Have you ever noticed how many terms of endearment are based around the notion of “sweetness”? The findings were aired on 60 Minutes and revealed the overwhelming consensus that excessive sugar consumption is strongly linked to many age-related diseases.
Statistics show we now have a not-so-sweet epidemic on our hands: 79 million American adults have blood sugar levels that, while still in the normal range, are too high — and a warning sign for further problems.
Unfortunately, you may not even know you have this problem unless your doctor has tested your fasting blood glucose levels. Blood glucose levels (also called blood sugar levels) reflect how well diabetes is being managed and how well the plan of care (healthy eating, exercise, and medication) is working. The HbA1c test is a laboratory blood test that gives an indication of longer-term blood glucose control over the last 2-3 months.
Getting blood glucose and HbA1c levels down into the optimal ranges means working with your doctor or diabetes nurse on implementing a plan for healthy eating, weight control, getting active and exercising and, when prescribed, using medications that help to control the way your body uses glucose.
Below is a general range of HBA1c levels for people with diabetes  – please check with your doctor about what the expected range is for you.
May be appropriate and acceptable in many individuals but higher than ideal from clinical trial evidence. If you are on tablets for your diabetes, your doctor may ask you to test your blood glucose at home. A fasting blood glucose test measures blood glucose levels after you've gone without food for at least eight hours. Wash your hands thoroughly with soap and water, rinse thoroughly and dry completely before lancing the finger and applying the test strip end to the blood droplet. Testing strips for the blood sample should be stored correctly and not out of date (95% of all testing errors are related to the storage of strips). Keeping your meter and supplies with you at all times so that you always have them when you need them. Checking your blood glucose meter's accuracy when you visit your pharmacy or doctor by comparing your results with your HbA1c test results. A regular schedule, such as before and after one meal each day, helps you see how your blood glucose changes.
You may also want to vary the times you check your blood glucose to learn more about your numbers at other times of the day. Checking glucose levels shouldn't be viewed as an annoying task, but instead as a tool to figure out what the next step is in treating the diabetes. Knowing your blood glucose level helps you treat low or high blood glucose before it becomes an emergency. Remember to take the records of your glucose tests with you when you see your doctor or nurse so you can discuss them. Blood glucose – webmd, A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Blood sugar – angelfire, Most of the food we eat is broken down into glucose, the form of sugar in the blood. Way back in 1991, on a Sunday afternoon, a young Parsi lady from Mumbai who was holidaying in a nearby village came to me with sudden breathlessness at my nursing home at Vapi, 160 km north of Mumbai. Sugar is the generalized name for sweet, short-chain, soluble carbohydrates, many of which are used in food. An important goal in the treatment of diabetes is to achieve and maintain blood glucose levels as close to normal as possible. Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia).
Self-monitoring of blood glucose (SMBG) has been accepted as an important instrument that empowers people with diabetes to achieve and maintain therapeutic goals.
Glucose is a simple sugar which is a permanent and immediate primary source of energy to all of the cells in our body. The blood sugar concentration or blood glucose level is the amount of glucose (sugar) present in the blood of a human or animal. The figure below shows fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the course of a day with three meals. Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. DM is classified on the basis of the pathogenic process that leads to hyperglycemia, as opposed to earlier criteria such as age of onset or type of therapy. Type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production. Other etiologies for DM include specific genetic defects in insulin secretion or action, metabolic abnormalities that impair insulin secretion, mitochondrial abnormalities, and a host of conditions that impair glucose tolerance . This article is written on SMBG and not DM and therefore detailed discussion on DM is inappropriate. For diagnosis of DM, persistent hyperglycemia is must but occasionally you may have transient hyperglycemia without DM.
Although chronic hyperglycemia is an important etiologic factor leading to complications of DM, the mechanism(s) by which it leads to such diverse cellular and organ dysfunction is unknown. No matter how mild your diabetes may be, it is very unlikely that any physician can tell you how to normalize your blood sugars throughout the day without knowing what your blood glucose values are around the clock. Levels which are significantly above or below normal range are problematic and can in some cases be dangerous. Hypoglycemia is most commonly caused by drugs used to treat diabetes mellitus or by exposure to other drugs, including alcohol. Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. New wealth and development in the Middle East has already led to one in 10 adults having the disease. Diabetes causes 4.6 million deaths and costs over 465 billion US dollars in global healthcare expenditure every year. The incidence of both type 1 and type 2 diabetes mellitus is increasing; the former has been attributed to an increase in environmental factors, whereas the latter is strongly associated with increasing rates of obesity.
Diabetes mellitus is a condition characterized biochemically by increased blood glucose concentrations and associated with both small blood vessel complications in the eyes (retinopathy), kidneys (nephropathy), and peripheral nerves (neuropathy) and large blood vessel complications of the heart (causing heart attacks), head and neck (causing strokes), and legs (leading to gangrene and amputations). The Diabetes Control and Complications Trial (DCCT) was a major clinical study conducted from 1983 to 1993 and funded by the National Institute of Diabetes and Digestive and Kidney Diseases. When the DCCT ended in 1993, researchers continued to study more than 90 percent of participants.
Large, long-term, randomized controlled trials in both type 1 diabetes (T1DM) and T2DM have shown that ag­gressive treatment of hyperglycemia significantly reduces the development and progression of microvascular com­plications. Proper glycemic control, including self-monitoring of blood glucose (SMBG) is key to managing diabetes. Widespread use of the FPG or the A1c as a screening test for type 2 DM is recommended by experts because (1) a large number of individuals who meet the current criteria for DM are asymptomatic and unaware that they have the disorder, (2) epidemiologic studies suggest that type 2 DM may be present for up to a decade before diagnosis, (3) some individuals with type 2 DM have one or more diabetes-specific complications at the time of their diagnosis, and (4) treatment of type 2 DM may favorably alter the natural history of DM. I have seen many patients who have normal FPG but higher PPG and these patients ultimately develop frank type 2 DM.
