Cgm And Time-in-range: What Do Diabetes Experts Think About Goals?
CGM and Time-in-Range: What Do Diabetes Experts Think About Goals? We interviewed 15 experts about time-in-range goals for those wearing CGM. Heres what they said Its been a big year in continuous glucose monitoring (CGM)! Talking with Dr. Roy Beck over the weekend, he in fact said, If I had to pick one thing that is most important for diabetes management among faster insulins, using a pump, and using CGM, it would be CGM. Information is power. Continuous glucose data can help people with diabetes know what their glucose is doing and how it changes while sleeping, in between meals, and during periods of exercise and stress, etc. In addition, 24/7 real-time CGM can help prevent hypoglycemia in people on insulin and sulfonylureas. Professional CGM worn intermittently can also help people with diabetes work with a healthcare provider to identify patterns, guiding therapy adjustments and changes to food choices. The goal, of course, is to spend more time-in-range 70-180 mg/dl (3.9-10 mmol/l) each day. Abbotts FreeStyle Libre was approved in the US ( now available in pharmacies) and is inthe hands of over 400,000 people around the world. The system does not require any fingersticks for calibration, eliminating a huge source of burden and hassle. Dexcoms G5 CGM received Medicare reimbursement and has begun shipping to thousands of beneficiaries, following its FDA approval for dosing insulin one year ago. The AGP standardized report to view CGM data isbecoming more mainstream - it was added to Dexcom Clarity in June, its always been in Abbotts FreeStyle Libre, and we hope to see it come to Medtronic too. Well share a follow-up article on why this report is important and how to use it. CGM data is becoming more user-friendly. For example, both Adam and Kelly now get automated Continue reading >>
Hyperglycemia: When Your Blood Glucose Level Goes Too High
Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when the blood glucose level is too high because the body isn't properly using or doesn't make the hormone insulin. You get glucose from the foods you eat. Carbohydrates, such as fruit, milk, potatoes, bread, and rice, are the biggest source of glucose in a typical diet. Your body breaks down carbohydrates into glucose, and then transports the glucose to the cells via the bloodstream. Body Needs Insulin However, in order to use the glucose, your body needs insulin. This is a hormone produced by the pancreas. Insulin helps transport glucose into the cells, particularly the muscle cells. People with type 1 diabetes no longer make insulin to help their bodies use glucose, so they have to take insulin, which is injected under the skin. People with type 2 diabetes may have enough insulin, but their body doesn't use it well; they're insulin resistant. Some people with type 2 diabetes may not produce enough insulin. People with diabetes may become hyperglycemic if they don't keep their blood glucose level under control (by using insulin, medications, and appropriate meal planning). For example, if someone with type 1 diabetes doesn't take enough insulin before eating, the glucose their body makes from that food can build up in their blood and lead to hyperglycemia. Your endocrinologist will tell you what your target blood glucose levels are. Your levels may be different from what is usually considered as normal because of age, pregnancy, and/or other factors. Fasting hyperglycemia is defined as when you don't eat for at least eight hours. Recommended range without diabet Continue reading >>
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Blood Sugar Level
The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the course of a day with three meals. One of the effects of a sugar-rich vs a starch-rich meal is highlighted. The blood sugar level, blood sugar concentration, or blood glucose level is the amount of glucose present in the blood of humans and other animals. Glucose is a simple sugar and approximately 4 grams of glucose are present in the blood of humans at all times. The body tightly regulates blood glucose levels as a part of metabolic homeostasis. Glucose is stored in skeletal muscle and liver cells in the form of glycogen; in fasted individuals, blood glucose is maintained at a constant level at the expense of glycogen stores in the liver and skeletal muscle. In humans, glucose is the primary source of energy, and is critical for normal function, in a number of tissues, particularly the human brain which consumes approximately 60% of blood glucose in fasted, sedentary individuals. Glucose can be transported from the intestines or liver to other tissues in the body via the bloodstream. Cellular glucose uptake is primarily regulated by insulin, a hormone produced in the pancreas. Glucose levels are usually lowest in the morning, before the first meal of the day, and rise after meals for an hour or two by a few millimoles. Blood sugar levels outside the normal range may be an indicator of a medical condition. A persistently high level is referred to as hyperglycemia; low levels are referred to as hypoglycemia. Diabetes mellitus is characterized by persistent hyperglycemia from any of several causes, and is the most prominent disease related to failure of blood sugar regulation. There are different methods of testing and measuring blood sugar le 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 >>
