Blood Sugar Monitoring Not So Beneficial, Canadian Study Finds - The New York Times
Research |Regimens: Questioning Benefit of Diabetes Test Strips See how this article appeared when it was originally published on NYTimes.com People with Type 2 diabetes are often advised to use blood- glucose test strips to monitor their blood sugar levels, but a Canadian analysis has found that routine self-monitoring is not cost-effective for many patients: the strips can cost almost a dollar each, and they prevent comparatively few complications of diabetes . The finding was part of an analysis that prompted the Canadian Agency for Drugs and Technologies in Health to issue a nonbinding recommendation against routine self-monitoring for many Type 2 diabetics those who do not take insulin. Experts in the United States said more studies were needed, but they emphasized that glucose test strips, which are covered by insurance, could be helpful for adjusting diet , exercise and drug regimens. In addition, they are recommended for Type 2 patients who take insulin or the drugs called sulfonylureas, which stimulate insulin production; those patients are at risk for hypoglycemia , or very low blood sugar. But for other Type 2 patients, the test strips benefits fall off sharply. Another Canadian study reported that more than 1,000 patients would need to use the strips regularly to prevent a single case of kidney failure , for example, and about 500 would need to be treated to prevent a single stroke, amputation or case of blindness . Rather than rely on test strips, Canadian experts said, patients need to be vigilant about their diet, exercise, weight and blood pressure . A version of this article appears in print on January 5, 2010, on Page D6 of the New York edition with the headline: Questioning Benefit of Diabetes Test Strips. Order Reprints | Today's Paper | Subscribe Continue reading >>
Print Overview Hypoglycemia is a condition characterized by an abnormally low level of blood sugar (glucose), your body's main energy source. Hypoglycemia is commonly associated with the treatment of diabetes. However, a variety of conditions, many of them rare, can cause low blood sugar in people without diabetes. Like fever, hypoglycemia isn't a disease itself — it's an indicator of a health problem. Immediate treatment of hypoglycemia involves quick steps to get your blood sugar level back into a normal range — about 70 to 110 milligrams per deciliter, or mg/dL (3.9 to 6.1 millimoles per liter, or mmol/L) — either with high-sugar foods or medications. Long-term treatment requires identifying and treating the underlying cause of hypoglycemia. Symptoms Similar to the way a car needs gas to run, your body and brain need a constant supply of sugar (glucose) to function properly. If glucose levels become too low, as occurs with hypoglycemia, it can cause these signs and symptoms: Heart palpitations Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability Tingling sensation around the mouth Crying out during sleep As hypoglycemia worsens, signs and symptoms may include: Confusion, abnormal behavior or both, such as the inability to complete routine tasks Visual disturbances, such as blurred vision Seizures Loss of consciousness People with severe hypoglycemia may appear as if they're intoxicated. They may slur their words and move clumsily. Many conditions other than hypoglycemia may cause these signs and symptoms. A blood sample to test your blood sugar level at the time of these signs and symptoms is how to know for sure that hypoglycemia is the cause. When to see a doctor Seek a doctor's help immediately if: You have what may be symptoms of hypoglycemia an Continue reading >>
All About Hypoglycemia (low Blood Sugar)
Hypoglycemia refers to an abnormally low level of sugar, or glucose, in the blood. Hypoglycemia is not a disease in itself, it is a sign of a health problem. The brain uses a lot of energy and needs glucose to function. Because the brain cannot store or manufacture glucose, it needs a continuous supply. Signs of low blood sugar include hunger, trembling, heart racing, nausea, and sweating. Hypoglycemia is commonly linked with diabetes, but many other conditions can also cause low blood sugar. This article will discuss the causes, diagnosis, and treatment of hypoglycemia, and the difference between hypoglycemia and hyperglycemia. We will also look at how to prevent it. Here are some key points about hypoglycemia. More detail is in the main article. Hypoglycemia is not a disease but a symptom of another condition. Early symptoms include hunger, sweating, and trembling. A common cause is diabetes. Alcohol abuse and kidney disorders can also lower