This section is for everyone. It is somewhat more applicable to type one diabetics but type twos need to know some of this too.
Normal blood sugars for fit young non diabetics are 4.7 on waking and prior to meals and bedtime provided no snacks have been eaten. Two hours after a meal such a persons blood sugar will be down to five or six. Blood sugars should not normally go below 4.0 even if a person has not eaten or has been exercising. A healthy young person can expect to have a hbaic of less than 5.0 although the range given in laboratories takes the not so fit into consideration and often gives an upper limit of normal as 6.0.
What we are trying to achieve with type one and type two diabetes is a replication of normal blood sugar patterns as much of the time as is achievable for you.
In the non diabetic person the pancreas secretes a small amount of insulin all the time. This small amount stops the liver from converting body proteins such as the muscles and vital organs such as the heart into sugar. This is called basal insulin. About the only time this is switched off completely is during very vigorous exercise.
When a meal is eaten an immediate surge of stored insulin enters the blood stream and tells the cells to grab hold of any glucose molecules that are circulating. This is called a first phase insulin response.
As eating continues the pancreas makes as much insulin as it needs to keep the blood sugar normal and it makes this insulin to order as it goes along. This is called the phase two insulin response.
There have been some advances recently in drugs and transplants that will help diabetics of both types one and two get better control or even cure the disease. Meanwhile, unless you are a mouse with a very good health insurance policy, you are best to take charge of your diet and glucose monitoring. Lower carbohydrate diets particularly can help you keep damage from high or swinging bood sugars minimal.
What you want to get from a tight food plan and monitoring schedule
- Normal blood sugar levels - or as near as you can get.
- Improvements in hbaic, lipids and kidney tests.
- Achieve a suitable weight for you.
- Reverse at least some diabetic complications
- Reduce the frequency and severity of low blood sugars.
- Relief from mild neurological problems associated with high blood sugars such as chronic fatigue and short term memory impairment.
- Blood pressure reduction.
- Reduced demand on pancreatic beta cells - this is important for type 2s and type ones in honeymoon or earlier in the disease process.
- Increased strength, stamina and sense of well being.
- Sleep better.
- Have fewer infections.
- Have healthier skin.
When do I test my blood sugars?
In order to find out how well your body is dealing with your diet and any medication you are taking blood sugars need to be taken:
- On waking
- Immediately before breakfast
- Before each meal
- Two hours after each meal
- At bedtime
When you are testing out new foods to see how they affect you testing every half hour or alternately at one hour after eating, two hours after eating and three hours after eating. This gives you a good idea of what types and dosages of insulin may be needed to cover that food successfully. See the "Eat to Meter" section in the type two diabetes section of this course for more information on this.
You also need to check blood sugars before, during and after exercising till you know how that particular sport, duration and intensity of exercise affects you.
Shopping and running errands can drop your blood sugar so have your meter and glucose handy.
It is extremely important to check your sugars before you drive and after every hour of driving.
Intense brain work such as sitting an exam can use up glucose but adrenaline can also raise it. Better check before the exam when you can correct a little or eat something.
Whenever you are hungry or suspect your blood sugars are running higher or lower than expected you should check.
It is useful to teach a toddler a nursery rhyme or song and get them to repeat it often. If you suspect a low blood sugar get them to repeat the song. If they get muddled up they may well have a low blood sugar. Test to check this system works for you a few times and if it is reliable for you you may omit the fingerstick.
If your vision for small print starts to go this can be a sign of low blood sugars so check.
For new college students or those in new or different jobs from usual increased walking to different places and different work schedules can put your sugars way out. You need to check your blood sugars more frequently than usual if your work pattern changes.
Shift work is a whole big problem area for diabetics. Your patterns will change with each type of shift and the transition periods will be particularly difficult as lack of sleep can seriously affect blood sugars too.
Women's blood sugar patterns shift a lot in relation to their menstrual cycle, some hormonal methods of contraception and of course in pregnancy. You will need to check more frequently during these periods.
If you drink alcohol always eat along with it and be moderate. Alcohol can cause low blood sugars but sugary mixes can raise your blood sugar. You must again test more frequently and of course before you go to sleep no matter how late or early you get in.
Tell people you see regularly that you can get quite crabbit with high and low blood sugars and ask them not to take it personally. Make a deal to check your blood sugar if they ask you to.
Finger prick testing is more accurate than arms pricks if your blood sugar is falling rapidly or if you are very low. If you think you are low test the finger tips or base of the thumb. If you think you are high test wherever you fancy.
How to I monitor my blood sugars in hospital?
Apart from times that your are under an anaesthetic or extremely unwell the person who should take responsibility for your blood sugar monitoring in hospital is YOU.
You must bring in all your kit and continue to look after yourself as if you were at home.
You must have your kit by your bedside or with you if you go off on a hospital trolley for any tests and do not allow it to be disposed of or hidden by the nursing staff.
To reduce the number of finger pricks you need get the nurses to check your figures against theirs. As long as the first few are reasonably similar they should give their agreement to accept your figures.
It is NOT SAFE to assume that the medical or nursing staff know more about your diabetes than you. Given the wide range of medications, insulins and delivery devices it is indeed unfair to expect them to know better than you do.
For insulin dependants it is very important indeed that you administer your own insulin if you are at all able to do this. There have been deaths from staff making mistakes with this.