Three of the major factors that influence glucose test results are the type of chemical analysis used for the test, the type of sample analyzed (whole blood verses plasma), and the source of the blood (venous, capillary, or arterial). Conversion of glucose concentrations determined in different sample systems by use of factors is an oversimplification and probably leads to unpredictable rates of discordant disease classifications. To prevent contamination of the sample with intravenous fluids, particular care should be given to drawing blood samples from the arm opposite the one in which an intravenous line is inserted. Excess water infused through routine IV drip would be excreted by kidneys and would not dilute blood glucose concentration. Home glucose monitoring has traditionally relied on a drop of capillary blood from the finger. When diagnosed with diabetes, your healthcare provider will have you begin checking your blood glucose levels at home with a glucose meter.
For a person with diabetes, checking glucose levels with a glucose monitor is a necessary daily task.
Diabetes, also known as diabetes mellitus, is the name of a group of diseases in which the body is unable to properly utilize blood sugar (glucose) for energy.
The end result: The body’s cells are deprived of their energy source and the blood sugar or glucose builds up in the blood.
Most adults will have their blood glucose tested as part of their annual visit with their healthcare provider. If your healthcare provider suspects you have diabetes because you have not achieved a normal blood glucose level, they will likely perform additional blood tests including a glycated hemoglobin or A1C which measures your average blood glucose level over the past 2 to 3 months and possibly an oral glucose tolerance test (OGTT) which measures how your body processes glucose by measuring your blood glucose level before and after ingesting a big glucose load. In addition to diabetes medications, there are other factors that may cause a drop in blood glucose level. Non-diabetes Medications: A variety of different non-diabetes medications can cause your blood glucose level to decrease.
Medical Conditions: Diseases that affect the liver such as hepatitis or liver damage from excessive alcohol consumption can cause lower blood glucose levels. Medications: Barbiturates (such as phenobarbitol), the antipsychotic olanzapine, corticosteroids, niacin (a form of vitamin B), thiazide diuretics (such as hydrochlorathiazide) some oral contraceptives, and cold medications containing phenylephrine or pseudoephedrine are examples of drugs that can raise your blood glucose level.
Medical Conditions: Stress of any sort, whether secondary to surgery, a traumatic injury, infection or emotion, can cause a release of hormones such as epinephrine and cortisol that raise blood glucose levels. Take Control!Download this expert FREE guide, Diabetes Symptoms and Treatments: How to lower blood sugar with a diabetic diet, medications, and lifestyle changes. This new report tells you how you can take command of your diabetes, simplify blood sugar management, and make the most of today’s breakthroughs in treatment. Subscribers will have unlimited access to the magazine that helps people live more sustainable, self-reliant lives, with feature stories on tending the garden, managing the homestead, raising healthy livestock and more! Subscribers will have unlimited access to the magazine that helps the small-scale poultry enthusiast raise healthy, happy, productive flocks for eggs, meat or fun - from the countryside to the urban homestead! Americans must start living a healthier lifestyle, including eating better diets and getting more exercise. David Brownstein has spent decades researching solutions to this high blood sugar epidemic, one he feels is now our country’s #1 health crisis. And if your levels were high but still in the clinically normal range, your doctor may not have told you about the potential health concerns. Another potential problem you should know about is that elevated blood sugar becomes much more common as you grow older. Learn the 7 Signs That Your Blood Sugar Is Out of Control. If the blood glucose levels are consistently under control (with levels near normal), diabetes complications may be reduced or even prevented. The test is used to diagnose diabetes and as a monitoring tool for those who have been diagnosed with diabetes.
Red blood cells have a lifespan of about 120 days and so the test gives a good indication of what the overall blood glucose levels have been throughout that time. Target ranges may vary according to age, or medical conditions or if you are taking medication. If you are prescribed insulin you will test your blood glucose levels up to several times a day. Your doctor and nurse will guide you on your personal target levels for glucose tests (SMBG) and HbA1c, and set them in partnership with you.
In the early morning hours, hormonal changes in our body may naturally cause blood glucose to rise. Think of monitoring as a compass: when you figure out what your glucose is at different times of the day and look at the patterns, it will be much easier to determine what direction to head in.
Do you sometimes miscalculate how much carbohydrate is in a particular food, and then find that your blood glucose is either too high or too low? It also helps you know how to exercise and how food affects your blood glucose, and how much insulin (if you take insulin) to take. That is why it is essential to train patients in how to effectively self-manage their diabetes, not only to improve their treatment but also to improve their quality of life.
In the fed state, the majority of circulating glucose comes from the diet; in the fasting state, gluconeogenesis and glycogenolysis maintain glucose concentrations. Glucose C6H12O6  is a carbohydrate whose most important function is to act as a source of energy for the human body, by being the essential precursor in the synthesis of ATP (adenosine triphosphate). After the glucose has been absorbed from the food eaten, it gets released in the bloodstream. The pancreas will continue to release insulin and liver and fat cells continue to use glucose till the drop of concentration of glucose is below a threshold; in that case, glucagon will be released instead of insulin. When glucagon reaches the liver cells, it initiates the conversion of glycogen into glucose, and fat into fatty acids, which many body cells can use as energy after the glucagon enables them to. The body naturally tightly regulates blood glucose levels as a part of metabolic homeostasis. Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
The spectrum from normal glucose tolerance to diabetes in type 1 DM, type 2 DM, other specific types of diabetes (type 3 DM), and gestational DM (type 4 DM) is shown from left to right.