blood sugar levels. What is hypoglycemia? Hypoglycemia is a condition where there is not enough glucose, or sugar, in the blood. Levels of blood sugar are below 4 mmol/L (72mg/dL). Adults and children with mild hypoglycemia may experience the following early symptoms: hunger tremor or trembling sweating irritability a pale face heart palpitations accelerated heart rate tingling lips dizziness weakness Severe hypoglycemia is sometimes called diabetic shock. It may involve: concentration problems confusion irrational and disorderly behavior, similar to intoxication inability to eat or drink Complications If a person does not take action when symptoms of hypoclycemia appear, it can lead to: A person who regularly experiences hypoglycemia may become unaware that it is happening. They will not notice the warning signs, and this can lea Continue reading >>
Effects Of Diabetes On Blood Pressure, Pulse, & Pupil Size
Diabetes is a condition that affects a growing number of individuals. It is a condition characterized by the inability of the body to process blood glucose (sugar), which leads to numerous complications in almost every organ system. Diabetes has effects on blood pressure, pulse and pupil size. Video of the Day Diabetes affects the blood vessels, accelerating the process of atherosclerosis (hardening of the arteries). This affects the fluid dynamics of the circulatory system and causes high blood pressure. In addition to the mechanical disruption of the circulation, atherosclerosis in the renal arteries supplying the kidneys causes a reflexive increase in the systemic blood pressure, because the renal arteries have special sensors to monitor blood pressure and flow. In an article for MERCK, George L. Bakris, M.D. explains that when these sensors are damaged, the body reflexively tries to increase the blood pressure to maintain perfusion of the kidneys. Pulse has two dimensions that are evaluated by medical professionals: pulse rate and pulse pressure. In diabetic patients, the pulse rate is not significantly related to long-term progress of the disease. Pulse rate, however, can increase greatly during a hypoglycemic episode when the individual’s blood sugar drops below the normal range. Rapid pulse is one of the signs of hypoglycemia and should be recognized and treated immediately. Pulse pressure is a measure of the force of the pulse against the walls of the arteries. Diabetes damages the blood vessels, causing them to harden, which results in an increased pulse pressure. An article published in the Journal of Hypertension, September 2002, by researcher M.T. Schram, reported that the increased pulse pressure is positively associated with serious cardiovascular morbid Continue reading >>
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Patient Education: Hypoglycemia (low Blood Sugar) In Diabetes Mellitus (beyond The Basics)
LOW BLOOD SUGAR OVERVIEW Hypoglycemia, also known as low blood sugar, occurs when levels of glucose (sugar) in the blood are too low. Hypoglycemia is common in people with diabetes who take insulin and some (but not all) oral diabetes medications. WHY DO I GET LOW BLOOD SUGAR? Low blood sugar happens when a person with diabetes does one or more of the following: Takes too much insulin (or an oral diabetes medication that causes your body to secrete insulin) Does not eat enough food Exercises vigorously without eating a snack or decreasing the dose of insulin beforehand Waits too long between meals Drinks excessive alcohol, although even moderate alcohol use can increase the risk of hypoglycemia in people with type 1 diabetes LOW BLOOD SUGAR SYMPTOMS The symptoms of low blood sugar vary from person to person, and can change over time. During the early stages low blood sugar, you may: Sweat Tremble Feel hungry Feel anxious If untreated, your symptoms can become more severe, and can include: Difficulty walking Weakness Difficulty seeing clearly Bizarre behavior or personality changes Confusion Unconsciousness or seizure When possible, you should confirm that you have low blood sugar by measuring your blood sugar level (see "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)"). Low blood sugar is generally defined as a blood sugar of 60 mg/dL (3.3 mmol/L) or less. Some people with diabetes develop symptoms of low blood sugar at slightly higher levels. If your blood sugar levels are high for long periods of time, you may have symptoms and feel poorly when your blood sugar is closer to 100 mg/dL (5.6 mmol/L). Getting your blood sugar under better control can help to lower the blood sugar level when you begin to feel symptoms. Hypoglyc Continue reading >>
Are My Daily Low Blood-sugar Spells Dangerous?
