What are the signs of high blood sugar in diabetes patients. How can you identify symptoms of low blood sugar. What strategies help maintain healthy glucose levels. How do continuous glucose monitors assist in diabetes management. When should you seek emergency care for blood sugar issues.

Understanding Blood Sugar Levels in Diabetes Management

For individuals living with diabetes, maintaining consistent blood glucose levels is a critical aspect of managing the condition. Both high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia) can occur, even with diligent care. Various factors influence blood glucose levels, including carbohydrate intake, emotional stress, medications, and physical activity.

Megan O’Neill, a Certified Diabetes Care and Education Specialist, emphasizes the importance of proper blood glucose management: “For people with diabetes, managing blood glucose levels is especially important. Levels that are too low or high can result in complications that affect your kidneys, heart, and vision, reduce your quality of life, require expensive interventions, or even be fatal.”

Target Blood Sugar Ranges for Diabetes Patients

While individual target ranges may vary, the American Diabetes Association (ADA) generally recommends the following blood sugar targets:

• Between 80 and 130 milligrams per deciliter (mg/dL) before meals
• Less than 180 mg/dL two hours after meals

It’s crucial to work with your healthcare provider to determine the appropriate range for your specific situation. Regular monitoring of blood glucose levels is essential for staying within these targets and making necessary adjustments.

The Importance of Blood Glucose Monitoring

Frequent blood glucose testing is a cornerstone of effective diabetes management. Clinical guidelines recommend that individuals taking insulin should test their glucose at least four times per day, and up to 12 times daily in some cases. Factors such as pregnancy, difficulty maintaining healthy blood sugar levels, type of insulin used, and past glucose control may necessitate more frequent testing.

Recognizing the Signs of High Blood Sugar (Hyperglycemia)

Hyperglycemia occurs when the body doesn’t have enough insulin or can’t properly utilize the insulin it has to transport glucose from the bloodstream to the body’s cells for energy. This results in a buildup of sugar in the blood. Several factors can contribute to high blood sugar levels:

• Consuming more carbohydrates or larger portions than usual
• Not taking enough insulin or other diabetes medications as prescribed
• Decreased physical activity
• Increased stress levels
• Certain non-diabetes medications (e.g., steroids, beta blockers, birth control pills, some mental health medications)

Dr. Athena Philis-Tsimikas, corporate vice president for the Scripps Whittier Diabetes Institute, outlines the common signs of high blood sugar:

• Frequent urination
• Fatigue
• Dry or itchy skin
• Increased thirst
• More frequent infections
• Increased appetite without corresponding weight gain

These symptoms typically manifest when blood sugar readings exceed 180 mg/dL, although it’s possible to have high blood sugar without experiencing noticeable symptoms.

When High Blood Sugar Becomes Dangerous

Blood sugar readings above 300 mg/dL can be dangerous and require immediate attention. The University of Michigan recommends informing your doctor if you have two or more consecutive readings of 300 mg/dL or higher. In severe cases, extremely high blood sugar levels (well above 300 mg/dL) can lead to a coma.

If you experience any of the following symptoms, seek emergency medical care immediately:

• Mental confusion
• Nausea
• Dizziness

Strategies for Managing High Blood Sugar

When dealing with high blood sugar levels, consider the following approaches:

1. Take medications as directed: Proper timing and dosage of insulin and other diabetes medications are crucial for maintaining stable blood glucose levels.
2. Adjust your diet: Work with a registered dietitian to create a meal plan that helps control blood sugar levels.
3. Increase physical activity: Regular exercise can help lower blood sugar levels and improve insulin sensitivity.
4. Stay hydrated: Drinking water can help flush excess glucose from your system.
5. Manage stress: Practice stress-reduction techniques such as meditation, deep breathing, or yoga.

Understanding Low Blood Sugar (Hypoglycemia)

While high blood sugar is a common concern for diabetes patients, low blood sugar (hypoglycemia) can be equally dangerous. Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL.

Common Causes of Low Blood Sugar

Several factors can contribute to hypoglycemia in diabetes patients:

• Taking too much insulin or diabetes medication
• Skipping or delaying meals
• Increased physical activity without adjusting medication or food intake
• Consuming alcohol, especially on an empty stomach
• Certain medications or medical conditions

Recognizing the Symptoms of Low Blood Sugar

It’s crucial to identify the signs of hypoglycemia early to prevent severe complications. Common symptoms include:

• Shakiness or trembling
• Sweating
• Rapid heartbeat
• Dizziness or lightheadedness
• Confusion or difficulty concentrating
• Irritability or mood changes
• Hunger
• Weakness or fatigue
• Blurred vision
• Headache

In severe cases, hypoglycemia can lead to seizures, loss of consciousness, or even death if left untreated.

