What is the difference between type 1 and type 2 diabetes (and what if I don't fit either type)?
As you can see in the preceding graph, every day starting at about 3am this person’s glucose levels started to go up. One colourful term for the liver’s tendency to release glucose into the blood overnight is a liver leak.
Rebounding (the so-called Somogyi phenomenon) is commonly cited by diabetes health care practitioners as a cause of high morning blood glucose readings. Gee, I could get writer’s cramp listing every possible cause for erratic blood glucose readings.
It is important to be aware that A1C levels are measured in different units and on a different scale than is blood glucose; hence an A1C level of 7 is not the same as saying that your average blood glucose is 7. Typically, type 1 diabetes in children, adolescents or teenagers and require immediate institution of insulin. Typically, type 2 diabetes develops in middle-aged or older persons who are overweight and can – at least initially - be managed with lifestyle therapy and non-insulin medications. There are also a large number of adults who, based on their age (and, often, based on their body size) are thought to have type 2 diabetes, but who don’t get their blood glucose levels down despite usual therapy with lifestyle and non-insulin medications and, soon after diagnosis, require insulin therapy. One helpful way to distinguish type 1 from type 2 diabetes is to do a blood test for a special protein called a GAD antibody. As you can see, if you have type 2 diabetes then at the time you were diagnosed your pancreas was only making ½ of the insulin it was supposed to and, as time passes, it progressively loses more and more of its ability to make insulin.
If you have type 2 diabetes and are on insulin therapy you still have type 2 diabetes, not type 1 diabetes. ACE inhibitors and ARBs (I list the various types below) are medications that were created years ago to help control high blood pressure, but medical research subsequently discovered that even if a person with diabetes does not have high blood pressure, taking an ACE inhibitor or ARB will still reduce the risk of having a heart attack or stroke if you are at high risk for these complications.
Statins are medicines that improve cholesterol levels in your blood and they do this very well indeed.
Back in the 1960s, The Beach Boys released a hit song about the “plight” of American teens, called “Wouldn’t It Be Nice.” Those of us who live with diabetes have our own forms of plight. We could go on and on, just wishing, and hoping, and thinking, and praying (lyrics from Dusty Springfield, also in the 1960s), but the fact is that healthcare providers who possess this kind of time, equipment and insight are becoming increasingly rare. All modern blood glucose meters are downloadable to a PC running in a Windows environment, and most download to Mac systems as well.
The Standard Day or Modal Day report provides a scatter plot of blood glucose values arranged by time of day. In the example above (a Modal Day report from Bayer’s WinGlucofacts software), the glucose levels at lunchtime are mostly above target.
Statistical summaries provide a good measure of what progress has been made since the last time changes were made to your program.
In the Statistics Report above (from Abbott’s CoPilot Software), high averages and a very large standard deviation are seen in the evening, perhaps related to carb counting inaccuracies at dinnertime. Glucose Trend Graphs provide a longitudinal plot of blood glucose values over an extended period of time, such as a month or several months. In the Glucose Trend Graph above (from Lifescan’s One Touch DMS software), glucose levels were elevated for several weeks from late March until mid-April.
Logbook reports provide a listing by time of day (or mealtime) of glucose values so that you can learn about cause-and-effect relationships. In the example above (from Nova Diabetes Software), elevated readings are common at bedtime. We’ve all heard the philosophical question, “If a tree falls in the forest and nobody is around to hear it, does it make a sound?” From a diabetes standpoint, that question should be, “If blood glucose is measured but the data goes unused, does it do any good?” Pricking our fingers is the hard part.
Our mission is to help individuals better understand their diabetes and to make our readers happier & healthier. Our mission is to help individuals better understand their diabetes and to make our readers happier and healthier.
The active site on the enzyme attaches to a substrate molecule (such as a disaccharide) forming an enzyme-substrate complex.
In the simplified "sandwich model" of a cell membrane, a phospholipid bilayer is sandwiched between two layers of protein. A more accurate model shows large protein (glycoprotein) molecules embedded in the membrane. In the "fluid mosaic model" of membrane structure, the membrane is a fluid phospholipid bilayer in which protein (glycoprotein) molecules are either partially or wholly embedded.
A good example of facilitated diffusion is the uptake of glucose by fat (adipose tissue) and muscle cells.
In type 2 (non-insulin dependent) diabetes, glucose won't pass through the plasma membrane. The above chart gives one a false sense of security because it does not tell the whole story. A molecule of hemoglobin is composed of 4 amino acid chains (proteins): 2 alpha chains (red) and 2 beta chains (blue).
A diet consisting of numerous slices of toast covered with peanut butter and high fructose grape jelly could lead to glucose spikes and higher A1c levels over a period of months.
When I had normal blood glucose AM & PM readings but an elevated A1C, I was consuming large quantities of carbohydrates during daytime botany field trips. The glycemic index (GI) ranks carbohydrate-rich foods according to their effect on our blood glucose levels.
Osmosis: Movement of water molecules (blue circles) through a cell membrane (red) from a region of high concentration (inside cell) to a region of lower concentration (outside cell).


