His Blood Sugar Was Above Normal. Why Did I Advise Against Tighter Glucose Control?
The case: A diabetic dissatisfied with his blood sugar control There was no doubt about it: For a man in his early 90s, Mr. T was in great shape. Despite having had type 2 diabetes for 10 years, as well as a heart attack in his 70s, he remained slim, fit, and was still able to drive confidently from his home in Oakland to our clinic in San Francisco. "I feel good," he told me during a check-up. "I'm hoping to live to be at least 100, like my father. I'm walking 30 minutes every day, just like he did. And I eat healthy foods. "But I'm worried about my blood sugar," he went on, pulling out his home blood glucose records. "Look. I've been taking my metformin every day, just like I'm supposed to. But the other day, I got all the way up to 182." (Blood sugar in non-diabetics usually measures between 70 and 120.) I looked over the log he handed me. Then I checked the computer for that day's bloodwork results. Mr. T's glycosylated hemoglobin, also known as hemoglobin A1C, was 7.1 percent, about the same as it had been over the past year. "Doctor, my son looked on the Internet and read that it's better to have lower blood sugar. Shouldn't I be taking more diabetes medication?" The challenge: Weighing the pros and cons of tight glucose control When people develop difficulty naturally regulating the amount of glucose (sugar), in their blood, they're said to have diabetes. Without treatment, diabetics have blood sugar levels that are higher than normal. People with type 2 diabetes often feel fine if their blood sugar gets only mildly-to-moderately high; they may not even realize they have the disease. But experts always urge diabetics to take this condition very seriously, because over several years higher blood sugar can cause permanent damage to the body, especially to the eyes Continue reading >>
Low Blood Sugar Symptoms And Ranges
Low blood sugar (hypoglycemia) definition and facts Hypoglycemia is the medical term for low blood sugar. It typically occurs as a side effect of medications for diabetes. The normal range of blood glucose is from 70 to 100 mg/dL in an individual without diabetes, Most people will feel the effects and symptoms of low blood sugar when blood glucose levels are lower than 50 mg/dL. Low blood sugar is treated by giving a readily absorbed source of sugar, including soft drinks, juice, or foods containing sugar. If the hypoglycemia has progressed to the point at which the patient cannot take anything by mouth, an injection of glucagon may be given. Glucagon is a hormone that causes a fast release of glucose from the liver. Hypoglycemia or low blood sugar is syndrome that results from low blood sugar. The severity and symptoms of hypoglycemia can vary from person to person. Blood tests can diagnose low blood sugar, and symptoms resolve when the levels of sugar in the blood return to the normal range. The medical term for blood sugar is blood glucose. What can cause low blood sugar? Despite advances in the treatment of diabetes, low blood sugar episodes occur as a side effect of many treatments for diabetes. In fact, these episodes are often the limiting factor in achieving optimal blood sugar control, because many medications that are effective in treating diabetes carry the risk of lowering the blood sugar level too much, causing symptoms. In large scale studies looking at tight control in both type 1 and type 2 diabetes, low blood sugars occurred more often in the patients who were managed most intensively. This is important for patients and physicians to recognize, especially as the goal for treating patients with diabetes becomes tighter control of blood sugar. While peopl Continue reading >>
Blood Glucose Monitoring
One of the main aims of diabetes treatment is to keep blood glucose levels within a specified target range. The key is balancing your food with your activity, lifestyle and diabetes medicines. Blood glucose monitoring can help you understand the link between blood glucose, food, exercise and insulin. Over time your readings will provide you and your health professionals with the information required to determine the best management strategy for your diabetes. Maintaining good blood glucose control is your best defence to reduce the chances of developing complications from diabetes. Self-blood glucose monitoring allows you to check your blood glucose levels as often as you need to or as recommended by your doctor or Credentialled Diabetes Educator. To test blood glucose levels, you need: A blood glucose meter A lancet device with lancets Test strips. Blood glucose meters are usually sold as kits giving you all the equipment you need to start. There are many different types, offering different features and at different prices to meet individual needs. Most of these are available from Diabetes Australia in your state or territory, pharmacies and some diabetes centres. Your doctor or Credentialled Diabetes Educator can help you choose the meter that’s best for you, and your Credentialled Diabetes Educator or pharmacist can show you how to use your meter to get accurate results. To test your blood glucose levels, you prick your finger with the lancet and add a small drop of blood onto a testing strip. This strip is then inserted into the meter, which reads the strip and displays a number – your blood glucose level. When and how often you should test your blood glucose levels varies depending on each individual, the type of diabetes and the tablets and/or insulin being us Continue reading >>
Elderly A1c Targets: Should Older People Have More Relaxed Glucose Goals?
