Diabetes Advice

High concentration of glucose in blood may cause diabetes. Insulin is the hormone that controls the amount of glucose in the blood at certain normal levels. But when it fails to keep levels in control it leads to high glucose levels and diabetes. When there is insufficient insulin or inability of insulin to respond to the glucose levels it may lead to Type 1 and Type 2 diabetes. Another type of diabetes is gestational diabetes that affects women during the pregnancy. It is often temporary and caused due to certain changes in the hormonal balance during pregnancy. Gestational diabetes may disappear after delivery. However, a woman suffering from gestational diabetes should ensure that she keeps normal blood glucose levels during pregnancy. Similarly a woman suffering from diabetes and pregnant should ensure that normal levels are maintained for the safety and health of self and child.

What is gestational diabetes?
Insulin is produced by the pancreas to keep the glucose levels in blood under control. During the pregnancy period, a woman’s body has plenty of insulin. But then what causes the levels to go beyond the normal blood glucose levels. The reason for this is that insulin gets partially blocked by a variety of other hormones causing a condition called as insulin resistance. The body produces several other hormones such as estrogen, cortisol and human placental lactogen which may have a blocking effect on insulin. So the body produces insulin in larger quantities and yet fails to be overcome their effect. Gestational diabetes usually goes away after delivery. In the second trimester as placenta grows the probability of gestational diabetes is more. It affects about 1 percent to 3 percent of all pregnant women.

Normal blood glucose levels during pregnancy
The target normal levels that are safe for you would be explained by your doctor depending upon your overall health and other conditions. Often in the first trimester the glucose levels may be a little higher. Typically normal levels during pregnancy that doctors expect are 60mg/dL to 90mg/dL before eating, less than 120mg/dL one hour after eating and the same after two hours after eating. Anything lower or higher requires immediate attention.

The most widely prescribed test is the oral glucose tolerance test. It is a series of blood glucose measurements to study the response of the body after you have taken a sugary liquid. It is considered most reliable in this period.

How would glucose levels affect the baby?
The effect on a woman with high blood sugar levels consistently during pregnancy is macrosomia. The size of the baby is considerably larger than normal size. This is because the fetus produces all insulin it needs to use the glucose that maternal blood provides. This causes large fat deposits leading to excessively large size of baby. There also exists the risk of hypoglycemia. After delivery the baby may continue to have high insulin level. However, it would not have the high level of sugar from its mother. This would cause lowering of blood sugar levels in newborns. The baby may be given glucose intravenously to bring it back to normal.

To maintain normal glucose levels during pregnancy women should undertake specific treatment that includes special diet, exercises, insulin injections and daily monitoring of glucose. It is of utmost importance for the safety and wellbeing of mother and the baby.

The fluctuation in blood glucose levels from very high to low may causes severe damage to the body system. The increase in the sugar levels may be the result of various factors and if left untreated may lead to complications. However, if you are aware of what should be the normal blood glucose levels you can ensure appropriate diet, exercises and medication to prevent future complications. There is a subtle difference in the normal blood glucose levels in diabetics and non diabetics. For diabetics it may be a little higher as it has often been seen that the safe levels may be affected by health conditions, state of diabetes, use of the diabetes medicines, insulin, diet and exercises. When the levels go low it may lead to hypoglycemia, thus the safe levels are relevant.

Normal blood glucose levels

The normal range of blood glucose accepted by all is around 80mg/dL before meals. Generally the levels increase after 1 to 2 hours after meals. The normal range should be less than 160mg/dL or 8.8mmol/L. These figures are for blood samples taken from veins also called as whole-blood sample. Sample drawn from the fingertips is called plasma blood sample and the readings for it should preferably be 70mg/dL to 130mg/dL or 7.2mmol/L before meals and less than 180mg/dL or 10mmol/L, 1 to 2 hours after meals.

A1-c

You need to be aware of the normal blood glucose levels that are result of the glycated hemoglobin or A1C (HbA1c) test. It is a measure of percentage of glucose stuck to hemoglobin. This enables you to find how well you have been able to control diabetes. The normal level for adults should be 7%. In children less than 6 years of age it is recommended between 7.5% and 8.5%. In children aged 6 to 12 years the level should be at 8%. For teens aged 13 to 19 years it should be less than 7.5%. A low level around the given ranges means you have been able to control glucose levels.

During pregnancy the doctor may advice certain levels. It should preferably be 70mg/dL to 100mg/dL before meals using a whole blood sample and 80mg/dL to 110mg/dL using a plasma blood sample. Two hours after the meal it is recommended to be less than 140 using a whole blood sample and 155mg/dL using a plasma blood sample. All these figures quoted are as recommended by ADA.