The internal body fluids of a marine fish are hypotonic compared with the hypertonic sea water; therefore, water molecules diffuse out of the fish through the gill region. Cloverleaf model of a transfer RNA molecule showing an attached amino acid at one end and an anticodon at the other end. An abbreviated model of transfer RNA showing the amino acid phenylalanine and the anticodon AAA. Immune (IgG) antibody model composed of four polypeptides: Two heavy (H) chains (longer green chains), and two light (L) chains (shorter blue chains). There are two general types of immunity to disease organisms, active immunity and passive immunity.
When vaccinated, you typically receive an intramuscular or subcutaneous injection of a vaccine. Passive immunity involves the intramuscular injection of a serum or antiserum containing ready-made antibodies. The RhoGam® given to an Rh negative woman after giving birth to an Rh positive baby is actually a serum containing anti-Rh antibodies. Rattlesnake antivenin is a polyvalent serum containing antibodies against several species of pit vipers of the family Crotalidae, including rattlesnakes (Crotalus), copperheads & cottonmouth moccasins (Agkistrodon), fer-de-lance (Bothrops) and bushmaster (Lachesis).
Hemotoxins of pit vipers, such as rattlesnakes, can cause severe damage to tissues in the vicinity of the bite, and can cause gangrene in the afflicted extremities.
Monoclonal antibodies are produced by a laboratory animal in response to an introduced tumor antigen on the membrane surface of injected tumor cells. Immunotoxin (Y-shaped antibody with attached protein toxin) attached to the membrane surface of a tumor cell. The animation below depicts how insulin signalling leads to the translocation of glucose receptorsfrom the cytoplasm into the plasma membrane, allowing glucose (small blue balls) to enter the cell. More gadgets on: GadgetifyiPhones and iPads are great for many things, including keeping track of your health. Speaking of health trackers for iOS, the OneTouch Verio Sync Meter is one designed for folks with diabetes.
Review glucose results and the important factors that affect them, with out-of-range results highlighted. Helps you quickly and accurately identify the frequency that readings fall within a certain range.
View important health-related factors sch as blood pressure, weight, doctor's visits, and A1c. The dawn phenomenon is the rise in blood glucose levels in the dawn (that is, the morning) due to excessive release of glucose from the liver into the blood. This individual, like so very many others living with diabetes who have high blood glucose levels first thing in the morning, blamed themselves and attributed their elevated morning blood glucose to having overeaten or snacked the night before. Not so! This is particularly likely to be the case if you are taking NPH insulin at supper or Levemir insulin (only) in the morning. If you are rebounding it means that you had a very low blood glucose overnight, slept through it, and your liver poured out so much glucose into your blood to bring your blood glucose back up that it ended up making too much and overshot the mark and as a result your blood glucose was high when you awakened.
The idea is that a certain amount of carbohydrates is likely to raise your blood sugar level by a predictable amount and thus, you can take an amount of insulin proportional to your carb intake to prevent this rise in blood glucose from occurring. Indeed, there are many middle-aged people who develop type 1 diabetes and there are increasing numbers of children who develop type 2 diabetes. Such people often have a form of type 1 diabetes called LADA (Latent Autoimmune Diabetes in Adults). This antibody is almost always present if a person has type 1 diabetes and is almost always absent if someone has type 2 diabetes.
Well, often it doesn’t, but there is at least one situation where it does; that is, the instance where a person with LADA is unsuccessfully treated with oral medicine after oral medicine in a fruitless attempt to control their blood glucose levels when what they really need is insulin! One involves the direction (or lack thereof) that we receive from our healthcare providers.
The meters attach a time and date stamp to each blood glucose value so that graphs, charts, and statistics can be generated.
Just visit the company website or call the company directly using the toll-free number on the back of the meter.
Statistical reports usually include glucose averages, standard deviations and percentage of values above, below and within the target range. By highlighting periodic peaks and valleys, these graphs can help determine whether therapy adjustments are needed for factors such as weekends versus weekdays, pre- versus post-menstrual cycles, or variations in seasonal activity. But also worth noting is that the elevated bedtime readings are often followed by elevated readings the following morning – indicating that the “correction doses” of insulin given at night may be too conservative. Richard Bowen at Colorado State University gave me permission to use his Animation For The Action Of Glut4 (Glucose Transport Protein 4); however, if your browser is not java-enabled, the animation will not be visible. Almost 2,500 years ago ancient healers noticed that sugar-loving ants were attracted to the urine of some individuals with a strange, debilitating illness. Whether you need to keep track of your heart rate or blood glucose, there is an iPhone accessory out there for you.
The user needs to put a finger over the two holes on the top of the unit to start the reading process. Then, using any of 11 pre-formatted charts and graphs, you can analyze your blood glucose data in detail.
Reports make it easy to see trends and patterns in your glucose levels, and meal-related changes in blood glucose. The usual best way to deal with the dawn phenomenon is to take a dose of NPH, Lantus, or Levemir insulin at bedtime.