5 Ways To Lower Your A1c
For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>
Must Read Articles Related To High Blood Sugar (hyperglycemia)
A A A High Blood Sugar (Hyperglycemia) Whenever the glucose (sugar) level in one's blood rises high temporarily, this condition is known as hyperglycemia. The opposite condition, low blood sugar, is called hypoglycemia. Glucose comes from most foods, and the body uses other chemicals to create glucose in the liver and muscles. The blood carries glucose (blood sugar) to all the cells in the body. To carry glucose into the cells as an energy supply, cells need help from insulin. Insulin is a hormone made by the pancreas, an organ near the stomach. The pancreas releases insulin into the blood, based upon the blood sugar level. Insulin helps move glucose from digested food into cells. Sometimes, the body stops making insulin (as in type 1 diabetes), or the insulin does not work properly (as in type 2 diabetes). In diabetic patients, glucose does not enter the cells sufficiently, thus staying in the blood and creating high blood sugar levels. Blood sugar levels can be measured in seconds by using a blood glucose meter, also known as a glucometer. A tiny drop of blood from the finger or forearm is placed on a test strip and inserted into the glucometer. The blood sugar (or glucose) level is displayed digitally within seconds. Blood glucose levels vary widely throughout the day and night in people with diabetes. Ideally, blood glucose levels range from 90 to 130 mg/dL before meals, and below 180 mg/dL within 1 to 2 hours after a meal. Adolescents and adults with diabetes strive to keep their blood sugar levels within a controlled range, usually 80-150 mg/dL before meals. Doctors and diabetes health educators guide each patient to determine their optimal range of blood glucose control. When blood sugar levels remain high for several hours, dehydration and more serious complicat Continue reading >>
Normal Range For Blood Sugar After Eating A Meal
When you have diabetes your blood sugar levels can be quite fragile. What are normal blood sugar levels? Blood sugar levels depend on what, when and how much you eat, as well as how effectively your body produces and uses insulin. Your blood sugar levels are an excellent indicator of your risk of developing diabetes; the higher your blood sugar, the greater your risk. Chronic high blood sugar can be a wake-up call, telling you that it’s time to lose weight and make healthier food choices. Normal Blood Glucose / Blood Sugar Level Ranges before Eating Target blood sugar levels depend on the time of day and if you already have diabetes or pre-diabetes. Before you eat, called a fasting or pre-prandial glucose level, a non-diabetic should have a glucose level between 3.88 and 5.3 mmol/L.. If your reading is higher than 5.33 mmol/L. but lower than 6.94mmol/L, you may have insulin resistance or pre-diabetes. Glucose readings above 7 mmol/L indicate you have diabetes. Ideally, if you have type 2 diabetes you should have a fasting glucose level between 3.88 mmol/L and 7.22 mmol/L, when your diabetes is under control due to a combination of diet, exercise and medication if needed. Normal Blood Sugar Ranges after Eating Your blood sugar or blood glucose levels starts to rise soon after you start to eat and is at its highest 1 to 2 hours after your meal. Normal postprandial, which means “after eating,” glucose levels are 6.67 mmol/L and below for non-diabetics, 8.83 mmol/L. and below for those with pre-diabetes and 10 mmol/L for diabetics. The National Institute of Diabetes and Digestive and Kidney Disease suggest that two hours after eating, diabetics should have a blood sugar reading of 10 mmol/L or less. If your blood sugar is higher than 18 mmol/L two hours after eating, 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 >>
Blood Sugar Levels For Adults With Diabetes
Each time you test your blood sugar, log it in a notebook or online tool or with an app. Note the date, time, results, and any recent activities: What medication and dosage you took What you ate How much and what kind of exercise you were doing That will help you and your doctor see how your treatment is working. Well-managed diabetes can delay or prevent complications that affect your eyes, kidneys, and nerves. Diabetes doubles your risk for heart disease and stroke, too. Fortunately, controlling your blood sugar will also make these problems less likely. Tight blood sugar control, however, means a greater chance of low blood sugar levels, so your doctor may suggest higher targets. Continue reading >>
Print Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes: Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, and having a close relative with diabetes. Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. Tests for type 1 and type 2 diabetes and prediabetes Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal. If the A1C test results aren't consistent, the test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes: Random blood sugar Continue reading >>
Time-in-range: What’s An Achievable Goal With Diabetes?
