What Is Good Control Of Diabetes?

Tight Control Of Type 1 Diabetes: Recommendations For Patients

STEPHEN HAVAS, M.D., M.P.H., M.S., American Medical Association, Chicago, Illinois THOMAS DONNER, M.D., University of Maryland School of Medicine, Baltimore, Maryland Am Fam Physician. 2006 Sep 15;74(6):971-978. Patient information: See related handout on type 1 diabetes, written by the authors of this article. Tight control of blood glucose levels and risk factors for cardiovascular disease (e.g., hypertension, hypercholesterolemia) can substantially reduce the incidence of microvascular and macrovascular complications from type 1 diabetes. Physicians play an important role in helping patients make essential lifestyle changes to reduce the risk of these complications. Key recommendations that family physicians can give patients to optimize their outcomes include: take control of daily decisions regarding your health, focus on preventing and controlling risk factors for cardiovascular disease, tightly control your blood glucose level, be cognizant of potentially inaccurate blood glucose test results, use physiologic insulin replacement regimens, and learn how to manage and prevent hypoglycemia. Randomized clinical trials1–5 have demonstrated that tight control of blood glucose levels reduces the risk of microvascular and macrovascular complications in patients with type 1 diabetes; this is not true for patients with type 2 diabetes. Although many patients with type 1 diabetes may benefit from tightly controlling their blood glucose levels,3 few do so.6 The Diabetes Control and Complications Trial (DCCT)4 showed that, compared with conventional therapy, intensive therapy significantly reduced the risk of retinopathy progression (4.7 versus 1.2 per 100 patient-years, number needed to treat [NNT] = three for 10 years) and clinical neuropathy (9.8 versus 3.1 per 100 patie Continue reading >>

10 Blood Sugar–lowering Foods

Adapted from The Carb Sensitivity Program It is no exaggeration—balancing your blood sugar could be a matter of life or death. Chronic high blood sugar levels are toxic to your body, destroying organs and blood vessels and paving the way to a heart attack, type 2 diabetes, stroke, dialysis, nerve damage, erectile dysfunction, or even blindness. The good news? Out-of-control sugar levels can be reigned in and regulated with the right foods. Here are most potent blood sugar-lowering foods so you know how to lower blood sugar levels naturally. Blood Sugar Benefit: A groundbreaking study published in the Journal of Nutrition in 2010 found a daily dose of the bioactive ingredients from blueberries increases sensitivity to insulin and may reduce the risk of developing diabetes in at-risk individuals. That's important because too many carbs produces too much insulin, which could lead to insulin resistance and type 2 diabetes. Adding blueberries to daily smoothies for six weeks also improves insulin sensitivity, so feel free to eat healthy doses of the superfood fruit, too. Added Perk: Low in naturally occurring sugars, blueberries are also packed with antioxidants that fight damage from free radicals, accelerated aging, and diseases like cancer and Alzheimer's. Blood Sugar Benefit: Don't let the fat content of avocados fool you—they're still good for you! Avocados are full of monounsaturated fat, the kind that helps slow the release of sugars into the bloodstream, prompting less insulin release, and can even help to lower your cholesterol. Added Perk: Avocados contain beta-sitosterol, a compound that could help quell inflammation after an intense workout. Just limit yourself to one-quarter of an avocado at a time to avoid calorie overload. Or, try avocado oil drizzled on a Continue reading >>

6. Glycemic Targets

Assessment of Glycemic Control Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C. Continuous glucose monitoring (CGM) may be a useful adjunct to SMBG in selected patients. Recommendations When prescribed as part of a broader educational context, SMBG results may help guide treatment decisions and/or self-management for patients using less frequent insulin injections B or noninsulin therapies. E When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results, and their ability to use SMBG data to adjust therapy. E Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. B When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥25 years) with type 1 diabetes. A Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. B CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. C Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. E When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use. E Self-monit Continue reading >>