Dietary Pattern and Exercises to maintain normal blood glucose levels

Blood glucose levels are affected not just by what you eat but also because of exercises or the lack of it, medication and quality of food intake. It is very important for all to have healthy diet. Those with higher levels should include a balanced diet with lesser carbohydrates and sweet foods. Fresh fruits and vegetables, whole grain breads are of great help. A reduction in carbonated sodas is advisable. Physical exercises like brisk walking, swimming or any other sport that you like helps as it consumes the glucose in the form of energy. Learn time management so that you are not stressed out which may cause the shooting up of glucose levels in your blood.

Ensure that you seek advice from your doctor on the normal blood glucose levels whether you are diabetic or not. Similarly take appropriate medication as well as have a healthy diet and exercise regularly to keep it within the acceptable range.

Diabetes management involves regular monitoring of blood glucose levels. If you are suffering from hyperglycemia or diabetes you should check if your glucose levels are in the normal acceptable or safe range. Prepare a normal blood glucose level chart which can prove to be really handy to compare the levels every time you test the glucose levels. By maintaining a chart on paper or in a worksheet will enable you to analyze the effect of medication, diet and exercises and the effectiveness of your control plan.

Normal blood glucose level chart

The American Diabetes Association has provided some guidelines for normal and abnormal glucose levels. Your doctor may set slightly different target ranges considering your overall health. Children may have a slightly higher target ranges. Similarly adults starting on insulin may also be given a different range.

* Morning fasting glucose levels advisable for non-diabetics are between 70 to 99mg/dL. However, for diabetics the range of 90-130 for adults and 90-140 for children.
* 2 to 4 hours after meals the glucose levels for non diabetics should be in the range of 70-139mg/dL. Among diabetics it should be less than 180mg/dL.
* Before bedtime glucose level should be 140-160mg/dL among adults and higher but not more than 180mg/dL in children.
* Blood glucose level less than 70mg/dL are indicative of hypoglycemia.
* Readings of 200mg/dL or higher are pointers to diabetes.

The American Diabetes Association provides guidelines to interpret the reading of the different tests like fasting blood glucose (FBG), Oral Glucose Tolerance Test (OGT) etc.

The fasting glucose test:
* A normal range of 70 to 99mg/dL or 3.9 to 5.5mmol/L is necessary for non diabetics.
* Readings between 100 to 125mg/dL or 5.6 to 6.9mmol/L indicate pre-diabetes or impaired fasting glucose (IGF)
* Levels of 126mg/dL i.e. 7.0mmol/L or higher may be diagnosed as Diabetes after confirmation using some more tests.

Oral glucose tolerance test
Sometimes glucose levels are higher than normal but lower than the diabetic range. An oral glucose tolerance test can be done to check levels 2 hours after consuming 75grams of glucose from a sugary drink.
* If the level is less than 140mg/dL or 7.8mmol/L after 2 hours after drinking then it indicates normal glucose tolerance.
* When readings are 140 to 200mg/dL or 7.8 to 11.1mmol/L it indicates impaired glucose tolerance or pre-diabetes. There is a higher risk of diabetes in such cases.
* Levels over 200mg/dL or 11.1mmol/L on one or more occasion would mostly be diagnosed as diabetes.

Gestational diabetes screening:

Glucose Challenge Test
The glucose challenge test helps find if you are suffering from gestational diabetes.1 hour after drinking 50grams of glucose if the level is less than 140mg/dl it indicates normal glucose tolerance and more than 140mg/dL means levels are abnormally elevated and the woman needs to take an Oral glucose tolerance test (OGTT).

Oral glucose tolerance test during pregnancy
Levels below 95mg/dL or 5.3mmol/L or lower after fasting i.e. before glucose load are normal levels. One hour after glucose load normal level means less than 180mg/dL or 10mmol/L. The normal level after two hours should be 155mg/dL or lower and after 3 hours it should be 140mg/dL or 7.8mmol/L or lower.

The ranges mentioned here are according to the guidelines provided by ADA as preferable normal levels and are intended for general purpose. The levels advised by the doctor may vary to a certain extent depending on your medical needs.

Diabetes a chronic disease is affecting millions of people around the world. The effect of diabetes, high blood glucose and low blood glucose levels are adverse and can affect your health severely if left untreated. Glucose level maintenance can be possible with proper care and attention to diet, exercises and medication. You can find the glucose levels by taking regular glucose tests at the labs or by using self monitoring devices like glucometers. Self monitoring with the blood glucose meter enables you to undertake glucose level tests regularly as per the need. The meters are extremely handy and simple to use which makes it possible for you to test glucose levels anytime whether you are at home, office, school, traveling etc. Manufacturers like Abbott, Accu-chek, Meditronic have introduced several types of finger stick meters that require a little prick on the finger tip for a small drop of blood for the test. Fingertips may experience itchiness or discomfort when the prick is repeated for a long time. Thus companies are trying to develop non invasive blood glucose meter that can make continuous monitoring even simpler.