Treating Low Blood Sugar

When experiencing symptoms of low blood sugar, it’s important to act quickly. The “15-15 Rule” is a common approach to treating mild to moderate hypoglycemia:

1. Consume 15 grams of fast-acting carbohydrates (e.g., glucose tablets, fruit juice, or regular soda).
2. Wait 15 minutes and recheck your blood sugar.
3. If your blood sugar is still below 70 mg/dL, repeat the process.
4. Once your blood sugar returns to normal, eat a small snack or meal to help stabilize levels.

For severe hypoglycemia, where the person is unable to eat or drink, glucagon injections may be necessary. Ensure that family members and close friends know how to administer glucagon in case of an emergency.

The Role of Continuous Glucose Monitoring in Diabetes Management

Continuous Glucose Monitoring (CGM) systems have revolutionized diabetes management by providing real-time glucose readings without the need for frequent finger pricks. These devices offer several advantages:

• Continuous readings: CGMs provide glucose readings every few minutes, offering a more comprehensive view of glucose trends.
• Alerts and alarms: Users can set customized alerts for high and low blood sugar levels, allowing for prompt intervention.
• Pattern recognition: CGM data can help identify patterns in glucose levels, enabling more informed treatment decisions.
• Improved quality of life: Reduced need for finger pricks and better glucose control can enhance overall well-being.

While CGM systems can be beneficial for many diabetes patients, they may not be suitable for everyone. Discuss with your healthcare provider to determine if CGM is appropriate for your diabetes management plan.

Preventing Blood Sugar Fluctuations: Lifestyle and Diet Strategies

Maintaining stable blood glucose levels requires a comprehensive approach that includes both lifestyle modifications and dietary considerations. Here are some strategies to help prevent significant blood sugar fluctuations:

Balanced Diet

A well-planned diet is crucial for managing blood sugar levels. Consider the following tips:

• Focus on complex carbohydrates with a low glycemic index
• Include lean proteins and healthy fats in your meals
• Incorporate plenty of fiber-rich foods
• Practice portion control
• Limit sugary foods and beverages

Regular Physical Activity

Exercise plays a vital role in blood sugar management. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, along with strength training exercises. Always consult your healthcare provider before starting a new exercise regimen.

Stress Management

Chronic stress can impact blood sugar levels. Incorporate stress-reduction techniques into your daily routine, such as:

• Meditation or mindfulness practices
• Deep breathing exercises
• Yoga or tai chi
• Regular relaxation time

Consistent Medication Schedule

Take your diabetes medications as prescribed by your healthcare provider. Establish a routine to ensure you don’t miss doses or take them at incorrect times.

Adequate Sleep

Poor sleep can affect blood sugar levels and insulin sensitivity. Aim for 7-9 hours of quality sleep each night and maintain a consistent sleep schedule.

The Importance of Regular Check-ups and Diabetes Education

Managing diabetes effectively requires ongoing education and regular check-ups with your healthcare team. These appointments provide opportunities to:

• Review your blood glucose logs and identify patterns
• Adjust your treatment plan as needed
• Discuss any concerns or questions you may have
• Receive updates on the latest diabetes management strategies and technologies
• Undergo necessary screening tests for diabetes-related complications

Staying informed and actively engaged in your diabetes management can significantly improve your overall health outcomes and quality of life.

Navigating Special Situations: Travel, Illness, and More

Certain situations can present unique challenges for blood sugar management. Being prepared for these scenarios can help maintain stable glucose levels:

Travel

When traveling with diabetes:

• Pack extra supplies and medications
• Carry a doctor’s note and prescription information
• Adjust insulin dosages for time zone changes if necessary
• Plan for meals and snacks during long trips

Illness

Illness can affect blood sugar levels. During sick days:

• Continue taking your diabetes medications
• Check blood sugar levels more frequently
• Stay hydrated
• Have a sick day plan prepared in advance with your healthcare provider

Alcohol Consumption

If you choose to drink alcohol:

• Do so in moderation
• Always eat food when consuming alcohol
• Be aware that alcohol can cause delayed hypoglycemia
• Check blood sugar levels before bed and the following morning

By understanding and preparing for these special situations, you can maintain better control over your blood sugar levels and reduce the risk of complications.

What Are the Signs of High and Low Blood Sugar?

One of the challenges of managing diabetes is maintaining consistent blood sugar (glucose) levels. Even with diligence, some situations can cause high blood sugar, or hyperglycemia, while others can bring on low blood sugar, or hypoglycemia.