First, the terms insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) are obsolete. Maturity-onset diabetes of the young (MODY) is a subtype of DM characterized by autosomal dominant inheritance, early onset of hyperglycemia (usually <25 years), and impairment in insulin secretion.
Insulin resistance is related to the metabolic changes of late pregnancy, and the increased insulin requirements may lead to IGT or diabetes. Stress hyperglycemia is a medical term referring to transient elevation of the blood glucose due to the stress of illness. The endothelial cells lining the blood vessels take in more glucose than normal, since they do not depend on insulin.
At least four prominent theories, which are not mutually exclusive, have been proposed to explain how hyperglycemia might lead to the chronic complications of DM. However, a number of other disorders, including critical organ failure, sepsis and inanition, hormone deficiencies, non–beta-cell tumors, insulinoma, and prior gastric surgery, may cause hypoglycemia.
Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Diabetes reduces the quality of life, can generate multi-system morbidities and premature death, and consequently increases healthcare costs. In 2010, statistics showed that over 25 million people in the United States, including children, have diabetes mellitus. In 2004, an estimated 3.4 million people died from consequences of high fasting blood sugar.
Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes. Alarmingly, during the past 10 years, type 2 diabetes has been diagnosed more frequently in patients younger than 44 years.
Diabetic retinopathy is the leading cause of blindness in industrialized countries in people between the ages of 20 and 74 years.
The study showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage caused by diabetes. The follow-up study, called Epidemiology of Diabetes Interventions and Complications (EDIC), is assessing the incidence and predictors of cardiovascular disease events such as heart attack, stroke, or needed heart surgery, as well as diabetic complications related to the eye, kidney, and nerves.
It has been shown that microvascular complications, such as neuropathy, nephropathy, and retinopathy, are reduced 40% for every percentage reduction in hemoglobin A1c values.
Historically, blood glucose values were given in terms of whole blood, but most laboratories now measure and report plasma or serum glucose levels.
These problems are becoming more relevant with the widespread use of point-of-care testing instruments, including blood gas analyzers with integrated glucose sensors that measure glucose in the plasma water fraction.
Alternatively, blood can be drawn from the same arm with an IV line after the IV has been turned off for at least 5 minutes, and the arm has been elevated to drain infused fluids away from the vein. If you divide it in three meals, breakfast, lunch and dinner equally, you eat approximately 300 to 430 Kcal of carbohydrate in each meal.
This allows you to see what a normal glucose level is—and how your blood glucose level changes with medication, food, and exercise. There are three primary forms of diabetes—type 1 diabetes, type 2 diabetes, and gestational diabetes—and, in each case, the body is unable to effectively move the glucose that results from the metabolism of the sugar and starches we eat into the cells of our muscles, brain, and other vital tissues. This is usually done after fasting overnight or for at least eight hours—hence its name: fasting blood glucose or FPG.
Hypoglycemia in someone with diabetes may be caused by too much insulin or other glucose-lowering medications.
Diseases that cause some hormone insufficiencies such as adrenal insufficiency and hypothyroidism can also result in hypoglycemia. All people with diabetes by definition have hyperglycemia in the absence of treatment, but they may experience episodes of hyperglycemia if they miss a dose of insulin or glucose-lowering medication or have taken an insufficient dose. Inflammation of the pancreas, called pancreatitis, can also cause elevated blood glucose levels. Your diabetes healthcare provider, however, will help you determine the best goals for you based on your age, other medical problems, and duration of your diabetes. Sanjay Gupta investigate this issue and interview some of America’s most respected scientists.
For people who don't have diabetes, the increase in blood glucose is offset by increased insulin production.


Log these observations and try to remember them so you'll have an easier time in the future. Simple sugars are called monosaccharides and include glucose (also known as dextrose), fructose and galactose.
The development in the late 1970s of methods to self-monitor blood glucose levels was an indispensable prerequisite for this. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood. On the other hand, determination of HbA1c is accepted as the gold standard for assessing glycemic control, but its limitations are not sufficiently appreciated.
Very little glucose is found in the diet as glucose; most is found in more complex carbohydrates that are broken down to monosaccharides though the digestive process. The energy stored in ATP can then be used to drive processes requiring energy, including biosynthesis, and locomotion or transportation of molecules across cell membranes. The cells will continue to burn fat from the adipose tissue as an energy source, and follow with the protein of the muscles, until the levels of glucose increase again by the digestion of food, and that terminates the cycle. This glucose gets absorbed by intestines and distributed to all of the cells in body through bloodstream and breaks it down for energy.
With some exceptions, glucose is the primary source of energy for the body’s cells, and blood lipids (in the form of fats and oils) are primarily a compact energy store.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production. In most types of DM, the individual traverses from normal glucose tolerance to impaired glucose tolerance to overt diabetes (these should be viewed not as abrupt categories but as a spectrum).
Both types of diabetes are preceded by a phase of abnormal glucose homeostasis as the pathogenic processes progress. Type 2 DM is preceded by a period of abnormal glucose homeostasis classified as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).
Since many individuals with type 2 DM eventually require insulin treatment for control of glycemia, the use of the term NIDDM generated considerable confusion.
Mutations in the insulin receptor cause a group of rare disorders characterized by severe insulin resistance. GDM occurs in 7% (range 2–10%) of pregnancies in the United States; most women revert to normal glucose tolerance postpartum but have a substantial risk (35–60%) of developing DM in the next 10–20 years.