There is always a reason for erratic blood glucose levels and if you’re having this problem, you and your health care providers need to play Sherlock Holmes and find out what is the cause! But if stress is part and parcel of your life (as it is of so many lives) your blood glucose levels can still be well controlled so long as your treatment program is tailored appropriately to your needs. Therefore, even if you aren't yet at the target A1C (and indeed even if you never reach target) it is important that you know that any reduction in your blood glucose (and, hence, your A1C) will substantially reduce your risk of diabetes damaging your body. But, if you don't keep a log book then you are not going to be able to recognize trends and patterns in your readings. Carbohydrate counting is essential if you are using an insulin pump and is often of major value if you are taking injections of rapid-acting (Humalog, NovoRapid, Apidra) before meals; especially if you have type 1 diabetes. Wouldn’t it be nice if they had the time and equipment to properly download all of our monitoring devices? Of course, it helps if the meter’s clock and calendar are set properly, so check these before doing a download.
This type of information is essential for getting to the root cause of out-of-range glucose levels. The glucose values before dinner are frequently below target, so it may be worth addressing carb-counting accuracy at lunchtime, midday insulin doses, or afternoon physical activity. A standard deviation that is more than 50% of the average indicates excessive variability in glucose levels; a value that is less than 33% of the average is highly desirable. Trend graphs are also useful for illustrating improvements (or worsening) in glucose control changes over prolonged periods of time. Once the cause of control deterioration is determined, strategies can be implemented to prevent a recurrence. Since it doesn't work properly on every browser and since many people are afraid of viruses, their browsers are not java-enabled.
In the 18th and 19th centuries the sweet taste of urine was used for diagnosis before chemical methods became available to detect sugars in the urine. The Zensorium Tinke is an iPhone Pulse Oximeter that provides blood oxygen level monitoring. The information helps you and your health care team easily and quickly spot trends, evaluate your progress, and modify your treatment plan. If you are already taking one of these insulins at bedtime then it may be that your dose needs to be adjusted. Except that recent medical studies suggest this doesn’t actually happen and that rebounding doesn’t even exist!
If you are able, try to have a straight shift (regardless whether this is days, nights, or something else).
So if your A1C was 10 and you get it down to 9 pat yourself on the back; you've just reduced your risk of eye and kidney damage by almost 40%! Speak to your diabetes educators (in particular, your dietitian) to see if this would be a helpful technique for you. And wouldn’t it be nice if they had the expertise to interpret the data in a way the led to practical solutions to our day-to-day blood sugar challenges? However, very few people who own advanced meters make full and consistent use of these features, so let’s focus on downloading blood glucose data only. Evaluate your readings as an independent third party, pretending they belong to someone else. Tests to measure glucose in the blood were developed over 100 years ago, and hyperglycemia subsequently became the sole criterion recommended for the diagnosis of diabetes. The Tinke is available for iOS devices but will also work with Android devices in the future.
The companion app, called reveal, shows the user’s information, including 14 day averages of readings. My strong expectation is that within the next few years we will have conclusive evidence for the non-existence of rebounding. If this is not possible, your blood glucose control can still be maintained but your insulin schedule may need to be overhauled.
It reveals the patterns and provides the clues as to what changes to make to your therapy, be they dietary, insulin or otherwise. More than 10% in a low range, or more than 25% above your target range, usually indicates a need to make adjustments. The companion app displays different heart metrics, including a Vita index computed from the user’s heart rate and other data. My preferred strategy for my patients with type 1 diabetes who perform shift work is for them to use an insulin pump or, failing that, using Lantus (or Levemir) insulin once daily (given at the one time of day they are always certain to be awake) and a rapid-acting insulin (Apidra, Humalog, or NovoRapid) before meals (whenever those meals happen to be for a particular shift). A log book is not meant to simply be a historical record and it is most definitely not a report card.
If your meter includes entries for items such as insulin doses, grams of carbohydrate and physical activity, the logbook report can provide insight for fine-tuning insulin-to-carb ratios and exercise adjustments. It is an interactive tool to assist you in deciding how much insulin to give every time you are due for an insulin injection.



Blood glucose and food journal
Normal glucose levels for 18 month old milestones
Blood sugar level 68 after eating


Comments

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