I tend to get low blood sugar at times throughout the day. I work out on a regular basis and have difficulty knowing when to eat, what to eat, how much to eat before a workout. So, information on that would be helpful. Also I am curious what kind of internal damage, if any, am I doing each time I experience low blood sugar? Dear Beth: Thanks for your question. Many people worry about low blood sugar, but in reality this is rarely a problem for other than diabetics under tight blood sugar control. Those few nondiabetics can usually avoid it with small frequent snacks containing carbohydrates. In order to be considered hypoglycemic the person has to have: 1) Symptoms of hypoglycemia, 2) A documented low blood sugar (less than 60 mg/dl) using a laboratory measurement -- not a personal glucometer -- and 3) relief of the symptoms after consumption of sugar. The symptoms of low blood sugar are sweating, trembling, a sensation of warmth, anxiety, nausea, palpitations, a fast heart rate and hunger. Most true hypoglycemic people have three or four of these symptoms and not all of them. Very low blood sugar can cause fatigue, dizziness, headache, visual disturbances, drowsiness and ultimately loss of consciousness and seizures. Again, all people with very low blood sugar will most likely not have all symptoms. Occasionally, people get hypoglycemia because they're taking certain drugs such as aspirin-like drugs, quinine-like drugs and antipsychotics such as haloperidol, or consuming alcohol. Extreme exercise also can lead to this condition. By far the most common cause of hypoglycemia is treatment of diabetes that is too strict. Some diabetics can actually get hypoglycemic by missing a meal or having a meal with fewer starches and carbohydrates than expected. Very rarely, hypoglyc Continue reading >>
Case Studies In Hypoglycemia
This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail [email protected] . The number of persons with diabetes in the United States has been rising steadily over the past five decades (Figure 1), and the far-reaching effects of chronic hyperglycemia are staggering. The CDC, in its National Diabetes Fact Sheet, report that: 25.8 million people, or 8.3% of the U.S. population, have diabetes. Among U.S. residents 65 and older, 10.9 million, or 26.9%, had diabetes in 2010. About 1.9 million people 20 or older were newly diagnosed with diabetes in 2010 in the U.S., and it is estimated that 7 million people are undiagnosed. In 200508, based on fasting glucose or A1C levels (see sidebar), 35% of U.S. adults 20 or older had prediabetes. Among those 65 or older, the rate rose to 50%. Applying this percentage to the entire 2010 U.S. population yields an estimated 79 million Americans aged 20 years or older with prediabetes. Diabetes is the seventh-leading cause of death in the United States. Diabetes is a major cause of heart disease and stroke and the leading cause of kidney failure, nontraumatic lower-limb amputations and new cases of blindness among adults in the United States.1 In this months article we will discuss the process of normal glucose metabolism, then review the pathophysiology of hypoglycemia. We will use a case-based approach to explore hypoglycemia in patients with type 1 and type 2 diabetes mellitus. In doing so, we will use the process of working through a differential diagnosis to show how Continue reading >>
A Low Blood Sugar Scenario Explained
Every type 1 fears having a hypoglycemic event. Because people are usually more accustomed to dealing with highs, however, a sudden low often catches them unaware. Use this fictional yet typical story to find out what might happen medically during a low and what you need to know to keep hypoglycemia in check. Joe, our fictional person with type 1 diabetes, uses multiple daily injections of insulin. Dr. Christopher Saudek, MD, our physician, is Director of the Johns Hopkins Diabetes Center in Baltimore and president of the American Diabetes Association from 2001 to 2002. He’s also a former medical consultant to the ABC News Diabetes Project. Carl Lindgren, an Arlington County, Virginia, Fire/EMS Battalion Chief, ensures that the paramedics under his command are trained to handle emergency calls to offices, residences, and heavily secured U.S. government buildings around Washington D.C. He averages at least one diabetic call every day. Joe is driving home from work, making the turn onto the Interstate that is going to take him home. He’s had a busy day and he’s tired, and he notices that sweat is showing through his shirt. No big deal, he thinks, it’s to be expected. After all, it’s summer in Washington, D.C. Dr. Saudek: Sweating is one of the symptoms that develops during a hypoglycemic event. Our body has a “fight or flight” reaction when it senses that blood glucose is low. Adrenaline increases, and the heart may beat faster. The amazing thing is each person may have his or her own first symptom. Knowing what your own first symptom is can be tremendously important. The brain needs glucose to function. The whole trick in treating hypoglycemia is to catch it before your thinking process is too confused to know what is going on. Just a few minutes into his d Continue reading >>
Dealing With Hypoglycaemia Low Blood Sugar