Transient hyperglycemia occurs as a part of stress response in acute illnesses and is brought about by elevated levels of counter regulatory hormones. They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker. An emerging hypothesis is that hyperglycemia leads to epigenetic changes in the affected cells. Currently, in many countries, people with diabetes have a significantly decreased life expectancy. While the global average prevalence is around 10%, up to one third of populations in some Pacific Island countries have this condition. If you’ve been following the trend in diabetes, it will not surprise you to know diabetes continues to rise, unabated, around the world.
By 2020, in countries such as the US, Malaysia and Indonesia over 10% of the population will be diabetic and there will be over 300m diabetics worldwide.
In this context, physicians face a dual challenge: not only are there more patients with diabetes, but also the disease is being increasingly diagnosed in younger patients who will require lifelong management. In fact, it demonstrated that any sustained lowering of blood glucose, also called blood sugar, helps, even if the person has a history of poor control. The EDIC study is also examining the impact of intensive control versus standard control on quality of life. However, in a systematic review with meta-analysis including 6 randomized controlled trials involving 27,654 patients, tight blood glucose control reduces the risk for some macrovascular and microvascular events, without effect on all-cause mortality and cardiovascular mortality. Furthermore, a survey of 1,895 diabetic patients suggested that decreased blood glucose monitoring compliance was observed in patients who had more than two hospitalizations in a 2-year period.
In contrast to type 2 DM, a long asymptomatic period of hyperglycemia is rare prior to the diagnosis of type 1 DM.
A large drop of blood (approximately 50–100 ?L) was applied to the reagent pad, and after one minute the surface blood was gently washed away and the pad colour visually assessed against a colour chart to give a semiquantitative blood glucose value. Test times vary from 5 seconds to 2 minutes (modern meters typically provide results in 5 seconds).
Intracellular water (intracellular fluid-ICF) makes up about two- thirds of total body water, with remaining one-third, the extracellular water (extracellular fluid- ECF) being distributed between intravascular (25 %) and interstitial (75 %) compartment. It is only after meals, when glucose uptake in the periphery is rapid, that glucose levels in fingerstick capillary blood samples can exceed those in concurrently drawn venous samples. Symptoms of hypoglycemia include shakiness, dizziness, weakness, fatigue, and blurred vision. Symptoms of hyperglycemia are the classic symptoms of diabetes such as increased thirst and frequent urination. Patient and her relatives flatly denied any history of diabetes and told me that she was investigated in Mumbai for weakness recently and there is no diabetes.
Only through regular self-monitoring of blood glucose levels (SMBG) it has become possible to coordinate drug therapy as well as food intake and exercise so that a good metabolic control can be achieved.
Patients with normal or near-normal HbA1c levels may still display postprandial hyperglycemia, putting them at risk for long-term adverse outcomes.
About half of the total carbohydrates in the diet are in the form of polysaccharides and the remainder as simpler sugars. According to cellular requirements, glucose can also be used in the creation of proteins, glycogen, and lipids. Insulin enables the muscle cells to take glucose as their source of energy and to form a type of molecule called glycogen that works as secondary energy storage in the case of low levels of glucose.
Body tries to maintain a constant supply of glucose for your cells by maintaining a constant blood glucose concentration. Glucose is transported from the intestines or liver to body cells via the bloodstream, and is made available for cell absorption via the hormone insulin, produced by the body primarily in the pancreas.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system. Arrows indicate that changes in glucose tolerance may be bidirectional in some types of diabetes.
DM can result from pancreatic exocrine disease when the majority of pancreatic islets are destroyed. One theory is that increased intracellular glucose leads to the formation of advanced glycosylation end products (AGEs), which bind to a cell surface receptor, via the nonenzymatic glycosylation of intra- and extracellular proteins. A table of blood sugar levels, with associated events (meals, exercise, and so on), measured at least 4 times daily over a number of days, is the key element in what is called a blood glucose profile. A patient who is hyperglycemic (high blood glucose) can also become temporarily hypoglycemic, under certain conditions (e.g.
Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. Type 2 diabetes, which many consider an epidemic currently, is increasing worldwide predominantly due to poor diet, sedentary lifestyle and the fact that we are living longer.
Diabetes imposes unacceptably high human, social and economic costs on countries at all income levels.
Up to 5% of GDP and over 25% of many public healthcare budgets globally will be typically being spent on dealing with the consequences of diabetes.
Adding to this burden is the increasing complexity of caring for patients with type 1 diabetes and the expanding armamentarium of medications for patients with type 2 diabetes. Diabetic neuropathy underlies most cases of lower extremity amputations, much more so than the large vessel complication in the legs. The DCCT involved 1,441 volunteers, ages 13 to 39, with type 1 diabetes and 29 medical centers in the United States and Canada.
Recent RCTs have not shown a benefit of tight glucose control on macrovascular disease in people with T2DM of long duration and high cardiovascular risk.
Yet, despite current evidence of the importance of daily SMBG, many patients who have diabetes do not regularly check their blood glucose at home. A number of immunologic markers for type 1 DM are becoming available, but their routine use is discouraged pending the identification of clinically beneficial interventions for individuals at high risk for developing type 1 DM. However, the colours were difficult to visualise as the colour blocks were affected by ambient lighting conditions, and variation in individual visual acuity made it difficult to obtain accurate and precise readings.
The experimental data clearly indicate that the use of plasma should be preferred to diagnose glucose intolerance, including diabetes. The pores between endothelial cells in capillary allow free movement of water and solutes but do not allow proteins to pass through. In other words, every meal generates minimum 37 to 53 gm of glucose to be assimilated in body.