After all, it’s not just carbohydrate intake that influences the amount of glucose coursing through your bloodstream when you have type 2 diabetes. Emotional stress and certain medications can increase your blood sugar levels, and a boost in activity can cause it to drop, says Megan O’Neill, CDCES, a medical science liaison for diabetes care at Abbott healthcare company in Monterey, California. Sometimes, people experience a spike in their blood sugar early in the morning due to the “dawn phenomenon,” a temporary surge of hormones that occurs as the body prepares to wake, according to the Cleveland Clinic.

“For people with diabetes, managing blood glucose levels is especially important,” O’Neill says. “Levels that are too low or high can result in complications that affect your kidneys, heart, and vision, reduce your quality of life, require expensive interventions, or even be fatal.”

RELATED: 5 Strategies to Help Avoid Diabetes Complications

The more prepared you are to spot the signs of both high and low levels, the better able you’ll be to quickly and easily bring them back within a desired range and stay healthy.

What’s the right range for you? The answer is slightly different for everyone, and your doctor can help you pinpoint yours. The American Diabetes Association (ADA) generally recommends trying to stay within these blood sugar targets:

• Between 80 and 130 milligrams per deciliter (mg/dL) before meals
• Less than 180 mg/dL two hours after meals

The first step to staying in these ranges, and course-correcting high and low blood sugar levels along the way, is to monitor your blood sugar levels with a glucose meter.

Clinical guidelines recommend that anyone taking insulin test their glucose at least four times per day and as many as 12 times per day. Those who are pregnant or have difficulty maintaining healthy blood sugar levels also need to test their blood sugar more often. Factors that increase the ideal testing frequency include the type of insulin, past levels of glucose control, and symptoms, O’Neill says. Some people with diabetes can benefit from continuous glucose monitoring, a device that allows you to get readings without finger pricks every five minutes, she says.

RELATED: 9 Signs Your Blood Sugar Is Out of Control

About High Blood Sugar (Hyperglycemia)

High glucose levels occur when the body doesn’t have enough insulin or can’t properly use the insulin it has to shuttle glucose from the bloodstream to the body’s muscles, organs, and tissues for fuel, O’Neill says. As a result, the amount of sugar in the blood builds up.

Hyperglycemia typically happens when you consume more carbohydrates or bigger portions of food than usual, if you don’t take enough insulin or other diabetes medication as prescribed, and if you decrease your levels of physical activity, she says. Heightened stress levels can also increase blood sugar levels. Non-diabetes-related medications that are known to raise blood sugar levels include steroids, beta blockers, birth control pills, and many mental health medications, she explains.

Signs of high blood sugar include frequent urination, fatigue, dry or itchy skin, feeling thirsty, more frequent infections, and eating more food but not gaining as much weight as usual, says Athena Philis-Tsimikas, MD, the corporate vice president for the Scripps Whittier Diabetes Institute in La Jolla, California.

High blood sugar levels can cause these symptoms through various mechanisms, according to the Mayo Clinic. For example, high blood sugar levels damage blood vessels and nerves throughout the body. They can also deprive organs of energy and can cause fluid to accumulate in the eyes. And in an attempt to get your blood sugar to a healthier level, your body will often increase urine output.

A blood sugar reading above 180 milligrams per deciliter (mg/dL) is considered above normal and can bring on these symptoms, although it’s possible to have high blood sugar without any symptoms, Dr. Philis-Tsimikas says.

A reading above 300 mg/dL can be dangerous, according to the University of Michigan, which recommends immediately informing your doctor if you have two or more readings of 300 mg/dL in a row. In severe cases, very high blood sugar levels (well above 300 mg/dL) can result in coma. If you experience mental confusion, nausea, or dizziness, proceed to the emergency room.

Ways to treat high blood sugar include:

• Take your medications as directed. Missing doses or taking insulin or other diabetes-managing medications at incorrect times can lead to large fluctuations in blood sugar levels up or down, O’Neill says. Apps such as Medisafe, which is free to download on the App Store and on Google Play, can help you stay on top of your medication regimen. The top-rated app allows you to plug your meds into your calendar and set reminders so you never miss a dose.
• Eat carbohydrates in moderation. The ADA recommends an individualized carb count for everyone with diabetes. Higher intakes can result in hyperglycemia and lower intakes in hypoglycemia. Count carbs by using an app such as the Carb Manager keto diet app, which is top rated and free to download on the App Store and Google Play. It’s not just for those on the ketogenic diet; with the free version, you can record food, track your carb and calorie intake, monitor weight loss, and log workouts.
• Exercise regularly with your doctor’s guidance. Exercise can lower blood sugar in the short term by using glucose for fuel. It can also help you manage your blood sugar over the long term by increasing insulin health, O’Neill says. Plenty of exercise apps and free online resources exist; work with your CDCES to come up with an individualized exercise plan.

