What causes blood glucose levels to rise. How can you manage blood sugar spikes. Why are carbohydrates important for blood glucose regulation. What is the relationship between insulin and blood sugar.

Understanding Blood Glucose and Its Regulation

Blood glucose, or blood sugar, is a crucial energy source for our bodies. Its regulation is a complex process involving several organs and hormones. When we consume carbohydrates, our digestive system breaks them down into simple sugars, primarily glucose, which enters the bloodstream.

The pancreas plays a pivotal role in blood glucose regulation by producing two key hormones:

• Insulin: Prompts cells to absorb blood sugar for energy or storage
• Glucagon: Signals the liver to release stored sugar when blood glucose levels fall

This interplay between insulin and glucagon ensures a steady supply of blood sugar to cells throughout the body, especially in the brain.

The Process of Blood Glucose Regulation

1. Carbohydrate consumption and digestion
2. Rise in blood sugar levels
3. Pancreas produces insulin
4. Cells absorb blood sugar
5. Blood sugar levels begin to fall
6. Pancreas produces glucagon
7. Liver releases stored sugar

Understanding this process is crucial for managing blood glucose levels, especially for individuals with diabetes or those at risk of developing the condition.

Common Causes of Blood Glucose Spikes

While carbohydrate intake is a well-known factor in blood glucose fluctuations, several other factors can cause unexpected spikes. Being aware of these triggers can help individuals better manage their blood sugar levels.

Dietary Factors

• Skipping breakfast: Can increase blood sugar after both lunch and dinner
• Artificial sweeteners: Some studies suggest they may raise blood sugar
• Coffee: Caffeine can make some people’s blood sugar extra-sensitive

Lifestyle and Environmental Factors

• Sunburn: The pain causes stress, which can increase blood sugar levels
• Sleep deprivation: Even one night of insufficient sleep can reduce insulin efficiency
• Dehydration: Less water in the body leads to a higher blood sugar concentration
• Time of day: Blood sugar can be harder to control later in the day

Physiological Factors

• Dawn phenomenon: A surge in hormones early in the morning can spike blood sugar
• Gum disease: Both a complication of diabetes and a blood sugar spiker

Medicinal Factors

• Nose sprays: Some contain chemicals that trigger the liver to produce more blood sugar

Can stress affect blood glucose levels? Indeed, stress is a significant factor in blood sugar fluctuations. When we experience stress, our bodies release hormones like cortisol and adrenaline, which can cause blood sugar levels to rise. This “fight or flight” response prepares the body for action by releasing stored energy, including glucose, into the bloodstream.

The Role of Carbohydrates in Blood Sugar Management

Carbohydrates play a central role in blood sugar management. They are the primary macronutrient that affects blood glucose levels. When consumed, carbohydrates are broken down into simple sugars, primarily glucose, which enters the bloodstream and raises blood sugar levels.

Types of Carbohydrates

• Simple carbohydrates: Quickly digested and can cause rapid blood sugar spikes
• Complex carbohydrates: Digested more slowly, leading to a more gradual rise in blood sugar
• Fiber: A type of carbohydrate that isn’t digested and can help slow the absorption of other carbohydrates

How does the glycemic index relate to blood sugar management? The glycemic index (GI) is a measure of how quickly a food can raise blood sugar levels. Foods with a high GI are rapidly digested and absorbed, causing a quick spike in blood sugar. Low GI foods are digested and absorbed more slowly, resulting in a more gradual rise in blood sugar. Choosing low GI foods can help individuals manage their blood sugar levels more effectively.

Insulin Resistance and Type 2 Diabetes

Insulin resistance is a condition where cells in the body become less responsive to insulin. This means that even though the pancreas is producing insulin, the cells are not effectively using it to absorb glucose from the bloodstream. Over time, this can lead to consistently elevated blood sugar levels and the development of type 2 diabetes.

Stages of Insulin Resistance and Type 2 Diabetes Development

1. Initial insulin resistance: Cells become less responsive to insulin
2. Increased insulin production: The pancreas produces more insulin to compensate
3. Prediabetes: Blood sugar levels are higher than normal but not yet in the diabetic range
4. Type 2 diabetes: The pancreas can’t produce enough insulin to overcome the resistance

Does insulin resistance always lead to type 2 diabetes? While insulin resistance is a significant risk factor for type 2 diabetes, it doesn’t always progress to the disease. Lifestyle changes, including diet modifications, increased physical activity, and weight management, can help improve insulin sensitivity and prevent or delay the onset of type 2 diabetes.

Managing Blood Glucose Spikes

Effectively managing blood glucose spikes is crucial for individuals with diabetes or those at risk of developing the condition. Several strategies can help mitigate sudden increases in blood sugar levels.

