood sugar levels which alleviates nausea A nurse is evaluating a client who is receiving chemotherapy. Which of the following statements by the client indicates adequate nutrition? i have maintained my weight since starting treatment A nurse is reviewing the laboratory findings of a client who has acute pancreatitis. Which of the following is an expected finding? *due to decreased insulin production by the pancreas A nurse is teaching the parent of a toddler about appropriate snack foods. Which of the following is an appropriate choice? A nurse is caring for a client who is pregnant and has a BMI of 29. The nurse should reinforce that the recommended gestational weight gain for this client is A nurse is educating a client who weighs 125 lb about physical act Continue reading >>

Diabetic Complications

Diabetic Complications

Diabetes mellitus is a disease of glucose dysregulation secondary to relative insulin resistance (non-insulin dependent diabetes mellitus) or an absolute insulin deficiency (insulin dependent diabetes mellitus). The pathophysiology and management of uncomplicated diabetes mellitus is too involved to describe here. Most veterinarians feel comfortable diagnosing diabetes mellitus in dogs and cats, and the diagnostics are straightforward and easy to interpret. Currently the options for long acting insulin include glargine, humulin N, detemir, porcine zinc (Vetsulin™) and protamine zinc (ProZinc™). Most of these products are human recombinant insulins. No insulin type has been definitively shown to be better than another in a single species. Several small studies within the last 4 years have suggested, however, that glargine and detemir may achieve better glycemic control and remission rates in cats when compared to humulin N and protamine zinc insulins. Several excellent resources to turn to for more information include Feline Internal Medicine (August JR 2010), Textbook of Veterinary Internal Medicine (Ettinger SJ, Feldman EC 2010), Current Veterinary Therapy XIII, XIV (Bonagura JD, Twedt DC 2009). Table 1 compares the most commonly used long acting insulins in dogs and cats. Table 1. Comparison of different types of insulin most commonly used in dogs and cats. Insulin Syringe Source Dose Humulin N u-100 Human recombinant Dogs and cats 0.1-0.2 u/kg q 12 hr Protamine Zinc, ProZinc™ u-40 Human recombinant Cats only 0.2 – 0.7 u/kg q 12 hr Glargine, Lantus ™ u-100 Synthetic 0.25 – 0.5 u/kg q12 hr Detemir , Levemir ™ u-100 Human recombinant Cats 0.25 – 0.5 u/kg q 12hr Dogs 0.1 – 0.2 u/kg q 12 hr Porcine Zinc, Vetsulin ™ u-40 Porcine Cats 1 – 2 u/kg q 12hr Continue reading >>

The Dawn Phenomenon – T2d 8

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 >>

High Fasting Levels

High Fasting Levels

High fasting levels are a huge problem for many ladies. Fasting blood sugar levels, levels taken first thing in the morning when you wake up, are the hardest thing to control with gestational diabetes. But why is that? When we're sleeping we are not eating and drinking and we are not active and so the body is left to it's own devices with regards to controlling blood sugar levels. Impacts on fasting blood sugar levels Many things can impact fasting levels: what you've eaten earlier in the evening when you last ate hydration levels how well you've slept the dawn phenomenon the Somogyi effect What you ate earlier in the evening Bearing in mind how much of each food group converts to glucose in the bloodstream and the time taken, your fasting levels may be impacted by this. Too much carbohydrate in your evening meal or as a snack before bed can contribute to high fasting levels, as your body can only produce or use so much insulin, so if you raise your blood sugars too high by eating too much carbohydrate, your body can spend the night battling to try to lower your blood sugar levels. A high fat meal such as takeaway food can also cause higher blood sugar levels and so eating a well paired evening meal is important. When you last ate The key to stabilising blood sugar levels is to eat small amounts, often. We obviously cannot do this throughout the night, but if you eat your evening meal early and do not eat again until breakfast the following day, it can be an extremely long time to go without eating. Likewise, if you eat a large meal just before going to bed, this too can have a detrimental effect on your fasting levels. Hydration levels Dehydration will cause higher blood sugar levels. Water helps to flush excess sugar from the body and so it is important to stay well h Continue reading >>

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