RELATED: 10 Surprising Causes of Blood Sugar Swings

About Low Blood Sugar (Hypoglycemia)

Low blood sugar levels happen when there’s too little glucose left in the bloodstream to continue supplying fuel to your organs, muscles, and tissues. It most often occurs when you don’t eat enough food, especially carb-containing foods, given your blood-sugar-lowering medications and physical activity levels, O’Neill says. Levels can decrease gradually or suddenly.

When the amount of glucose in the bloodstream drops to too-low levels, the body reacts by releasing epinephrine, also called adrenaline or the “fight or flight” hormone. Epinephrine revs your heart rate and can cause sweating, shaking, anxiety, and irritability. If not enough glucose is able to reach the brain, the result may be difficulty concentrating, confused thinking, and slurred speech. In extreme cases, a lack of glucose within the brain can lead to seizures, coma, and even death, she says.

People with low glucose levels (lower than 70 mg/dL) can use the ADA’s “15-15 Rule,” which advises people consume 15 g of carbs, wait 15 minutes, and check their levels again. If the number is still low, repeat until reaching at least 70 mg/dL. It’s recommended that you check glucose with a traditional glucometer, not a continuous glucose monitor, given the lag time of the latter.

You can find 15 g of carbs in:

• 1 slice of bread
• 1 small piece of fresh fruit
• ? cup of yogurt
• ½ to 1 cup of juice, skim milk, or regular soda
• Three to four hard candies (such as Jolly Rancher or Werther’s Original)
• Glucose tablets (such as ReliOn and TRUEplus) as indicated on the label
• Glucose gel (such as Glutose 15 and Insta-Glucose) as indicated on the label

Once your glucose levels are back to normal, the ADA suggests going ahead and eating your next scheduled meal or snack, which will help prevent levels from dropping again.

But if your symptoms don’t stop, call your doctor or seek medical attention. If you experience more than two blood sugar readings below 70 mg/dL in a week, notify your doctor and go over your treatment plan.

RELATED: 10 Warning Signs of Low Blood Sugar

A Few Final Notes on Keeping Blood Sugar Stable

Taking an active, intentional approach to your blood sugar levels is crucial to your quality of life and overall health, O’Neill says. Avoiding too-high or too-low blood sugar levels will help you avoid adverse symptoms and health complications, and staying within your target range can enable you to feel your best and do whatever you want to do in life, she says.

Test your blood sugar regularly, listen to your body, and don’t ever hesitate to reach out to your doctor.

Additional reporting by Karen Appold.

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What is a dangerous level of blood sugar and what you can do about it

Dangerous blood sugar levels vary by individual but anything more than 200 mg/dl is considered high, and should be addressed

If you have Type 1 or Type 2 diabetes, your healthcare provider will recommend that you aim to stay within your target range, or normal range, as much as possible. Doing so is best for your overall health and helps you prevent or delay long-term complications of high blood sugar. 

Hypoglycemia is the medical term for low blood glucose levels (or blood sugar levels). Hyperglycemia is the medical term for high blood sugar levels. People with diabetes will see their blood sugar levels rise and fall often, as a result of food, exercise, or other variables. Fluctuating blood sugar levels are normal, as long as they return to the normal range. However, having long periods of high blood sugar can be dangerous, both in the short term and long term. This article will focus on hyperglycemia. 

What is a dangerous level of blood sugar?

Hyperglycemia is the medical term for high blood sugar. 

Blood sugar levels can spike for a variety of reasons, including: 

• Taking too little insulin or oral diabetes medication (or missing a dose)
• The body is not effectively using your natural insulin (insulin decreases blood sugar levels)
• Eating or drinking more carbohydrates than the amount of insulin you injected, or the amount of insulin your body can make 
• Less physical activity
• Illness 
• Emotional stress
• The dawn phenomenon (this occurs when a hormone surge causes blood sugar to increase in the early morning hours)
• The Somogyi effect (this occurs when blood sugar drops overnight, and the body makes more sugar to compensate, and you wake up with higher blood sugar)

For patients who do not have diabetes, blood sugar may increase due to other conditions or medications, such as endocrine conditions, pancreatic diseases or tumors, certain medications (such as diuretics or steroids), or surgery.  

What is a dangerous high level of blood sugar? That may vary slightly by the individual. Your healthcare provider will give you a detailed treatment plan, which will include information about what level of blood sugar is dangerously high for you, and what you should do if it occurs. 

The American Diabetes Association recommends that if your blood sugar is higher than 240 mg/dl, you should check your urine for ketones. 

Checking blood sugar regularly, or wearing a continuous glucose monitor (CGM), is important for people with high blood glucose due to diabetes or other medical conditions. 