For people on insulin that should be administered prior to food it may be best to wait till the trolley arrives on the ward or at your bedside before you inject. You may not get it delivered at the time you are expecting and you may also have to count the carbs and estimate the protein before injecting. You may need the food to be kept warm for you to get the optimal time for eating or for allowing a high blood sugar to drop if you need to.
What laboratory test may I need to have regularly?
Thyroid function tests
Type one diabetics are prone to the development of other autoimmune diseases so this test should be done every so often and particularly if you begin to feel particularly cold, tired, you gain weight unexpectedly, you have more hypos than usual or your cholesterol suddenly rockets.
Lipids and Liver Tests
All diabetics in the UK over the age of 40 are routinely put on drugs called statins whether they have a raised lipid level or not. Recent guidance is that this should be extended to all type ones over 18 who have one or more complications from their diabetes.
Statins work because they reduce inflammation in the lining of blood vessels and reduce atheroma and clot formation which damage blood vessels and blood supply. Statins can upset liver function and creatine kinase so these are tested routinely.
It is accepted by most doctors that there is a benefit in taking statins for people with diabetes and those with ischaemic heart disease. The problem is that a group benefit may not transfer into a personal benefit for YOU. One in 20 people get liver enzyme rises, muscle pain or general malaise and need to stop statins. They are dangerous to take if a woman is pregnant or at risk of becoming pregnant so women in their childbearing years need to think very carefully about them.
The albumin-creatinine ratio is as test that can detect early signs of kidney damage. If this or microalbumen tests in the urine are positive you may be asked for 24 hour samples and blood tests to clarify the extent of any problem.
The estimated glomerular filtration rate or eGFR is a new blood test done at the same time as the Urea and Electrolyte test. It gives an idea of what stage of kidney impairment may be going on.
ACE inhibitors or ARBs are new drugs that can reduce the rate of kidney deterioration. They end in "pril" or "sartan" respectively. They are also effective in reducing high blood pressure. If you start them for the first time you need a blood test after two weeks to see that they are not worsening kidney function. This can happen in some people who have a condition called renal artery stenosis which is hard to detect otherwise.
Coeliac Disease Tests
Coeliac disease is an autoimmune disease of gluten sensitivity. It can occur at any age. The symptoms can be very vague and it can take a very long time to develop the raised enzyme tests of endomysial antibody and tissue transglutamase and obvious anaemia. Tiredness and abdominal pains are probably the main symptoms. An easy and less expensive test to do is the ferritin level in the blood. This is the amount of stored iron and low levels occur frequently in coeliac disease.
The C reactive protein test is a non specific tests that indicates inflammation. It is often raised in metabolic syndrome and type 2 diabetes.
In the absence of any inflammatory condition or infection you could have high levels of this if you are a type one who is getting quite tubby round the middle and you seem to need a lot of insulin to get your sugars down. In other words it is a marker that you are getting both kinds of diabetes at once. A good exercise regime and lower carb diet is what you need to deal with this problem. High insulin levels cause damage to blood vessels too. Getting insulin and blood sugar levels reduces cardiovascular deterioration.
The hbaic must be the diabetologists favourite blood test. It is also known as the haemoglobin AIC or the glycosylated haemoglobin. It is a test of your average blood sugar over the last 3 months. A truly normal level is less than 5.0 and more accurately 4.2-4.8%.
The average UK figures for 10-18 year old diabetics is a whopping 9.5%
The American Association of Endocrinologists have set a target of 6.5 % or less for diabetics and the UK National Institute for Clinical Excellence are going to recommend that level quite soon. Diabetes UK have set the level at 7.4% or less for children and teenagers but less than one in 7 meet this target at present.
Control of 8.0 or over is considered to be poor and can be an indication that insulin is necessary in type 2s who are struggling on maximal oral therapy.
Diabetic complications can come on in people who have never been diagnosed with diabetes but who have had hbaics of 5.5 or more for many years. Type 2 diabetics are often discovered to have complications at the time of their diabetes diagnosis because of the slow and stealthy development of problems. Visual troubles, breathlessness on exertion and subtle coordination problems are often seen as something to do with middle age or complications can entirely asymptomatic as in kidney disease.
The American Diabetes Association have decided that from next year they will provide patients with a measure of their average blood sugar to help them understand more about what the hbaic test really means.
Here is a chart to help you:
hbaic = average blood glucose value UK / US
5 = 5 / 90
6 = 6.6 / 119
7 = 8.3 / 149
8 = 10 / 180
9 = 11.6 / 209
10 = 13.3 /239
11 = 15 / 270
12 = 16.6 / 299
13 = 18.3 / 329
14 = 20 / 360
It is in your best interest to keep as low as you can towards normal without risking severe hypoglycaemia. Fortunately this is achievable with a low carbohydrate diet.
Why not find out what tests you have been getting done by your doctor ?
If you keep a record of them you will be in a much better position to understand more about how the diabetes has been affecting you. This can help if you need to see a different doctor from usual or you take ill on holiday.
There is no quiz for this section. Type ones however will be getting questions on it later!
- Dr. Bernstein's Diabetes Solution
- 487 Really Cool Tips for Kids with Diabetes
- A Low Carbohydrate Diet in Type 1 Diabetes: Clinical Experience
- The hbaic/average blood sugar chart is adapted from Diabetes For Dummies by Sarah Jarvis and Alan Rubin.
Where to Next?
Please move on to the How To: Know How Proteins, Fats, and Carbs Affect My Blood Sugar section next.
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