How To Stabilize Your Blood Sugar

Life with type 2 diabetes can sometimes seem like an hourly or even minute-by-minute effort to stabilize your blood sugar. All of the recommendations and drugs you’ve been given as part of your type 2 diabetes treatment plan are intended to help you reach — and keep — healthy blood sugar levels most of the time. But doctors are learning that to control type 2 diabetes well, better information about why blood sugar matters and how to manage it is essential. The Facts About Diabetes and Blood Sugar As the American Diabetes Association (ADA) explains, your body needs sugar (glucose) for fuel, and there’s a fairly complicated process that makes it possible for your body to use that sugar. Insulin, which is made by the pancreas, is the hormone that enables the cells in your body to take advantage of sugar. Type 2 diabetes occurs when your body isn’t able to remove sugar from your blood. This can happen if your body stops being sensitive to insulin or if it starts to respond in a delayed or exaggerated way to changes in your blood sugar. Diabetes is signaled by an elevated blood sugar level of more than 126 milligrams per deciliter (mg/dL) for a fasting blood test, or more than 200 mg/dL at any time during the day. It can also be indicated by a hemoglobin A1C level of 6.5 percent or higher, a measure of the percentage of blood sugar attached to hemoglobin in the blood during the past two to three months. (Hemoglobin is a protein in red blood cells that transports oxygen throughout the body. So an A1C of 6.5 means that 6.5 percent of your red blood cells have sugar attached to them.) Unchecked high blood sugar gradually damages the blood vessels in your body. Over the long term, this slow, progressive harm can lead to a dangerous loss of sensation in your legs and fe Continue reading >>

Diabetes Blood Sugar Levels Chart [printable]

JUMP TO: Intro | Blood sugar vs blood glucose | Diagnostic levels | Blood sugar goals for people with type 2 diabetes | Visual chart | Commonly asked questions about blood sugar Before Getting Started I was talking to one of my clients recently about the importance of getting blood sugar levels under control. So before sharing the diabetes blood sugar levels chart, I want to OVER EMPHASIZE the importance of you gaining the best control of your blood sugar levels as you possibly can. Just taking medication and doing nothing else is really not enough. You see, I just don’t think many people are fully informed about why it is so crucial to do, because if you already have a diabetes diagnosis then you are already at high risk for heart disease and other vascular problems. Maybe you've been better informed by your doctor but many people I come across haven't. So if that's you, it's important to know that during your pre-diabetic period, there is a lot of damage that is already done to the vascular system. This occurs due to the higher-than-normal blood sugar, that's what causes the damage. So now that you have type 2 diabetes, you want to prevent any of the nasty complications by gaining good control over your levels. Truly, ask anyone having to live with diabetes complications and they’ll tell you it’s the pits! You DO NOT want it to happen to you if you can avoid it. While medications may be needed, just taking medication alone and doing nothing is really not enough! Why is it not enough even if your blood sugars seem reasonably under control? Well, one common research observation in people with diabetes, is there is a slow and declining progression of blood sugar control and symptoms. Meaning, over time your ability to regulate sugars and keep healthy gets harder. I Continue reading >>

Diabetes: Your Management Plan

When you have diabetes, it’s very important to keep your blood glucose (sugar) in good control. To do so, you need a personal plan to help you manage your diabetes. This patient education sheet tells you how to control your blood glucose level and manage your diabetes. What is good control? Good control of diabetes means that your blood glucose stays within certain ranges. These ranges are based on guidelines from the American Diabetes Association (ADA). Here are the numbers that show where your blood glucose should be: Before meals Recommended goal is 70 to 130. You need to improve if your level is often over 150. If your blood glucose is below 70, you need to follow the guidelines for treating low blood glucose. See UPMC education sheet Diabetes: Short-Term Problems. After meals Recommended goal is no higher than 180. If it has been two hours or longer after the start of a meal, this number should be even lower. At bedtime Recommended goal is 110 to 150. You need to improve if your level is often under 110 or over 180. Certain diabetes medications may drop blood glucose too low through the night if you are running in the lower ranges before bedtime. Speak to your doctor or diabetes educator if your are at risk for having low blood glucose. A1c test (A-one-C) This test measures the amount of hemoglobin with sugar attached. The results show your estimated average blood glucose level over 3 months. The light areas on the chart show the recommended target range for A1C. Note that A1c is measured in percent. The chart shows how this compares to your blood glucose readings. Normal A1c is under 5.7 percent. When you have diabetes, recommended goal is 7 percent or less. Goals may vary from person to person. Talk to your doctor or diabetes educator about what goals are best Continue reading >>

Diabetes Management

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment. Overview[edit] Goals[edit] The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies. The targets are: HbA1c of 6%[1] to 7.0%[2] Preprandial blood Continue reading >>

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 >>

Is Avocado Good For Diabetes?