If you're unsure whether their blood sugar is high or low Too much insulin can cause low blood sugar or hypoglycaemia (hypo). This often happens when someone with diabetes misses a meal or does too much exercise. It can also happen after someone has had an epileptic seizure or has been binge drinking. If someone knows they are diabetic, they may recognise the start of a hypo attack, but without help they may quickly become weak and unresponsive. Medical warning bracelet or necklace and glucose gel or sweets. Medication such as an insulin pen or tablets and a glucose testing kit. Help them sit down. If they have their own glucose gel, help them take it. If not, you need to give them something sugary like fruit juice, a fizzy drink, two teaspoons of sugar, or sugary sweets. If they improve quickly, give them more sugary food or drink and let them rest. If they have their glucose testing kit with them, help them use it to check their glucose level. Stay with them until they feel completely better. If they do not improve quickly, look for any other causes and then call 999 or 112 for medical help. While waiting, keep checking their responsiveness, breathing and pulse. If you're unsure whether their blood sugar is high or low If you're not sure whether someone has high or low blood sugar, give them something sugary anyway, as this will quickly relieve low blood sugar and is unlikely to do harm in cases of high blood sugar. If they don't improve quickly, call 999 or 112 for medical help. If they lose responsiveness at any point, open their airway, check their breathing and prepare to treat someone who's become unresponsive. Note: these hints are no substitute for thorough knowledge of first aid. St John Ambulance holds first aid courses throughout the country. Adapted from t Continue reading >>
Hypoglycemia Clinical Presentation: History, Physical Examination
Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... The patient's medication and drug history should be reviewed carefully for potential causes of hypoglycemia. Inquire if the patient is taking any new medications. A history of insulin usage or ingestion of an oral hypoglycemic agent may be known, and possible toxic ingestion should be considered. Injecting a shot of insulin and skipping a meal or overdosing insulin is the most common cause in patients with diabetes. The medical history may include diabetes mellitus, renal insufficiency/failure, alcoholism, hepatic cirrhosis/failure, other endocrine diseases, or recent surgery. However, obtaining an accurate medical history may be difficult if the patient's mental status is altered. Central nervous system (CNS) symptoms include headache, confusion, and personality changes. The social history may include ethanol intake and nutritional deficiency. Review systems for weight reduction, fatigue, somnolence, nausea and vomiting, and headache. Look for other symptoms suggesting infection. Symptoms of hypoglycemia may be categorized as neurogenic (adrenergic) or neuroglycopenic. Sympathoadrenal activation symptoms include sweating, shakiness, tachycardia, anxiety, and a sensation of hunger. Neuroglycopenic symptoms include weakness, tiredness, or dizziness; inappropriate behavior (sometimes mistaken for inebriation), difficulty with concentration; confusion; blurred vision; and, in extreme cases, coma and death. The timing of onset of symptoms relative to the time of meal ingestion is crucial in the evaluation of a patient with hypoglycemia. Fasting hypoglycemia typically occurs in the morning before eating or during the day, particularly in the afternoon if meals are missed or delayed. Postprand Continue reading >>
Diabetes: The Highs, Lows, And "when Can They Go's"
Diabetic emergencies come in a variety of types and causes, but the tools available to EMS professionals allow excellent evaluation and initial treatment of the patient. For most EMS professionals, the evaluation of emergency patients with diabetes is built around a protocol for "Patients with Mental Status Changes who are Known or Suspected Diabetic." A good history from the patient or knowledgeable bystanders, an assessment of the vital signs, and a physical evaluation that looks for all potential causes of altered mental status, are the first elements of managing patients with this problem. The information then provided by testing a very small amount of blood will provide the approximate level of glucose in the patient's vascular system, and treatment can then be targeted to restore the patient's normal level of functioning. At the hospital, further testing may need to be done to establish the cause of the blood sugar abnormality, or whether there are other significant medical problems. The process begins with the request by a patient or others who have noted the person acting abnormally. This can be family, friends, co-workers, teachers, police officers, or just a passerby. Beginning with the history and examination, the EMS professional can make a decision that the patient has a medical presentation consistent with an abnormal blood sugar. In a known diabetic, the patient, family, or friends may describe the patient as having symptoms that are consistent with high or low blood sugar (usually when they have seen this patient act like this in the past). The medic will then make proper use of the blood glucose evaluation tool utilized by the EMS organization. It is probably unnecessary for EMS to test for blood sugar if the patient has had a valid blood sugar test don Continue reading >>
Vital Signs: Possible Help For Those With Type 2 Diabetes?