Levels are higher in the arterial blood because some of the glucose diffuses from the plasma to interstitial fluid (IF) as blood circulates through the capillary system. If you have diabetes and are experiencing hypoglycemia, most healthcare providers will recommend you consume 15-20 grams of simple carbohydrates immediately. Furthermore, it has become easier to identify asymptomatic hypo- and hyperglycemias and blood glucose fluctuations.
Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications.
In addition, frequent unrecognized hypoglycemia may lead to falsely low HbA1c levels, and HbA1c does not allow any estimate of glycemic variability.
About two-thirds of the sugar in the diet is sucrose, which is a disaccharide of glucose and fructose.
For example, individuals with type 2 DM may return to the impaired glucose tolerance category with weight loss; in gestational DM, diabetes may revert to impaired glucose tolerance or even normal glucose tolerance after delivery. Although type 1 DM most commonly develops before the age of 30, an autoimmune beta cell destructive process can develop at any age.
The risk of chronic complications increases as a function of the duration and degree of hyperglycemia; they usually do not become apparent until the second decade of hyperglycemia. Nonenzymatic glycosylation results from the interaction of glucose with amino groups on proteins. This profile gives you and your physician or diabetes educator a glimpse of how your medication, lifestyle, and diet converge, and how they affect your blood sugars. In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method). Already, diabetes extracts a high cost in health care dollars, economies’ financial stability, lost productivity, and it destroys lives and families. The research, published by the American Heart Association’s journal Circulation, found that eating fast food two or more times a week increases the risk of developing Type 2 diabetes by 27 percent. In Africa, three quarters of diabetes deaths are in people under 60 years old, handicapping Africa’s ability for development.
The chronic hyperglycemia of diabetes is associated with both micro- and macrovascular complications, which result in significant increases in morbidity and mortality.
There is overwhelming evidence that keeping blood glucose near normal will have a marked beneficial effect of limiting (and possibly preventing) the small vessel complications.
In the earlier studies, the benefits of tight control on macrovascular outcomes were seen only many years after the initial trial had ended and when levels of glycemic control in the intervention and control arms had converged. For example, up to 67% of patients do not check their blood glucose regularly for reasons such as sore fingers, inconvenience, and the fear of needles.
Although the Dextrostix was designed for use in doctors’ offices, the concept of diabetic patients undertaking the measurements had not been considered. Under usual circumstances, the concentration of glucose in whole blood is about 15% lower than in plasma or serum, but the difference will be less in patients with low hematocrits.
Arterial blood glucose and capillary blood glucose have been shown to be almost identical in concentration, even though the distribution of the glucose to the systemic capillaries does not occur instantaneously. Examples of foods that provide this include 1 tablespoon of honey or sugar, 4 ounces of juice, or 2 tablespoons of raisins. One such emergency is diabetic ketoacidosis which is a life-threatening condition in which the body, in the absence of insulin, breaks down fat for energy and releases waste products called ketones that build up in the blood causing dangerous metabolic changes. When a blood sample is taken by the doctor or nurse, it is taken from a vein and called a venous sample.
In the physiological context, the term sugar is a misnomer because it refers to glucose, yet other sugars besides glucose are always present. Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). Determination of immediate blood glucose control is best assessed by SMBG because this provides timely information of hyperglycemia and hypoglycemia.
Glucose is classified as a monosaccharide because it cannot be broken down further by hydrolysis. Human body has two hormones released by pancreas that have opposite effects: insulin and glucagon.
In the fat cells of the adipose tissue, insulin also promotes the conversion of glucose into more fat and the uptake of glucose.
The fasting plasma glucose (FPG), the 2-h plasma glucose (PG) after a glucose challenge, and the A1c for the different categories of glucose tolerance are shown at the lower part of the figure. It is estimated that between 5 and 10% of individuals who develop DM after age 30 years have type 1 DM.
Since type 2 DM often has a long asymptomatic period of hyperglycemia, many individuals with type 2 DM have complications at the time of diagnosis. Without this information, it is impossible to come up with a treatment plan that will normalize blood sugars. Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode.
Measurement of glycated hemoglobin is the standard method for assessing long-term glycemic control. At this rate, the number of people diagnosed with diabetes in the world is expected to increase by 114% from the year 2000 to 2030. In 2013, the world spent $548 billion (US) on diabetes health care — 11 percent of the total spent for health care worldwide.
Improving glycemic control in diabetic patients has been shown to reduce these complications. Although one recent article showed that lowering blood glucose concentrations in type 1 diabetic patients had a beneficial effect on coronary artery disease (CAD) many years later, five previous articles in type 2 diabetic patients did not.
This so called ‘metabolic memory’ or ‘legacy effect’ suggests that, while the short-term benefits of tight glycemic control for macrovascular disease have not been shown in RCTs, the longer-term benefits may be substantive particu­larly when good HbA1c levels are achieved and maintained early in the course of the disease. Around the same time, the German company Boehringer Mannheim developed a competitive blood glucose strip, the Chemstrip bG.
Collection of blood in clot tubes for serum chemistry analysis permits the metabolism of glucose in the sample by blood cells until separated by centrifugation. Chan showed that delays in processing blood specimens in hospital practice may lead to misclassification in up to 7% of GTTs. Since his blood sugar is far higher than renal threshold, he would have massive renal glycosuria with osmotic diuresis and polyuria.
The finger-prick blood sampling is to collect blood in peripheral capillaries and the blood glucose concentration approximates to the level of arterial blood glucose (Rasaiah, 1985). Severe hypoglycemia may cause unconsciousness or seizures and should be treated with injectable glucagon, a hormone that stimulates the liver to release glucose.
This might include diet adjustments, exercise, and insulin (as instructed by the health care provider). Thus, SMBG is a prerequisite for implementing strategies to optimally treat, as well as to avoid, out-of-range glucose values.