You may have read that the lower your A1C level, the better. For best health, people with diabetes should aim for glucose as close to normal as possible. But some new research shows this may not be true for older people. According to these studies, seniors could decide not to shoot for tight control of blood sugar or cholesterol. One study from Japan showed that lower HbA1c levels (a measure of average glucose control over the previous 2–3 months) were actually linked with an increased the risk of frailty in older adults. Frailty was measured in the study as how much help a person needs in living, and how poorly he or she recovers from an illness or injury. Toshihiko Yanase, MD, PhD of Fukuoka University School of Medicine, Japan, reported, “The risk factors of metabolic syndrome, such as high blood glucose, obesity, high cholesterol, and hypertension, in middle age may shift from an unfavorable risk to favorable factors in old age.” The study was published in the Journal of Diabetes Investigation and reported by the online site Healio.com. Yanase and colleagues analyzed data from 132 adults aged at least 65 years with Type 2 diabetes Average age was 78. The subjects had had diabetes for an average of 17 years and their mean A1C was 7.3%. The subjects were categorized as frail or not on a 9-point clinical frailty scale (CFS). The CFS goes from 1 (very fit) to 9 (terminally ill). People who rated 5 or higher were classed as frail. Seventy-seven were not frail; 55 were. In those with higher frailty scores, HbA1c levels were found to be significantly lower. The causes of frailty are not well understood. In men, frailty is strongly associated with loss of muscle mass. As you get weaker and thinner, you become more fragile. The same is probably true of women, although Continue reading >>
Control Your Blood Sugar Levels
Know your numbers A fasting blood glucose level (or blood sugar level) above 125 milligrams per deciliter indicates diabetes. And anything over 100 mg/dL is generally considered prediabetes, though some experts say that 110 mg/dL should be the cutoff. But blood sugar levels represent a continuum, and any cutoff point is somewhat arbitrary. In general, the higher your blood sugar level, the greater your risk. And the presence of other risk factors, such as high blood pressure and high LDL (bad) cholesterol, are reasons to take even slightly elevated blood sugar seriously. People who already have diabetes should try to keep their A1C level, which is a marker for long-term blood sugar control, under 7 percent. The table below lists the A1C levels that most people should aim for. Also shown are the blood pressure and cholesterol levels people should strive for if they have diabetes or prediabetes. Get screened Adults who are at elevated risk for diabetes should have their blood sugar level measured at least every three to five years. That includes people with a personal history of heart attack, stroke, or heart disease, as well as those with any of these coronary-risk factors: a systolic (upper) blood pressure over 135 mmHg or a diastolic (lower) pressure over 80 mmHg; obesity (with a body mass index of 30 or over); or an LDL (bad) cholesterol over 130 mg/dL. Adults without those risks should also consider screening, though the benefits for them are less certain. Early symptoms. You should also be tested if you have early symptoms of diabetes, listed below: Extreme thirst Extreme hunger Frequent urination Sores or bruises that heal slowly Dry, itchy skin Unexplained weight loss Blurry vision that changes from day to day Unusual tiredness or drowsiness Tingling or numbness i Continue reading >>
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Diabetes, The Glycaemic Index And Older People