Non invasive blood glucose meters

Studies and research is being undertaken to develop noninvasive devices that enable continuous monitoring. Research is underway for noninvasive and minimally invasive methods for measuring blood glucose, such as using infrared or near-infrared light, electric currents and ultrasound. One of the noninvasive glucose meters approved by the FDA is the Cygnus GlucoWatch G2 Biographer. It is designed to be worn on the wrist, and draws out body fluid for testing using electric fields. However, it does not replace conventional blood glucose meters in any way. A limitation of the GlucoWatch system is that it is unable to cope with perspiration at the measurement site. It requires that sweat must be allowed to dry before the measurement is done. This and other limitations have caused early demise of the product from the market.

The attempts to use noninvasive blood glucose measurement by spectroscopic measurement methods have not been successful due to fact that the devices measure tissue sugar, and not the blood sugar. At the moment there are two continuous glucose monitoring systems (CGMS) available. One is the GlucoWatch G2 Biographer and the other is Medtronic’s Minimed Paradigm RTS. The Minimed comes under the minimally invasive type, as it requires a small plastic catheter to be inserted just under the skin. Small amounts of liquid is collected which is passed through a “biosensor” to measure the amount of glucose present. The probe is attached to a small transmitter which sends interstitial glucose levels every five minutes to a small pager sized receiver. Minimed is not suitable for continuous day to day monitoring. It helps to discover trends in glucose levels during the day. The readings are collected after measurements over a 72-hour period. The data has to be then downloaded for study. It can prove to be an indicator to understand the trends to know the best time to do standard fingerstick tests. A prescription to buy MiniMed is required.

Another one is the DexCom STS System which is a hypodermic probe with a small transmitter. The receiver, the size of a cell phone can operate up to five feet from the transmitter. It can monitor and log levels at five-minute intervals for up to 72 hours. You can even set alarm for the high and low glucose levels.

The noninvasive blood glucose meters cannot replace the standard glucose testing. Over a period of time improvement in technology would make it a good device.

The number of people suffering from diabetes has gone into millions. Diabetes requires proper care and attention to diet, exercises and medication. Self monitoring has enabled people to undertake glucose level tests regularly as per the need. The blood glucose meters or glucometer that are available are highly handy and easy to use making it possible for you to test the levels irrespective of where you are home, office, school, play ground, traveling etc. The ones that are more popular are the finger stick ones that require a little prick on the finger tip for a small drop of blood for the test. However, these may cause some discomfort when done for a long time. There are studies being undertaken to develop non invasive blood glucose meter that can make continuous monitoring even simpler.

Non invasive blood glucose meter

Development of noninvasive devices may enable continuous monitoring. Research is being done on noninvasive methods for measuring blood glucose, technologies such as using infrared or near-infrared light, electric currents and ultrasound are being tried and tested in several labs of manufacturers. There is one noninvasive glucose meter approved by the FDA: The GlucoWatch G2 Biographer. It is to be worn on the wrist, and uses electric fields to draw out body fluid for testing. However it is no replacement for conventional blood glucose monitors. A limitation of the GlucoWatch system is its inability to cope with perspiration at the measurement site. Before measurement sweat must be allowed to dry. Due to limitations, the product is no longer on the market.

The market introduction of noninvasive blood glucose measurement systems by spectroscopic measurement methods has failed so far because at present the devices measure tissue sugar and not blood sugar. At the moment 2 continuous glucose monitoring system (CGMS) are available. One is the GlucoWatch G2 Biographer and the other is Medtronic’s Minimed Paradigm RTS. The Minimed is of the minimally invasive type and consists of a small plastic catheter inserted just under the skin. It collects very small amounts of liquid which is passed through a “biosensor” to measure the amount of glucose present. The sub-cutaneous probe is attached to a small transmitter which every 5 minutes sends interstitial glucose levels to a small pager sized receiver. Minimed is not for continuous day to day monitoring. It is used occasionally to discover trends in glucose levels during the day. The readings are not for individual tests and collects measurements over a 72-hour period. The data has to be then downloaded by the patient or healthcare provider. It might help patients to understand the trends to know the best time to do standard fingerstick tests. A prescription to buy MiniMed is required.

There is one more noninvasive meter called as the DexCom STS System which is a hypodermic probe with a small transmitter. The receiver which is about the size of a cell phone can operate up to five feet from the transmitter. It monitors and logs levels at five-minute intervals for up to 72 hours. There are high and low glucose alarms which can be set.

The noninvasive blood glucose meter is not a replacement to the standard glucose testing which is the most reliable system as yet. With improvement these may also become good devices over time.