It is further classified as a hexose because of its six-carbon skeleton and as an aldose, because of the presence of an aldehyde group on carbon 1. Insulin is produced by beta cells of the pancreas while glucagon is produced by alpha cells. A persistently high level is referred to as hyperglycemia; low levels are referred to as hypoglycemia. Despite widely variable intervals between meals or the occasional consumption of meals with a substantial carbohydrate load, human blood glucose levels tend to remain within the normal range. Although type 2 DM more typically develops with increasing age, it is now being diagnosed more frequently in children and young adults, particularly in obese adolescents. Thus, DM is often a feature of endocrinopathies such as acromegaly and Cushing’s disease. In some people, stress hyperglycemia may indicate a reduced insulin secretory capacity or a reduced sensitivity, and is sometimes the first clue to incipient diabetes.
The microvascular complications of both type 1 and type 2 DM result from chronic hyperglycemia.
The serum level of AGEs correlates with the level of glycemia, and these products accumulate as the glomerular filtration rate (GFR) declines. If your treatment includes insulin injections before each meal, your diabetes is probably severe enough to render it impossible for your body to automatically correct small deviations from a target blood glucose range. It should be considered in any patient with episodes of confusion, an altered level of consciousness, or a seizure.


When plasma glucose is consistently elevated, there is an increase in nonenzymatic glycation of hemoglobin; this alteration reflects the glycemic history over the previous 2–3 months, since erythrocytes have an average life span of 120 days (glycemic level in the preceding month contributes about 50% to the A1C value). As a result, effective diabetes management will continue to be an important consideration for patients and is key to reducing the risk of complications such as heart disease, blindness, renal disease, and unnecessary amputations.
The main goal of treatment is to keep blood sugar levels in the normal or near-normal range. The study compared the effects of standard control of blood glucose versus intensive control on the complications of diabetes. The longer-term findings suggest that greater benefits (clinical and economic) are obtained when simultaneous control of glycemia, blood pressure and lipid levels has been achieved. In addition to the difficulties posed by SMBG, maintaining proper glycemic control can be a challenge, especially for patients who are on insulin therapy. This was easier to use because the drop of blood was wiped off using a cotton wool ball, and, as it had a dual colour pad (one beige, the other blue), it was easier to visualise the colour.
Despite few differences between fasting capillary blood glucose and fasting venous blood glucose, postprandial venous blood glucose is lower than postprandial capillary blood glucose by 7 % because glucose absorbed by the human tissues and remaining glucose returns to veins. I believed the story of relatives, ignored my gut feeling of diabetes, did ECG and X-ray chest which were normal, gave some primary care and sent patient back to Mumbai in their car.
Healthcare professionals must be capable of making evidence-based clinical decisions in regard to the use of SMBG and balance issues, such as patient abilities, costs, and clinical outcomes. The aldehyde group condenses with a hydroxyl group so that glucose exists as a hemiacetal ring structure. The release of insulin is triggered when high levels of glucose are found in the bloodstream, and glucagon is released with low levels of glucose in the blood. 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. Viral infections have been implicated in pancreatic islet destruction but are an extremely rare cause of DM. Because of this, it is occasionally appropriate to perform diabetes screening tests after recovery from an illness in which significant stress hyperglycemia occurred.  Even fear of needles or pain during blood collection may provoke transient hyperglycemia. Large, randomized clinical trials of individuals with type 1 or type 2 DM have conclusively demonstrated that a reduction in chronic hyperglycemia prevents or delays retinopathy, neuropathy, and nephropathy.
A second theory is based on the observation that hyperglycemia increases glucose metabolism via the sorbitol pathway. To achieve blood sugar normalization, it therefore may be necessary for you to record blood glucose profiles every day for the rest of your life, so that you can fine tune any out of range values. One study found that hospital admissions for diabetic hypoglycemia increased by 50% from 1990-1993 to 1997-2000, as strict blood sugar control efforts became more common. In patients achieving their glycemic goal, the ADA recommends measurement of the A1C at least twice per year. Checking one’s blood sugar is one of the best ways to know how well the diabetes treatment plan is working. Intensive control meant keeping hemoglobin A1C levels as close as possible to the normal value of 6 percent or less. Diabetes is a significant and growing worldwide concern with potentially devastating consequences. Patients who use short-acting insulin to help control blood glucose during a meal must constantly estimate their insulin doses by counting the carbohydrate content of the meal. The visually monitored blood glucose test strips, Dextrostix (Ames) and Chemstrip bG (Boehringer Mannheim), were widely used in clinics, surgeries and hospital wards, notably intensive care units, for adults and neonates. Higher than normal amounts of white or red blood cell counts can lead to excessive glycolysis in the sample, with substantial reduction of glucose level if the sample is not processed quickly.
This 52 mg glucose is distributed in 13.8 liter of extracellular water in a 70 kg man (blood water plus interstitial water).
Accordingly, the level of arterial blood glucose or postprandial capillary blood glucose is higher than that of postprandial venous blood glucose. She got admitted in Mumbai same night and they repeated the same story of not having diabetes. This yields either serum or plasma (depending on whether or not the blood sample in the tube is treated with a special reagent called an anticoagulant). As a base of diabetes treatment, blood glucose monitoring contributes to clinically determining the level of carbohydrate metabolism, formulating therapeutic measures, evaluating effects, and realizing optimal blood glucose control. Intake of alcohol causes an initial surge in blood sugar, and later tends to cause levels to fall.
A form of acute onset of type 1 diabetes, termed fulminant diabetes, has been noted in Japan and may be related to viral infection of islets.