My approach to time-in-range goals, five key tips to spend more time-in-range each day, and what’s still to come from experts… Q: “What do you think is an attainable percent time in range? My son’s doctor is happy about his A1c around 7.1%, and I think that can lead to being complacent or thinking he is good enough. What is a good goal for percent time in range on a daily basis?” – Madeline G. Madeline – thank you for this important question! We love that you are thinking Beyond A1c. This is a big topic, so it is tackled in parts below. How do we define “time-in-range”? The diabetes research community has reached consensus that 70 mg/dl (low) and 180 mg/dl (high) are the lower and upper thresholds for measuring “time-in-range” when using CGM in studies – i.e., glucose readings between 70-180 mg/dl (3.9-10 mmol/l) are considered “in range,” while hypoglycemia is less than 70 mg/dl and hyperglycemia is above 180 mg/dl. As with anything in diabetes, however, this can be individualized. Personally, I try to aim for a tighter range of 70-140 mg/dl, in part because I have access to CGM and feel like “my best self” in this range (energy, mood, productivity, etc.). People without diabetes also typically spend most of their day in this zone, so it’s something I strive for – of course, I almost never spend 100% of any day in it. I mention this definition upfront because the person – and the circumstances surrounding that person – defines the goal. Staying in a tighter range requires more vigilance and tools, and an achievable time-in-range for a two-year old is almost certainly different from a pregnant woman or an 86 year-old with impaired hypoglycemia awareness and no access to CGM. How do I think about my own time-in-range? Do I have a s Continue reading >>
Goals For Blood Glucose Control
Discuss blood glucose (sugar) targets with your healthcare team when creating your diabetes management plan. People who have diabetes should be testing their blood glucose regularly at home. Regular blood glucose testing helps you determine how well your diabetes management program of meal planning, exercising and medication (if necessary) is doing to keep your blood glucose as close to normal as possible. The results of the nationwide Diabetes Control and Complications Trial (DCCT) show that the closer you keep your blood glucose to normal, the more likely you are to prevent diabetes complications such as eye disease, nerve damage, and other problems. For some people, other medical conditions, age, or other issues may cause your physician to establish somewhat higher blood glucose targets for you. The following chart outlines the usual blood glucose ranges for a person who does and does not have diabetes. Use this as a guide to work with your physician and your healthcare team to determine what your target goals should be, and to develop a program of regular blood glucose monitoring to manage your condition. Time of Check Goal plasma blood glucose ranges for people without diabetes Goal plasma blood glucose ranges for people with diabetes Before breakfast (fasting) < 100 70 - 130 Before lunch, supper and snack < 110 70 - 130 Two hours after meals < 140 < 180 Bedtime < 120 90- 150 A1C (also called glycosylated hemoglobin A1c, HbA1c or glycohemoglobin A1c) < 6% < 7% < = less than > = greater than > = greater than or equal to < = less than or equal to Information obtained from Joslin Diabetes Center's Guidelines for Pharmacological Management of Type 2 Diabetes. Continue reading >>
What Are Blood Sugar Target Ranges? What Is Normal Blood Sugar Level?