Dietary Strategies

• Balanced meals: Include a mix of carbohydrates, proteins, and healthy fats
• Portion control: Monitor carbohydrate intake and stick to recommended serving sizes
• Regular meal timing: Avoid skipping meals, especially breakfast
• Choose low GI foods: Opt for complex carbohydrates and high-fiber options

Lifestyle Modifications

• Regular physical activity: Exercise can help improve insulin sensitivity
• Stress management: Practice relaxation techniques to reduce stress-induced spikes
• Adequate sleep: Aim for 7-9 hours of quality sleep per night
• Stay hydrated: Drink plenty of water throughout the day

How effective is post-meal walking in managing blood glucose? Research has shown that taking a short walk after meals can significantly improve blood sugar control. A study published in Diabetes Care found that three 15-minute bouts of moderate post-meal walking significantly improved 24-hour glycemic control in older people at risk for impaired glucose tolerance.

The Impact of Sleep on Blood Glucose Levels

Sleep plays a crucial role in maintaining healthy blood glucose levels. Lack of sleep or poor sleep quality can negatively impact insulin sensitivity and glucose metabolism.

Effects of Sleep Deprivation on Blood Glucose

• Decreased insulin sensitivity
• Increased insulin resistance
• Elevated cortisol levels
• Altered hunger hormones (ghrelin and leptin)

How much sleep is needed to maintain healthy blood glucose levels? The National Sleep Foundation recommends 7-9 hours of sleep per night for adults. Consistently getting adequate sleep can help improve insulin sensitivity and lower blood glucose levels.

Tips for Improving Sleep Quality

1. Stick to a consistent sleep schedule
2. Create a relaxing bedtime routine
3. Ensure a comfortable sleep environment
4. Limit exposure to blue light before bedtime
5. Avoid caffeine and large meals close to bedtime

The Role of Exercise in Blood Glucose Management

Regular physical activity is a cornerstone of effective blood glucose management. Exercise can improve insulin sensitivity, help maintain a healthy weight, and reduce the risk of developing type 2 diabetes.

Benefits of Exercise for Blood Glucose Control

• Improved insulin sensitivity
• Enhanced glucose uptake by muscles
• Reduced blood glucose levels during and after exercise
• Better long-term glycemic control
• Reduced risk of diabetes-related complications

What types of exercise are most effective for blood glucose management? Both aerobic exercise and resistance training have been shown to be beneficial for blood glucose control. A combination of both types of exercise is often recommended for optimal results.

Exercise Recommendations for Blood Glucose Management

1. Aim for at least 150 minutes of moderate-intensity aerobic activity per week
2. Include resistance training exercises at least twice a week
3. Break up periods of prolonged sitting with short bouts of activity
4. Monitor blood glucose levels before, during, and after exercise
5. Stay hydrated during physical activity

It’s important to note that individuals with diabetes should consult with their healthcare provider before starting a new exercise program to ensure safety and effectiveness.

The Connection Between Oral Health and Blood Glucose

The relationship between oral health and blood glucose levels is bidirectional. Poor blood glucose control can increase the risk of oral health problems, while gum disease can make it more difficult to manage blood sugar levels.

Impact of Diabetes on Oral Health

• Increased risk of gum disease
• Higher susceptibility to oral infections
• Slower wound healing in the mouth
• Dry mouth, which can lead to tooth decay

Impact of Gum Disease on Blood Glucose

• Increased inflammation throughout the body
• Potential for higher blood glucose levels
• Possible interference with diabetes management

How can maintaining good oral health help manage blood glucose levels? By practicing good oral hygiene and receiving regular dental check-ups, individuals can reduce inflammation in the mouth and potentially improve their overall blood glucose control. This includes brushing twice daily, flossing daily, and visiting a dentist regularly for professional cleanings and examinations.

Tips for Maintaining Oral Health with Diabetes

1. Control blood glucose levels
2. Brush teeth at least twice daily
3. Floss daily
4. Use an antimicrobial mouthwash
5. Quit smoking
6. Visit the dentist regularly
7. Inform your dentist about your diabetes status

By understanding the intricate relationship between blood glucose levels, diet, lifestyle factors, and overall health, individuals can take proactive steps to manage their blood sugar effectively. Whether you have diabetes or are at risk of developing the condition, implementing these strategies can contribute to better glycemic control and improved overall health.

Blood Glucose Spikes: Common Causes

SOURCES:

Kidshealth.org: “Carbohydrates and Diabetes.”

Cleveland Clinic: “Good Carbs,” “High Blood Sugar is Toxic to Your Nerves — Here’s How to Avoid It.”

National Sleep Foundation: “Sleep Longer to Lower Blood Glucose Levels.”

University of California, San Francisco: “Exercise & Blood Sugar.”

Joslin Diabetes Center: “Why Can’t I Exercise With Ketones?”

BD Diabetes Learning Center: “Common Medications That Can Cause High Blood Sugar.”

NHS Choices: “Hyperglycaemia (high blood sugar).”

American Diabetes Association: “Diabetes and Oral Health Problems,” “Stress.”

American Dental Association: “Diabetes and Your Smile.”

Marc Jaffe, MD, endocrinologist, Kaiser Permanente Medical Group, San Francisco.