Older people differ from younger people but most of what is known about diabetes is derived from studies that have not involved older people. This is highlighted in the developing story about glucose metabolism and older people. There is a very high prevalence of type 2 diabetes in those over the age of 60 years. More than 20% of people over 60 years have type 2 diabetes and another 20% will have impaired glucose tolerance. Indeed isolated post-challenge hyperglycaemia defined as a 2 h level glucose >11.1 mmol/l by OGTT despite a fasting glucose of 7.0 mmol/l is also common in this group . Isolated post-challenge glucose levels increase with age by about 0.3–0.5 mmol/l per decade. This is not benign; in all ages all-cause mortality increases as the post-challenge glucose rises. In addition HbA1c levels are positively associated with age in non-diabetic people even when people with impaired glucose tolerance are excluded . Previously the normal range for HbA1c was derived from non-diabetic healthy volunteers aged 13–39 years. Now data from large population-based cohorts established by NHANES 2001–04 and Framingham Offspring Study has compared HbA1c levels from people over 70 years with people below 40 years. This shows that HbA1c levels are significantly increased in older people. They also demonstrated that the 2 h post-glucose load increased with age in non-diabetic people. Why should this be and does it matter? In older people, as part of normal ageing, intracellular body water is reduced, body fat increases and muscle mass is reduced and this can lead to the development of insulin resistance . At the same time hepatic glucose output is normal in older people but pancreatic islet cell function declines and insulin levels are lower. Insulin secretion dec Continue reading >>
Diabetes Mellitus (dm)
Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs. Urination and thirst are increased, and people lose weight when they are not trying to. Diabetes damages blood vessels and increases the risk of heart attack, stroke, chronic kidney disease, and vision loss. People with diabetes need to follow a healthy diet that is low in refined carbohydrates (including sugar), saturated fat, and processed foods. They also need to exercise and usually take drugs to lower blood sugar levels. Diabetes mellitus is a disorder in which the amount of sugar in the blood is elevated. Doctors often use the full name diabetes mellitus, rather than diabetes alone, to distinguish this disorder from diabetes insipidus. Diabetes insipidus is a relatively rare disorder that does not affect blood glucose levels but, just like diabetes mellitus, also causes increased urination. Continue reading >>
Your Guide To Diabetes
Table of Contents To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. —Public Health Agency of Canada Your Guide to Diabetes Diabetes affects roughly two and a half million Canadians. Left untreated, diabetes can lead to many serious complications, including: heart disease, kidney disease, vision loss, and lower limb amputation. The Public Health Agency of Canada (PHAC) estimates that 5 million Canadians over the age of 20 are currently pre-diabetic. An additional 1 million new cases of pre-diabetes are expected by 2016. Pre-diabetes is a key risk factor for type 2 diabetes, and if left untreated more than half of the people with pre-diabetes will develop type 2 diabetes within 8 to 10 years. Although diabetes can lead to serious complications and premature death, there are steps that can be taken to prevent or control the disease and lower the risk of complications. This guide is intended to help you understand diabetes, how certain types can be prevented or managed, and how to live with the condition. Did You Know? You may be pre-diabetic and not know it. Pre-diabetes occurs when blood sugar levels are high, but not high enough to diagnose diabetes. Talk to your health care provider to learn more. What is diabetes? Diabetes is a chronic disease that results from the body's inability to sufficiently produce and/or properly use insulin, a hormone that regulates the way glucose (sugar) is stored and used in the body. The body needs insulin to use sugar as an energy source. There are several forms of diabetes: type 1, type 2 and gestational diabetes. What is pre-diabetes? Pre-diabetes occurs when blood glucose (sugar) levels are higher than normal, but not high enough for a diagnosis of diabetes. Glucos Continue reading >>
What Is Pre-diabetes?