The humble avocado, shunned for years during the fat-free diet craze of the 1990s, may have finally hit its stride. No longer just for guacamole, this nutritious fruit is popping up as a healthy addition to various diet plans. But can people with diabetes eat this food? It turns out that avocados are not only safe for people with diabetes, but they may be downright beneficial. Research shows that avocados offer many ways to help people manage their diabetes and improve their overall well-being. Contents of this article: Diet and diabetes A healthy diet is critical for people with diabetes. The foods that they eat each day can have a considerable impact on how they feel and how well their diabetes is controlled. In general, people with diabetes should eat foods that help control blood sugar levels and that offer health benefits such lowering blood pressure and cholesterol. This is one of the best ways to keep diabetes under control, avoid complications, and lead the healthiest life possible. Avocados are an excellent choice for people with diabetes because they offer all these benefits - and possibly more. How do avocados affect blood sugar levels? Blood sugar control is critical for people who have diabetes. A physician or dietitian may advise patients to choose foods that are lower in carbohydrates and sugar. They may also recommend foods that help control blood sugar spikes. An avocado meets both of these requirements. According to the United States Department of Agriculture, an average medium avocado has around 17 grams of carbohydrates. For comparison, an apple has 25 grams of carbohydrates and a banana has 27. A 1-ounce serving, or about one-fifth of an avocado, contains only 3 grams of carbohydrates and less than 1 gram of sugar. With so few carbohydrates, people Continue reading >>

A Glass Of Wine A Day May Help Control Type 2 Diabetes

If you're in the habit of drinking wine with dinner, there may be a bonus beyond the enjoyment of sipping a glass at night. A new study published in the Annals of Internal Medicine adds to the evidence that drinking a moderate amount of wine can be good for your health. The evidence comes from a new two-year-long study on people with diabetes. Researcher Iris Shai of Ben Gurion University says in Israel and elsewhere, lots of people with diabetes get the message that alcohol — even in moderation — can be harmful. "There is a myth that alcohol is not so safe for them," Shai says. In order to test the influence of wine on people with diabetes, Shai recruited about 225 people who already had elevated blood sugar, and they agreed to follow a Mediterranean style diet for two years. Everyone in the study was eating the same mix of foods but when it came to what to drink, some began drinking one glass of red wine per day, some began drinking one glass of white wine per day and others drank mineral water. And at the end of the study? "We found that a glass of red wine with dinner can improve the cardiovascular health of people with Type 2 diabetes," Shai says. In particular, Shai found that compared to people who drank mineral water with dinner, the wine drinkers — both those who drank white and red — benefited from improvements in blood sugar control. And the red wine drinkers got an additional benefit: They saw improvements in their levels of good cholesterol. The effects are not huge, but physician Christopher Wilcox of Georgetown University Medical Center says they could be significant. "One glass of alcohol per day had these admittedly modest but worthwhile benefits," he says. There's been a lot of interest in the idea that specific compounds in red wine may help p Continue reading >>

Managing Diabetes With Blood Glucose Control

There are two common ways that physicians assess how well diabetes is controlled: [1] Frequent measurements of blood glucose, and [2] measurement of glycohemoglobin (A1c). Each method has its good and bad points, but combined they give a fairly accurate picture of the state of glucose control in a diabetic. Most physicians will use both methods. Why Tight Blood Glucose Is Important Measurement of Blood Glucose (Blood Sugar) When we speak about measuring blood glucose levels, it can be done 2 different ways. Blood glucose can be measured randomly from a sample taken at any time (called a "random blood sugar" or RBS). Blood glucose can also be measured in the "fasting" state, meaning that the person has not eaten or taken in any calories in the past 8 hours (usually this is done overnight and it is referred to as an overnight fast and is called a "fasting blood sugar" or FBS). In a person with normal insulin production and activity (a non-diabetic) blood sugar levels will return to "fasting" levels within 3 hours of eating. People with diabetes (type 1 and type 2) may not be able to get their blood glucose down this quickly after a meal or drinking a calorie-containing drink. More about this can be found on our Diagnosing Diabetes page. Learn More about How to Manage Diabetes Remember, the normal fasting blood glucose level is between 70 and 110 mg/dL. Frequent Measurements of Blood Glucose. The goal in this part of diabetes management is to strive to keep fasting blood sugars under 140 mg/dL and preferably closer to the 70 to 120 mg/dL range. Ideally, one could monitor blood sugars 4 times per day (or more) to follow how well the sugars are controlled. This information could be used to adjust your diet and medications to achieve this goal. Usually blood glucose measureme Continue reading >>