Understanding blood sugar target ranges to better manage your diabetes As a person with diabetes, you may or may not know what your target ranges should be for your blood sugars first thing in the morning, before meals, after meals, or at bedtime. You may or may not understand what blood sugar ranges are for people without diabetes. You may or may not understand how your A1C correlates with your target ranges. How do you get a clear picture of what is going on with your blood sugar, and how it could be affecting your health? In this article, we will look at what recommended blood sugar target ranges are for people without diabetes. We will look at target ranges for different times of the day for people with diabetes. We will look at target ranges for Type 1 versus Type 2 diabetes. Is there a difference? We will also look at what blood sugars should be during pregnancy for those with gestational diabetes. We will look at other factors when determining blood sugar targets, such as: Age Other health conditions How long you’ve had diabetes for Stress Illness Lifestyle habits and activity levels We will see how these factors impact target ranges for your blood sugars when you have diabetes. We will learn that target ranges can be individualized based on the factors above. We will learn how target ranges help to predict the A1C levels. We will see how if you are in your target range, you can be pretty sure that your A1C will also be in target. We will see how you can document your blood sugar patterns in a notebook or in an “app,” and manage your blood sugars to get them in your target ranges. First, let’s look at the units by which blood sugars are measured… How is blood sugar measured? In the United States, blood sugar is measured in milligrams per deciliter (by w Continue reading >>
Is My Blood Sugar Normal?
“Is my blood sugar normal?” seems like a simple question – but it’s not! The answer can vary dramatically based on your situation. Let’s look at some of the factors to consider. Please remember: you should figure out your personal goals in consultation with your doctor. Normal Blood Sugar in Diabetic vs. Non-Diabetic First, a quick note on how we measure blood sugar. In the USA, blood sugars are measured by weight in milligrams per deciliter, abbreviated as mg/dL. Most everyone else uses millimole per liter, abbreviated mmol. If you are in the USA, look at the big numbers, most everyone else look at the small numbers. In a person without diabetes, blood sugars tend to stay between 70 and 100 mg/dL (3.8 and 5.5 mmol). After a meal, blood sugars can rise up to 120 mg/dL or 6.7 mmol. It will typically fall back into the normal range within two hours. In a person with diabetes, the story is much more complex: Below 70 mg/dL Below 3.8 mmol Low Blood Sugars (Hypoglycemia). When blood sugars drop below this level, you may start feeling hunger, shakiness, or racing of the heart. Your body is starved for sugar (glucose). Read how to detect and treat low blood sugars. 70 mg/dL to 140 mg/dL 3.8 mmol to 7.7 mmol Normal Blood Sugar. In this range, the body is functioning normally. In someone without diabetes, the vast majority of the time is spent in the lower half of this range. 140 mg/dL to 180 mg/dL 7.7 mmol to 10 mmol Elevated Blood Sugars. In this range, the body can function relatively normally. However, extended periods of time in this zone put you at risk for long-term complications. Above 180 mg/dL Abovoe 10 mmol High Blood Sugars. At this range, the kidney is unable to reabsorb all of the glucose in your blood and you begin to spill glucose in your urine. Your bo Continue reading >>
Blood Sugar Level Ranges
Tweet Understanding blood glucose level ranges can be a key part of diabetes self-management. This page states 'normal' blood sugar ranges and blood sugar ranges for adults and children with type 1 diabetes, type 2 diabetes and blood sugar ranges to determine people with diabetes. If a person with diabetes has a meter, test strips and is testing, it's important to know what the blood glucose level means. Recommended blood glucose levels have a degree of interpretation for every individual and you should discuss this with your healthcare team. In addition, women may be set target blood sugar levels during pregnancy. The following ranges are guidelines provided by the National Institute for Clinical Excellence (NICE) but each individual’s target range should be agreed by their doctor or diabetic consultant. Recommended target blood glucose level ranges The NICE recommended target blood glucose levels are stated below for adults with type 1 diabetes, type 2 diabetes and children with type 1 diabetes. In addition, the International Diabetes Federation's target ranges for people without diabetes is stated.    The table provides general guidance. An individual target set by your healthcare team is the one you should aim for. NICE recommended target blood glucose level ranges Target Levels by Type Upon waking Before meals (pre prandial) At least 90 minutes after meals (post prandial) Non-diabetic* 4.0 to 5.9 mmol/L under 7.8 mmol/L Type 2 diabetes 4 to 7 mmol/L under 8.5 mmol/L Type 1 diabetes 5 to 7 mmol/L 4 to 7 mmol/L 5 to 9 mmol/L Children w/ type 1 diabetes 4 to 7 mmol/L 4 to 7 mmol/L 5 to 9 mmol/L *The non-diabetic figures are provided for information but are not part of NICE guidelines. Normal and diabetic blood sugar ranges For the majority of healthy ind Continue reading >>