High blood sugar can quickly turn into a serious problem if left untreated, so you should treat it as soon as you realize that it is high. Left untreated, high blood sugar can cause diabetic ketoacidosis, or DKA. DKA is more common in people with Type 1 diabetes than Type 2 diabetes, but can still occur in people with Type 2 diabetes. DKA can develop when the body does not have enough insulin. Without enough insulin, the body cannot use glucose for energy, so the body breaks down fats to use for energy. When the body breaks down fats, it makes waste products called ketones. The body tries to eliminate ketones in the urine, but the body cannot get rid of all the ketones, so they build up in the blood, which can lead to DKA. DKA can lead to a diabetic coma or death—it is life-threatening and requires emergency treatment. 

Hyperosmolar hyperglycemic syndrome, or HHS, is more common in people with Type 2 diabetes who do not have their diabetes under control. It can occur when blood sugar is high over a long time. Normally, the kidneys try to eliminate excess blood sugar in the urine, but this also causes water loss. If you do not drink enough fluids, you become dehydrated. When this happens, the kidneys can no longer eliminate extra sugar in the urine, and blood sugar levels become very high, sometimes more than 10 times the normal number. HHS is a medical emergency and can cause a coma or death if not treated. People who develop HHS often have very high blood sugar levels, around 600 mg/dl. Along with very high blood sugar, dehydration and decreased alertness or consciousness may occur. 

Having high blood sugar over long periods of time can also lead to serious health problems, and long-term complications, such as problems with the eyes, feet, skin, blood pressure, cholesterol, nerves, kidneys, and digestion. Some of these problems can lead to other complications such as heart attack, stroke, or amputation. It is important to control high blood sugar levels as much as possible to prevent both short-term and long-term problems.

What are the signs and symptoms of high blood sugar?

The most common signs and symptoms of high blood sugar include:

• High blood sugar levels (as tested on a meter or CGM)
• High levels of glucose in the urine
• Increased thirst
• Frequent urination

DKA is a medical emergency and requires emergency treatment in a hospital. Symptoms of DKA may include:

• Fruity-smelling breath
• Nausea and vomiting
• Dry mouth 
• Shortness of breath

HHS is also a medical emergency and requires emergency treatment. Symptoms of HHS, which may worsen over days or weeks, may include:

• Increased thirst and urination (especially at first)
• Weakness
• Nausea
• Weight loss
• Dry mouth and tongue
• Fever
• Seizures
• Confusion 
• Coma 
• Problems with movement or speech
• Loss of feeling or function of the muscles

If you are diagnosed with diabetes, or hyperglycemia due to another medical condition, make sure you know the symptoms that require emergency treatment.

Blood sugar chart

The chart below shows normal blood sugar levels by age for individuals with and without diabetes, starting from children less than 6 years old, through adults 20 years and older. These are general guidelines. Your doctor may give you different guidelines, so consult your healthcare provider for more information.

How to lower your blood sugar quickly

If you need to quickly lower your blood sugar, follow the directions provided by your health care professional. If you use insulin, this is the best way to quickly lower blood sugar. If you take oral diabetes medication, check to see if you missed a dose. You can ask your doctor if you are not sure how much insulin to administer or if you need to take an extra dose of medication. 

Exercising can be another effective method of lowering blood sugar. Drinking lots of water can also help decrease blood sugar. There are no foods that will lower your blood sugar quickly, but if your blood sugar is high, you will want to avoid foods that spike blood sugar (such as white rice, pasta, and sweets) until your blood sugar comes back into the normal range. 

You can also ask your healthcare provider or another member of your diabetes healthcare team such as your Certified Diabetes Care and Education Specialist (CDCES) about other ways to help lower blood sugar quickly, as well as steps you can take to lower blood sugar in general.  

When to see a doctor

Your treatment plan will include information about when you should consult your doctor or when you need to go to the emergency room. Always consult your healthcare provider if you have any questions about your blood sugar, and get emergency medical help if your symptoms are severe or life-threatening. Conditions such as DKA or HHS are life-threatening and can cause coma or death if not treated. If you are not sure what to do, it is better to err on the side of caution and get emergency medical help. And remember to always wear a medical ID to alert first responders to your medical condition. 

Frequently asked questions about dangerous levels of blood sugar

What is an alarming high blood sugar level?

An alarming high blood sugar level may vary, based on your target range. Generally, if blood sugar is 240 mg/dl or higher, you will need to test for ketones. Your healthcare provider will give you a full treatment plan that outlines what action needs to be taken for certain ranges of blood sugar. For example, if your target range is 80-130 mg/dl, your healthcare provider may advise you to inject a certain amount of insulin if your blood sugar is 200 mg/dl, or check ketones and contact your doctor if your blood sugar is 240 mg/dl.