12 Powerfoods To Beat Diabetes

Can controlling your blood sugar and preventing diabetes complications be as simple as eating the right foods? Yes. Certain foods are packed with nutrients that stabilize blood sugar levels, protect your heart, and even save your vision from the damaging effects of diabetes. These 12 foods can give you an extra edge against diabetes and its complications. 1. Apples In a Finnish study, men who ate the most apples and other foods high in quercetin had 20 percent less diabetes and heart disease deaths. Other good sources of quercetin are onions, tomatoes, leafy green vegetables, and berries. 2. Cinnamon A study at the Human Nutrition Research Center in Beltsville, Maryland, found that if you use ½ teaspoon of cinnamon daily, it can make cells more sensitive to insulin. Therefore, the study says, the cells convert blood sugar to energy. After 40 days of taking various amount of cinnamon extract, diabetics experienced not only lower blood sugar spikes after eating, but major improvements in signs of heart health. And you can sprinkle cinnamon on just about anything. 3. Citrus Fruit Studies show that people with diabetes tend to have lower levels of vitamin C in their bodies, so antioxidant-packed citrus fruit is a great snack choice. It may seem quicker to get your C from a pill, but since fruit is low in fat, high in fiber, and delivers lots of other healthy nutrients, it's a better choice. 4. Cold-Water Fish Heart disease strikes people with diabetes twice as often as it does people without the illness, according to the American Diabetes Association. Diets high in omega-3 fatty acids—the "good fat" in cold-water fish such as wild Alaskan salmon, sardines, and Atlantic mackerel—can help lower artery-clogging LDL cholesterol and triglycerides while raising levels of HDL Continue reading >>

Managing Blood Sugar For Kidney Health

Diabetes and Blood Sugar Diabetes is a serious disease in which your body has trouble controlling the level of sugar in your blood (also called “glucose”). Over time, having high blood sugar can cause damage to your eyes, nerves, heart, blood vessels, and kidneys. Good control of blood sugar and other self-management actions can help slow or stop this damage from happening. It can also help you maintain kidney health. Diabetes and Your Kidneys You have two kidneys—each is about the size of a fist. Kidneys clean waste from your blood. Over time, having high blood sugar from diabetes can cause damage inside your kidneys. As a result, they filter out some good things along with waste. As more damage happens, kidneys will have less function and waste builds up. This is known as chronic kidney disease (CKD). Diabetes is the leading cause of chronic kidney disease. Controlling blood sugar helps lessen your risk for getting kidney disease. It can also help slow or even stop kidney disease from getting worse. Managing Blood Sugar Ask your doctor what your blood sugar targets should be. Not everyone will have the same blood sugar target. In general, the recommended targets for most people are: Before meals: 90-130 mg/dL Two hours after the start of a meal: Below 180 mg/dL A1C Test: Around 7% What can make blood sugar rise above target range in people with diabetes? A meal or snack with more food or more carbohydrates than usual Lack of physical activity Not enough diabetes medication Side effects of some other medications Infection or other illness such as a cold or the flu Changes in your hormone levels, such as during menstrual periods Stress What can make blood sugar fall lower than target range in people with diabetes? A meal or snack with less food or fewer carbohydra Continue reading >>

Test Id: Hba1c Hemoglobin A1c, Blood

Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled. Hemoglobin A1c (HbA1c) is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period (approximately 8-12 weeks, depending on the individual) and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations. Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. Diagnosis of diabetes includes 1 of the following: -Fasting plasma glucose > or =126 mg/dL -Symptoms of hyperglycemia and random plasma glucose >or =200 mg/dL -Two-hour glucose > or =200 mg/dL during oral glucose tolerance test unless there is unequivocal hyperglycemia, confirmatory testing should be Continue reading >>

Good Diabetes Control

Blood Glucose Levels Good diabetes control means having blood glucose (sugar) values within these limits: Before Breakfast : 4.0 - 8.0 mmol/l 2 hours after meals : 6.0 - 10.0 mmol/l Randomly, at any time : below 10.0 mmol/l However, because of individual differences, your target blood glucose level is best decided by your doctor. It is very useful to do home blood glucose monitoring if you wish to have good control of your diabetes. Glycosylated Haemoglobin (HBA1c) Glycosylated haemoglobin, or HBA1c, measures the average blood glucose in the blood over the past 6 to 8 weeks. Excellent : less than 6% Satisfactory : 6% to 8% Poor : more than 8% Urine Glucose Urine glucose is measured with a special test strip which changes colour after being dipped into urine depending on the amount of glucose in the urine. For various reasons it is not as accurate as blood glucose monitoring which is preferred. For good control of your diabetes, keep your urine free of glucose always. Blood fats In all people, cholesterol should be below 5.2 mmol/l (200 mg/dl) and certainly not above 6.5 mmol/l (250 mg/dl). Blood Pressure Blood pressure should be below 140/85 mm Hg in young people, and below 160/95 mmHg in older people. Weight and Height Tall people naturally weigh more, so weight has to be interpreted in relation to height. This is done by the 'Body Mass Index' or BMI. BMI = Weight (kg) / Height(m)2 The ideal BMI is between 20 to 25, and the health risk increases steadily above this level. Smoking Among other problems, smoking causes diseases of the heart and circulation. As diabetes also carries a risk of damage to the heart and circulation, smoking is particularly dangerous to people with diabetes, and greatly increases the risk of a heart attack, stroke and foot gangrene. Continue reading >>