What Should I Do If I Have It? Are you one of the estimated 54 million people in this country who have pre-diabetes? If you have pre-diabetes, you are at high risk of developing type 2 diabetes and also are at increased risk of developing heart disease. Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be classified as full-blown diabetes. Those with pre-diabetes are at increased risk of developing type 2 diabetes within a decade unless they adopt a healthier lifestyle that includes weight loss and more physical activity. First, let's define what "pre-diabetes" is and is not. Diabetes is defined as having a fasting plasma blood glucose level of 126 mg/dl or greater on two separate occasions. If diabetes symptoms exist and you have a casual blood glucose taken at any time that is equal to or greater than 200 mg/dl, and a second test shows the same high blood glucose level, then you have diabetes. In general, people who have a fasting plasma blood glucose in the 100-125 mg/dl range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test, and at two-hours your blood glucose is 140-199 mg/dl, you have "impaired glucose tolerance". Either of these is medical terminology for what your doctor is probably referring to when he says you have "pre-diabetes." Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have "pre-diabetes." Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes. Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those u Continue reading >>
Final Recommendation Statement
Importance Cardiovascular disease (CVD) is the leading cause of death in the United States, and nearly one quarter of deaths caused by CVD are considered to be preventable. Modifiable cardiovascular risk factors include abnormal blood glucose, hypertension, hyperlipidemia or dyslipidemia, smoking, overweight and obesity, physical inactivity, and an unhealthy diet. Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and relative insulin deficiency, resulting in hyperglycemia. Type 2 diabetes typically develops slowly, and progression from normal blood glucose to glucose abnormalities that meet generally accepted criteria for diabetes (Table) may take a decade or longer. Glucose abnormalities that do not meet the criteria for diabetes include impaired fasting glucose (IFG), an impaired response to oral glucose intake (impaired glucose tolerance [IGT]), or an increased average blood glucose level as evidenced by increased levels of hemoglobin A1c (HbA1c). Abnormal glucose metabolism is a risk factor for CVD and, in some individuals, may progress to meet the threshold for the diagnosis of diabetes. According to national data estimates from 2012, approximately 86 million Americans aged 20 years or older have IFG or IGT.1 Approximately 15% to 30% of these persons will develop type 2 diabetes within 5 years if they do not implement lifestyle changes to improve their health.1 Modifiable risk factors for abnormal glucose metabolism (manifested as either diabetes or abnormal glucose levels below the threshold for diabetes) include overweight and obesity or a high percentage of abdominal fat, physical inactivity, and smoking. Abnormal glucose metabolism is also frequently associated with other cardiovascular risk factors, such as hyperlipidemia and Continue reading >>
What Are The Ideal Levels Of Blood Sugar?
A blood sugar or blood glucose chart identifies ideal blood sugar levels throughout the day, including before and after meals. Doctors use blood sugar charts to set target goals and monitor diabetes treatment plans. Blood sugar charts also help those with diabetes assess and self-monitor blood sugar test results. What is a blood sugar chart? Blood sugar charts act as a reference guide for blood sugar test results. As such, blood sugar charts are important tools for diabetes management. Most diabetes treatment plans involve keeping blood sugar levels as close to normal or target goals as possible. This requires frequent at-home and doctor-ordered testing, along with an understanding of how results compare to target levels. To help interpret and assess blood sugar results, the charts outline normal and abnormal blood sugar levels for those with and without diabetes. In the United States, blood sugar charts typically report sugar levels in milligrams per deciliter (mg/dL). In the United Kingdom and many other countries, blood sugar is reported in millimoles per liter (mmol/L). A1C blood sugar recommendations are frequently included in blood sugar charts. A1C results are often described as both a percentage and an average blood sugar level in mg/dL. An A1C test measures the average sugar levels over a 3-month period, which gives a wider insight into a person's overall management of their blood sugar levels. Blood sugar chart guidelines Appropriate blood sugar levels vary throughout the day and from person to person. Blood sugars are often lowest before breakfast and in the lead up to meals. Blood sugars are often highest in the hours following meals. People with diabetes will often have higher blood sugar targets or acceptable ranges than those without the condition. These Continue reading >>
Controlling Blood Sugar In Diabetes: How Low Should You Go?