What are normal blood sugar levels before and after eating?

For adults with diabetes, a normal range before eating is generally 80-130 mg/dl. For adults without diabetes, a normal blood sugar before eating is less than 100 mg/dl. 

A normal blood sugar one or two hours after eating, for someone with diabetes, is usually less than 180 mg/dl. For someone who does not have diabetes, normal blood sugar is less than 120 to 140 mg/dl. 

Ask your healthcare provider what numbers you should aim for, as targets vary by individual. 

What sugar level starts a diabetic coma?

People with Type 1 diabetes have a greater chance of going into a diabetic coma due to DKA. A diabetic coma due to high blood sugar can occur at blood sugar levels of 300 mg/dl, or more.  

People with Type 1 diabetes also have a greater chance of going into a diabetic coma due to severe hypoglycemia (severely low blood sugar). 

People with Type 2 diabetes have a greater chance of going into a diabetic coma due to 

diabetic hyperosmolar hyperglycemic syndrome (HHS). With HHS, blood sugars can be very high, reaching 600 mg/dl or higher. Left untreated, HHS can cause a coma or death.

Can someone survive a diabetic coma?

Yes, but emergency treatment needs to occur immediately. There is a risk of brain damage or death if there is any delay in responding to a diabetic coma. 

Ways to save on insulin

Some people skip doses of medicine or try to ration insulin because they have trouble affording their medications. With several ways to save money, such as choosing generics when available, using manufacturer coupons for brand-name drugs or insulin, or accessing a free SingleCare card, cost should not prevent you from taking medications as prescribed.  

If you are having trouble affording your medications or insulin, tell your healthcare professional so they can make some adjustments to your regimen that can be just as effective but more affordable.

Blood sugar levels – targets and recommendations

Understanding blood glucose levels is a key skill in diabetes self-management. In this article, we look at target blood sugar ranges for people without diabetes and for adults and children with type 1 and type 2 diabetes.

If you are self-monitoring with a glucometer, you need to understand what the numbers (blood sugar readings) are saying.

Recommended blood sugar levels are subject to individual interpretation, so you should discuss your target blood sugar ranges with your doctor.

The following ranges are guidelines provided by the National Institute for Clinical Excellence (NICE), but each person’s target range should be agreed upon by their physician or diabetes advisor.

Recommended Blood Glucose Levels

The NICE recommended blood glucose levels are listed below for adults with type 1 diabetes, type 2 diabetes, and children with type 1 diabetes.

In addition, the target group of the International Diabetes Federation for people without diabetes is indicated.

The table gives general recommendations. The individual goal set by your doctor is the one you should aim for.

Normal and diabetic blood sugar levels

For most healthy people, normal blood sugar levels look like this:

• 4.0 to 5.4 mmol/l during fasting.
• up to 7.8 mmol/l 2 hours after eating.

For people with diabetes, blood sugar levels are as follows:

• Before meals : 4 to 7 mmol/l for people with type 1 or type 2 diabetes.
• After a meal : up to 9 mmol/l for people with type 1 diabetes and less than 8.5 mmol/l for people with type 2 diabetes.

Blood sugar level in the diagnosis of diabetes

The following table lists the criteria for diagnosing diabetes and prediabetes.

A blood sample for a random plasma glucose test can be taken at any time. It does not require such planning and is therefore used in the diagnosis of type 1 diabetes when time is of the essence.

Fasting plasma glucose test

Fasting plasma glucose test is taken after at least eight hours of fasting and is therefore usually taken in the morning. The NICE guidelines consider a fasting plasma glucose result of 5.5 to 6.9 mmol/L, because someone has a higher risk of developing type 2 diabetes, especially when accompanied by other risk factors for developing type 2 diabetes.

Glucose Tolerance Test (OGTT)

An oral glucose tolerance test involves first taking a fasting blood sample and then taking a very sweet drink containing 75 g of glucose.

After drinking this drink, you must remain still until another blood sample is taken 2 hours later.

HbA1c Test for Diabetes Diagnosis

The HbA1c test does not directly measure blood glucose, but the test result depends on how high or low the blood glucose is, typically lasting 2 to 3 months.

Indications for diabetes or pre-diabetes are given under the following conditions:

• Normal: below 42 mmol/mol (6.0%)
• Prediabetes: 42 to 47 mmol/mol (6.0 to 6.4%)
• Diabetes: 48 mm ol/mol (6.5% or more)

Diabetes mellitus

Diabetes is an endocrine disease, a complex of pathological conditions, which are based on the pathology of the synthesis and function of insulin, as well as impaired glucose metabolism. As a result, the patient develops persistent hyperglycemia – a high concentration of glucose in the blood.