Intracellular glucose is predominantly metabolized by phosphorylation and subsequent glycolysis, but when increased, some glucose is converted to sorbitol by the enzyme aldose reductase.
If you are not treated with insulin, or if you have a very mild form of insulin treated diabetes, it may only be necessary to prepare blood glucose profiles when needed for readjustment of your diet or medication. More frequent testing (every 3 months) is warranted when glycemic control is inadequate or when therapy has changed. The A1C blood test reflects a person’s average blood glucose over the last 2 to 3 months.
Numerous studies have demonstrated that optimal management of glycemia and other cardiovascular risk factors can reduce the risk of development and progression of both microvascular and macrovascular complications. Since most of us do not eat the same meal every day for breakfast, lunch, and dinner, counting carbohydrates can become a cumbersome process. However, colours were prone to fade and it was realised that there were highly significant visual variations in the assessment of colours across the range of glucose concentrations using Dextrostix. The use of capillary hemolysate together with a reduced decision limit thus may be a second choice for the detection of diabetes. Intensive blood glucose monitoring and strict blood glucose control significantly eliminate or postpone occurrence or development of chronic diabetic complications.
For example, despite long-standing DM, some individuals never develop nephropathy or retinopathy.
Increased sorbitol concentration alters redox potential, increases cellular osmolality, generates reactive oxygen species, and likely leads to other types of cellular dysfunction. Typically, this might be for one to two weeks prior to every routine follow up visit to your physician, and for a few weeks while your treatment plan is being fine tuned for the first time. In children and adolescents following intensive blood sugar control, 21% of hypoglycemic episodes occurred without explanation. The degree of glycation of other proteins, such as albumin, can be used as an alternative indicator of glycemic control when the A1C is inaccurate (hemolytic anemia, hemoglobinopathies). Furthermore, improperly estimating an insulin dose can potentially result in undertreatment or overtreatment, which may have grave consequences.
These limitations became the trigger to develop an automatic, electronic glucose test strip reader to improve precision and give more quantitative blood glucose results.
At refrigerator temperatures, glucose remains relatively stable for several hours in a blood sample. In other words, maximum urine glucose loss in uncontrolled diabetes is 40 to 60 gm glucose in 24 hours. When a home blood glucose test is performed, blood is usually taken from a finger-prick sample which gives capillary whole blood glucose. It is important to monitor accurate blood glucose concentrations which may obviously fluctuate from time to time due to various factors such as daily activity, mental status, diet component, environmental change. The strong reducing properties of glucose made it relatively easy to measure and thus the clinical estimation of circulating glucose was one of the earliest tests available to the clinician.
Part of the reason why this amount is so small is that, to maintain an influx of glucose into cells, enzymes modify glucose by adding phosphate or other groups to it. The fact that 40% of diabetics who carefully control their blood sugar nevertheless develop neuropathy, and that some of those with good blood sugar control still develop nephropathy, requires explanation. However, testing of this theory in humans, using aldose reductase inhibitors, has not demonstrated significant beneficial effects on clinical endpoints of retinopathy, neuropathy, or nephropathy. After all, your physician or diabetes educator cannot tell if a new regimen is working properly without seeing your blood glucose profiles. In addition to the deaths caused by diabetic hypoglycemia, periods of severe low blood sugar can also cause permanent brain damage.
The fructosamine assay (measuring glycated albumin) reflects the glycemic status over the prior 2 weeks. Based on discharge data of Californian hospitals, hypoglycemia was found to be responsible for approximately 1.7% of hospitalized diabetic patients.
So approximately 6 % of blood glucose is lost in urine and 94 % of filtered glucose is still reabsorbed in uncontrolled diabetes. If I had glucometer available, I could have clinched diagnosis, could have given insulin and saved her life. Now there is a move towards all glucometers giving plasma-calibrated results so that readings made at home and at the laboratory can be more easily compared. Blood glucose monitoring is also a necessary method adopted by many food nutrition experts to investigate the carbohydrate-induced glycemic reaction in addition to its clinic applications to diabetes patients. The recent introduction of microglucose oxidase technology has now made it possible for the patient to measure his or her own blood glucose concentration and undoubtedly makes the estimation of blood glucose the most widely used test of blood chemistry. Many of these patients have glycemic control that is indistinguishable from those who develop microvascular complications, suggesting that there is a genetic susceptibility for developing particular complications. A third theory proposes that hyperglycemia increases the formation of diacylglycerol leading to activation of protein kinase C (PKC). It is wise, however, that you also do a blood glucose profile for 1 day at least every other week, so you will be assured that things are continuing as planned. Interestingly, although diabetic nerve disease is usually associated with hyperglycemia, hypoglycemia as well can initiate or worsen neuropathy in diabetics intensively struggling to reduce their hyperglycemia. Alternative assays of glycemic control should not be routinely used since studies demonstrating that it accurately predicts the complications of DM are lacking. In today’s society, even with better understanding of the importance of glycemic control, only 41% of people with diabetes have the ability to calculate an insulin dose based on carbohydrate intake and blood glucose levels.
The first description of a biosensor, an amperometric enzyme method for glucose measurement, was made by Clarke and Lyons in 1962. However, these should only be used when blood will be transported from one hospital laboratory to another for glucose measurement.
The corollary is that if you have collected blood from the arm opposite the one in which an intravenous line is inserted, and if you are getting high glucose level, do not blame IV drip but patient may be diabetic.