Diabetes is an ancient disease, but the first effective drug therapy was not available until 1922, when insulin revolutionized the management of the disorder. Insulin is administered by injection, but treatment took another great leap forward in 1956, when the first oral diabetic drug was introduced. Since then, dozens of new medications have been developed, but scientists are still learning how best to use them. And new studies are prompting doctors to re-examine a fundamental therapeutic question: what level of blood sugar is best? Normal metabolism To understand diabetes, you should first understand how your body handles glucose, the sugar that fuels your metabolism. After you eat, your digestive tract breaks down carbohydrates into simple sugars that are small enough to be absorbed into your bloodstream. Glucose is far and away the most important of these sugars, and it's an indispensable source of energy for your body's cells. But to provide that energy, it must travel from your blood into your cells. Insulin is the hormone that unlocks the door to your cells. When your blood glucose levels rise after a meal, the beta cells of your pancreas spring into action, pouring insulin into your blood. If you produce enough insulin and your cells respond normally, your blood sugar level drops as glucose enters the cells, where it is burned for energy or stored for future use in your liver as glycogen. Insulin also helps your body turn amino acids into proteins and fatty acids into body fat. The net effect is to allow your body to turn food into energy and to store excess energy to keep your engine running if fuel becomes scarce in the future. A diabetes primer Diabetes is a single name for a group of disorders. All forms of the disease develop when the pancreas is unable to 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 >>
The Correct Interpretation Of Blood Glucose
Go to:Table of Contents of all my Rejuvenation Pages The Glucose Theory of Aging (The Gospel only According to Saint Ellis...) NOTE: See another opinion below... Chad: "I feel obligated, based on my knowledge of this subject, to attempt to prevent people (particularly diabetics) from reading the advice on your website and going out there and attempting it... and killing themselves." "EAT IN SUCH A WAY THAT YOU KEEP YOUR FASTING BLOOD GLUCOSE LEVEL BETWEEN 70 AND 85 mg/dl, AND (AT MOST) 70 - 100 mg/dl. AFTER EATING. EVERY MOMENT THAT YOUR GLUCOSE LEVEL IS HIGHER THAN 85 mg/dl YOU ARE AGING A LITTLE BIT FASTER THAN THE MINIMUM. THIS IS TRUE EVEN IF IT IS "NORMAL". THE HIGHER ABOVE 85 YOU GO, THE LONGER IT WILL TAKE FOR BLOOD GLUCOSE TO COME DOWN TO 85 AGAIN, AND THE FASTER AND MORE SERIOUSLY WILL YOU AGE. - Ellis Toussier, June 2001 Aging does not occur as a function of the passing of time: hours, or days... Aging occurs as a function of events that occur during the passing of time, the passing of a unit which I will call "high glucose level seconds" or hours, or days... - Ellis Toussier, May, 2006 The following table is my interpretation of the meaning of the various glucose levels. The figure on the right is my educated guess of the relative damage in seconds that you might be suffering at various glucose levels... it is not just "more damage" the higher up you go, but "more damage, squared" because a red hot iron will then cool off to a very hot iron, and then to a hot iron... you suffer damage going up, then you also suffer damage going down. Perhaps the figures are mistaken, but the idea that damage is much worse the higher the glucose goes up is correct. My interpretation of blood glucose levels is as follows: > 200 mg/dl SUICIDAL 180 mg/dl DEATHLY 160 mg/dl HORRIBL Continue reading >>
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Blood Glucose Levels
What is the blood sugar level? The blood sugar level is the amount of glucose (sugar) in the blood. It is also known as plasma glucose level. It is expressed as millimoles per litre (mmol/l). Normally blood glucose levels stay within narrow limits throughout the day: 4 to 8mmol/l. But they are higher after meals and usually lowest in the morning. In diabetes the blood sugar level moves outside these limits until treated. Even with good control of diabetes, the blood sugar level will still at times drift outside this normal range. Why control blood sugar levels? When very high levels of blood glucose are present for years, it leads to damage of the small blood vessels. This in turn increases your risk of developing late-stage diabetes complications including: With type 1 diabetes, these complications may start to appear 10 to 15 years after diagnosis. They frequently appear less than 10 years after diagnosis of type 2 diabetes, because this type of diabetes is often present for years before it is recognised. By keeping the blood sugar level stable, you significantly reduce your risk of these complications. How can I measure blood sugar levels? Home testing kits come in a variety of shapes and sizes. A pharmacist or the diabetes clinic nurse can advise you about the best model. You can usually obtain a blood glucose meter at little or no cost via the diabetes clinic. Testing strips are available on NHS prescription. You can learn to measure blood sugar levels simply and quickly with a home blood glucose level testing kit. All kits have at least two things: a measuring device (a 'meter') and a strip. To check your blood sugar level, put a small amount of blood on the strip. Now place the strip into the device. Within 30 seconds it will display the blood glucose level. The Continue reading >>