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Pathology refers to chronic diseases. Gradually, in addition to carbohydrate pathology affects other types of metabolic processes – fat, protein, mineral. The clinical picture of diabetes is diverse, because it affects different organs and systems. The consequences of diabetes affect the condition of the skin, peripheral nerves, brain, kidneys, heart and blood vessels. Each of the violations entails appropriate consequences, and as a result, diabetes is a combination of several pathologies.

Laboratory diagnosis of diabetes is important for making a diagnosis, monitoring treatment, determining the degree and stage of the process. Various features of hyperglycemia are indicators for a particular therapeutic tactic.

How to recognize the disease?

Symptoms of diabetes develop depending on the stage of the process. The disease can gradually develop or debut in the form of an acute condition – coma. To organize the signs of diabetes, they are divided into two categories: basic and additional.

Consider the main signs of diabetes:

• Polyuria. Frequent urination, increased fluid output. This is due to the fact that high glucose levels increase osmotic pressure, which affects the functioning of the renal glomeruli and tubules. Glucosuria develops – there is a lot of glucose in the urine, although normally it is not there at all. Patients note an increase in the nighttime urge to urinate.
• Polydipsia. In diabetes, there is intense thirst, which is not associated with physical exertion or weather conditions. If in the usual mode of life the patient notes a strong thirst and a frequent desire to drink water, it is worth considering taking a blood test for glucose. This clinical sign is associated with increased fluid loss.
• Polyphagy. A person constantly wants to eat. This hunger, like thirst, is not associated with environmental conditions or increased stress. The reason is that more nutrients are consumed and their metabolism in tissues is disrupted. Glucose is in the blood, but does not enter the cells. This affects the receptors, the body perceives the situation as a lack of glucose and increases appetite to replenish the supply.
• Slimming. Since glucose metabolism is disturbed, the catabolism of fats and proteins increases. This leads to a decrease in the volume and weight of the body. Weight loss occurs with increased appetite, which further enhances it.

This is a typical pattern for type 1 diabetes. In this case, the pathology can begin acutely, the symptoms develop quickly and the patient remembers the approximate time of onset of the disease.

Less specific, additional symptoms are common to all types of diabetes. They occur gradually, the patient cannot remember exactly how long they have been bothering him.

The following changes may occur:

• skin and mucous membranes constantly itch and itch;
• unpleasant dryness of the oral mucosa appears;
• muscle weakness is felt;
• persistent headache;
• frequent and prolonged inflammation of the skin, including purulent nature, which do not heal even during treatment;
• visual disturbances;
• the appearance of acetone in the urine.

There may be other general symptoms such as weakness and fatigue. It becomes difficult for a person to work or study, working capacity decreases, sleep is disturbed.

Modern diagnostic program for pathology

There are the following diagnostic methods for disorders of glucose metabolism:

• Determination of the level of glucose in the blood
• Glucose tolerance study
• Determination of glycated hemoglobin
• Urinalysis for the presence of acetone and glucose and determination of their level
• Determination of the level of insulin in the blood
• Analysis for C-peptide
• Analysis for Leptin
• Determination of antibodies to pancreatic beta cells (ICA, GAD, IAA, IA-2)

Let us consider in more detail these methods and their features

1) Determining the concentration of glucose in the blood shows how well insulin performs its functions, whether glucose is supplied to cells or is it in the blood. The normal concentration of glucose in the blood in humans is 3.3 -5.5 mmol / l. If the result is below the normal level, this is called hypoglycemia. It occurs in case of poisoning, functional disorders of the digestive tract, some diseases of the liver and pancreas, oncopathology, intoxication. High glucose levels – hyperglycemia. Characteristic for diabetes mellitus, chronic pathology of the liver, pancreas, hyperkalemia, hemorrhages in the brain tissue.

The technique is indicated for pathology of the liver, pancreas, obesity, to confirm or exclude diabetes, as well as to control its treatment.
Blood for analysis is collected in the morning, before meals and not earlier than 8 hours after the last meal. The patient should not be subjected to physical or emotional stress from the evening before the study.