The familial clustering of the degree and type of diabetic complications indicates that genetics may also play a role in causing complications such as diabetic retinopathy and nephropathy. Among other actions, PKC alters the transcription of genes for fibronectin, type IV collagen, contractile proteins, and extracellular matrix proteins in endothelial cells and neurons. Controlling blood sugar with fast-acting insulin is difficult because it poses the risk of hypoglycemia or hyperglycemia if insulin is not administered in a correct manner. This concept was incorporated in the measurement of blood glucose in the Yellow Spring 24AM ‘desktop’ analyser, which became commercially available in the mid-1970s. Red-top serum separator tubes also preserve glucose in samples after being centrifuged isolating the serum from cells.
Non-diabetic offspring of type 2 diabetics have been found to have increased arterial stiffness and neuropathy despite normal blood glucose levels, and elevated enzyme levels associated with diabetic renal disease have been found in non-diabetic first-degree relatives of diabetics.
The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continue to rise after 2-3 tests. It is difficult to estimate the amount of insulin required with varying portion sizes and fluctuating sugar levels throughout the day.
If you have so far been using a blood glucose monitoring system calibrated for whole blood and are now switching to one calibrated for plasma or vice versa, you may need new target values. Indian physicians around 3500 years ago identified diabetes and classified it as madhumeha or honey urine noting that the urine would attract ants.
Evidence implicating a causative role for chronic hyperglycemia in the development of macrovascular complications is less conclusive. A fourth theory proposes that hyperglycemia increases the flux through the hexosamine pathway, which generates fructose-6-phosphate, a substrate for O-linked glycosylation and proteoglycan production. High blood sugar levels are known as hyperglycemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. In addition, one survey of type 2 diabetics found that they rated the harm to their quality of life from intensive interventions to control their blood sugar to be just as severe as the harm resulting from intermediate levels of diabetic complications. You will have to re-adjust though when interpreting the results: since glucose concentration in plasma is approx. 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. However, coronary heart disease events and mortality rate are two to four times greater in patients with type 2 DM. The hexosamine pathway may alter function by glycosylation of proteins such as endothelial nitric oxide synthase or by changes in gene expression of transforming growth factor  (TGF-) or plasminogen activator inhibitor-1 (PAI-1).
The strip contained glucose oxidase and an electron transfer mediator, ferrocene, which replaced oxygen in the original glucose oxidase reaction; the reduced mediator was reoxidised at the electrode to generate a current detected by an amperometric sensor. 10-15 per cent higher than in whole blood, the levels indicated by meters with plasma-calibrated test strips are approx.
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.
These events correlate with fasting and postprandial plasma glucose levels as well as with the A1c.
Growth factors appear to play an important role in some DM-related complications, and their production is increased by most of these proposed pathways. Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications in those susceptible and sometimes even death. The meter was available in two highly original forms, a slim pen or a thin card the size of a credit card.
Self-monitoring of blood glucose (SMBG) was described as one of the most important advancements in diabetes management since the invention of insulin in 1920. Other factors (dyslipidemia and hypertension) also play important roles in macrovascular complications. Vascular endothelial growth factor A (VEGF-A) is increased locally in diabetic proliferative retinopathy and decreases after laser photocoagulation.
Evaluation reports showed that accuracy, precision and error grid analysis were satisfactory.
All the manufacturers will probably switch to plasma in future and in many European countries it has already taken place. Since approximately 1980, a primary goal of the management of type 1 and type 2 diabetes mellitus has been achieving closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by SMBG several times a day. TGF- is increased in diabetic nephropathy and stimulates basement membrane production of collagen and fibronectin by mesangial cells. Diabetics are therefore recommended to check their blood sugar levels either daily or every few days. The use of electrode technology thus heralded what became designated the third-generation BGMS. Diabetics will find the information about how their meter has been calibrated on the leaflet accompanying the test strips or also in the operating instructions for the meter. The benefits include a reduction in the occurrence rate and severity of long-term complications from hyperglycemia as well as a reduction in the short-term, potentially life-threatening complications of hypoglycemia.
Other growth factors, such as platelet-derived growth factor, epidermal growth factor, insulin-like growth factor I, growth hormone, basic fibroblast growth factor, and even insulin, have been suggested to play a role in DM-related complications. There is also diabetes management software available from blood testing manufacturers which can display results and trends over time.
In 1987, with the increased use of SMBG systems, the American Diabetic Association (ADA) lowered the preferred glucose meter deviation compared to laboratory reference methods to 15%. Unlike some other diseases that rely primarily on professional medical treatment, diabetes treatment requires active participation by the person who has it. A possible unifying mechanism is that hyperglycemia leads to increased production of reactive oxygen species or superoxide in the mitochondria; these compounds may activate all four of the pathways described above.
Monitoring your blood glucose level on a regular basis and analyzing the results is believed by many to be a crucial part of the treatment equation.
Although hyperglycemia serves as the initial trigger for complications of diabetes, it is still unknown whether the same pathophysiologic processes are operative in all complications or whether some pathways predominate in certain organs.
A history of blood sugar level results is especially useful for the diabetic to present to their doctor or physician in the monitoring and control of the disease. Worldwide, the glucose monitoring devices market is expected to be more than $16 billion by the end of this year.
Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly.
Additionally, tight glucose control decreased the risk of progression of retinopathy and nephropathy, and decreased the incidence peripheral neuropathy, but increased the risk of hypoglycemia 2.4 times.
World Diabetes Day is celebrated every year on November 14 and this article will promote awareness about diabetes via SMBG.



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Comments

  1. 05.10.2015 at 23:38:10


    Can be transformed into a special type of sugar sugar may go too high eating.

    Author: gizli_sevgi
  2. 05.10.2015 at 22:11:53


    Minutes to make sure it's after fasting must range between 110-126 treat.

    Author: Fitness_Modell