Researchers at UT Southwestern Medical Center have targeted another possible way to control high blood sugar for the 25 million Americans with Type 2 Diabetes. The discovery occurred amid research into people born without fat, and why such people develop health problems associated with fat such as diabetes. In this edition of Vital Signs, Dr. Anil Agarwal, Professor of Internal Medicine, said the research led to phosphatidic acid that plays a role in hyperglycemia – blood glucose or sugar rising to above normal levels. What Is Hyperglycemia? The Mayo Clinic says Hypoglycemia is a condition characterized by an abnormally low level of blood sugar (glucose), your body’s main energy source. Hypoglycemia is commonly associated with the treatment of diabetes. However, a variety of conditions, many of them rare, can cause low blood sugar in people without diabetes. Like fever, hypoglycemia isn’t a disease itself — it’s an indicator of a health problem. Early signs and symptoms Recognizing early symptoms of hyperglycemia can help you treat the condition promptly. Watch for: Frequent urination Increased thirst Blurred vision Fatigue Headache Later signs and symptoms If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include: Fruity-smelling breath Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Coma Abdominal pain Call 911 or emergency medical assistance if: You’re sick and can’t keep any food or fluids down, and Your blood glucose levels are persistently above 240 mg/dL (13 mmol/L) with ketones in your urine Make an appointment with your doctor if: You experience ongoing diarrhea or vomiting, but you’re able to take some foods or drinks You have a fever t Continue reading >>
What Is The Difference Between Hyperglycemia And Hypoglycemia?
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>
Hypoglycemia or an abnormally low blood sugar level is a common complication among diabetic patients. People with diabetes have poor control of their blood sugar level due to either a relative or absolute deficiency in insulin, the hormone that helps the body utilize glucose effectively. Hypoglycemia may also occur in other disease states such as hormonal disorders or Addison's disease and due to starvation, malnutrition or poisoning. The symptoms of hypoglycemia mainly arise due to over activity of the sympathetic nervous system which occurs in response to a fall in blood sugar. Some examples of such symptoms include: Tremors - The patient often complains of feeling shaky or weak Sweating - There may be intense sweating, with the skin appearing cold and clammy Palpitations - There may be a rapid heart rate and palpitations Anxiety, depression, tearfulness and feeling of dread Restlessness Dilated pupils A sensation of pins and needles or tingling in the extremities such as the fingers and toes Other symptoms that may manifest As the blood sugar levels fall, the hunger centre in the brain may be stimulated, giving rise to intense hunger and noises made by the stomach called borborygmus. Nausea and sometimes retching can also result. In newborn babies with hypoglycemia the symptoms include irritability, crying, jitters and jerky movements, difficulty in breathing, sweating, cold extremities (hands and feet), increased sleepiness, bluish discoloration of the hands and feet (cyanosis), refusal to feed and convulsions. The brain The brain is especially sensitive to a decreasing blood sugar level. Since the brain has a very minimal glucose reserve, it depends on the continuous availability of glucose and symptoms may manifest soon after the blood sugar drops. Some of these i Continue reading >>