2) Test for glucose tolerance. The study is indicated when the concentration of glucose in the blood does not go beyond the critical limits. If the measurement of glucose shows a result of 3.88 to 7 mmol / l, it is too early to speak of hyper- or hypoglycemia and the patient’s condition should be clarified. The test is also used for those who have risk factors for developing diabetes.
The study is carried out in the morning, before meals and not earlier than 8 hours after the last meal. The patient should be in a calm state, not subjected to physical exertion and stress. The test is not performed if the blood glucose level exceeds 7 mmol/L.
How is the test going? First, the level of glycemia is measured with a glucometer, after which blood is taken. Next, the patient is asked to drink 300 ml of water with 75 g of glucose dissolved in it. After 2 hours, blood is taken again. During this time, you can not drink and eat, smoke and exercise.
The test is deciphered as follows: a positive result is a blood glucose concentration of less than 7.8 mmol / l, from 7.8 to 11.0 – tolerance is considered impaired, if glycemia is above 11. 0 – a diagnosis of “Diabetes mellitus” is made.

3) Glycated hemoglobin is an indicator that distinguishes short-term hyperglycemia from a long-term pathological glucose metabolism. The principle of the study is based on the detection and measurement of the amount of hemoglobin that has irreversibly bound to glucose molecules. The technique allows you to evaluate the picture for the last 3 months, since that is how long an erythrocyte with altered hemoglobin remains in the blood. The score is important in predicting the complications of diabetes and making a diagnosis. Also, the analysis shows how good the treatment of the disease was over the past period and whether correction is needed.
The normal concentration of glycated hemoglobin is 4 to 5.9%. If the value exceeds 8% – correction of treatment tactics is urgently required.
Special preparation before the analysis is not required. The results do not depend on food intake, exercise and time of day. The study is indicated in the diagnosis of diabetes, to control the dynamics of the process.

4) Diabetic urine test includes acetone and glucose testing. An assessment of the daily amount of urine is used to determine the total glucosuria per day. Normally, there should be no glucose in the urine. Sometimes the analysis is divided into time intervals so that four servings of urine are obtained. This allows you to determine the daily fluctuations and find out their cause. Single urine collection is the standard procedure for determining or ruling out glucosuria. The assessment of the level of acetone occurs in a similar way and is performed simultaneously with the determination of glucose. Acetone is also normally absent in the urine, its appearance indicates pathology.
The technique is used to control the quality of treatment. It is also used for poor health, general health disorders, during illness.

5) Determination of the level of insulin is necessary for prolonged hyperglycemia. The hormone rises in response to a high concentration of glucose – this is natural and physiological. And the doctor manages to assess the features of glucose-insulin metabolism, thanks to this technique. Venous blood is used for analysis. It is advisable to combine this test with a glucose tolerance test.
The study is carried out on an empty stomach and after an 8-hour break after eating. Intense exercise should be avoided. The day before, you should stop eating food with a high sugar content. Do not smoke for 2 hours before the test.

6) Analysis for C-peptide is included in the diagnosis of diabetes, as it is a product of carbohydrate metabolism and shows its quality in the body. As a rule, the level of this substance corresponds to the concentration of insulin in the blood. Insulin resistance and pancreatic islet pathology are accompanied by a decrease in C-peptide. Normal indicator – 0.9-7.9. An elevated concentration indicates the presence of type 2 diabetes mellitus, reactions to glucose-lowering drugs may indicate the presence of insulinoma, antibodies to insulin, neuroendocrine processes and kidney problems.
Preparation for analysis involves the rejection of intense loads, exercise, stress. It is necessary to donate blood on an empty stomach, before giving up not only food, but also smoking.

7) Analysis for leptin is also part of the Comprehensive Diabetes Health Assessment Program. It is a hormone that regulates appetite and body weight. It is produced by adipocytes – fat cells. The norm is 1.1 – 27.6 ng / ml for men and 0.5-13.5 ng / ml for women.
Preparation for the analysis includes the refusal of food 8 hours before blood donation, a small amount of water is allowed. The patient should avoid stress and stress.
The study is indicated if the patient is suspected of having a deficiency of this hormone, impaired reproductive function, if it is necessary to differentiate diabetes or obesity, as well as with frequent thrombosis. The value may increase with increased food intake, diabetes, which does not depend on insulin levels, as well as obesity. A reduced result may accompany rapid weight loss, prolonged fasting, and a genetic deficiency of the hormone.

8) Pancreatic cell antibody test is used to diagnose autoimmune disorders of carbohydrate metabolism. This is an indicator of the destruction of gland cells, which has an autoimmune mechanism. It is used to correct therapy, differential diagnosis, determine the type of diabetes in complex cases and with an incomprehensible clinic.
Normally, antibodies to pancreatic cells and the body should not be. Their presence indicates a malfunction of the immune system.
The blood test is taken on an empty stomach, it is necessary to avoid physical and emotional stress before the examination. In addition to eating, you should stop smoking, you can drink a small amount of water without gas.
All analyzes must be carried out under appropriate conditions, with asepsis and antisepsis. The collected biological material must be properly stored and transported to the laboratory.