University of Michigan C.S. Mott Children’s Hospital: “Learning to Control After-Meal High Blood Sugars.”

Mayo Clinic: “Hyperglycemia in Diabetes,” “Diabetes Management.”

Duke Diet & Fitness Center, Duke University: “5 Things that Spike Your Blood Sugar.”

Diabetes Care: “Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial.”

The Journal of Nutrition: “A High-Protein Breakfast Induces Greater Insulin and Glucose-Dependent Insulinotropic Peptide Responses to a Subsequent Lunch Meal in Individuals with Type 2 Diabetes.”

CDC: “10 Surprising Things That Can Spike Your Blood Sugar.”

Diabetologia: “High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial.”

Kaiser Permanente: “Living Well With Diabetes: How Food Affects Blood Sugar.”

Diabetes Care: “Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose Tolerance.”

Journal of the American Dental Association (JADA): “Gum Disease Can Raise Your Blood Sugar Level.”

10 Surprising Things That Can Spike Your Blood Sugar

When you first found out you had diabetes, you tested your blood sugar often to understand how food, activity, stress, and illness could affect your blood sugar levels. By now, you’ve got it figured out for the most part. But then—bam! Something makes your blood sugar zoom up. You try to adjust it with food or activity or insulin, and it dips really low. You’re on a rollercoaster no one with diabetes wants to ride.

Do you know all of these blood sugar triggers?

Knowledge is power! Look out for these surprising triggers that can send your blood sugar soaring:

1. Sunburn—the pain causes stress, and stress increases blood sugar levels.
2. Artificial sweeteners—more research needs to be done, but some studiesexternal icon show they can raise blood sugar.
3. Coffee—even without sweetener. Some people’s blood sugar is extra-sensitive to caffeine.
4. Losing sleep—even just one night of too little sleep can make your body use insulin less efficiently.
5. Skipping breakfast—going without that morning meal can increase blood sugar after both lunch and dinner.
6. Time of day—blood sugar can be harder to control the later it gets.
7. Dawn phenomenon—people have a surge in hormones early in the morning whether they have diabetes or not. For people with diabetes, blood sugar can spike.
8. Dehydration—less water in your body means a higher blood sugar concentration.
9. Nose spray—some have chemicals that trigger your liver to make more blood sugar.
10. Gum disease—it’s both a complication of diabetes and a blood sugar spiker.

Watch out for other triggers that can make your blood sugar fall. For example, extreme heat can cause blood vessels to dilate, which makes insulin absorb more quickly and could lead to low blood sugar. If an activity or food or situation is new, be sure to check your blood sugar levels before and after to see how you respond.

Carbohydrates and Blood Sugar | The Nutrition Source

When people eat a food containing carbohydrates, the digestive system breaks down the digestible ones into sugar, which enters the blood.

• As blood sugar levels rise, the pancreas produces insulin, a hormone that prompts cells to absorb blood sugar for energy or storage.
• As cells absorb blood sugar, levels in the bloodstream begin to fall.
• When this happens, the pancreas start making glucagon, a hormone that signals the liver to start releasing stored sugar.
• This interplay of insulin and glucagon ensure that cells throughout the body, and especially in the brain, have a steady supply of blood sugar.

Carbohydrate metabolism is important in the development of type 2 diabetes, which occurs when the body can’t make enough insulin or can’t properly use the insulin it makes.

• Type 2 diabetes usually develops gradually over a number of years, beginning when muscle and other cells stop responding to insulin. This condition, known as insulin resistance, causes blood sugar and insulin levels to stay high long after eating. Over time, the heavy demands made on the insulin-making cells wears them out, and insulin production eventually stops.

Glycemic index

In the past, carbohydrates were commonly classified as being either “simple” or “complex,” and described as follows:

Simple carbohydrates:

These carbohydrates are composed of sugars (such as fructose and glucose) which have simple chemical structures composed of only one sugar (monosaccharides) or two sugars (disaccharides). Simple carbohydrates are easily and quickly utilized for energy by the body because of their simple chemical structure, often leading to a faster rise in blood sugar and insulin secretion from the pancreas – which can have negative health effects.

Complex carbohydrates:

These carbohydrates have more complex chemical structures, with three or more sugars linked together (known as oligosaccharides and polysaccharides).  Many complex carbohydrate foods contain fiber, vitamins and minerals, and they take longer to digest – which means they have less of an immediate impact on blood sugar, causing it to rise more slowly. But other so called complex carbohydrate foods such as white bread and white potatoes contain mostly starch but little fiber or other beneficial nutrients.

Dividing carbohydrates into simple and complex, however, does not account for the effect of carbohydrates on blood sugar and chronic diseases. To explain how different kinds of carbohydrate-rich foods directly affect blood sugar, the glycemic index was developed and is considered a better way of categorizing carbohydrates, especially starchy foods.

The glycemic index ranks carbohydrates on a scale from 0 to 100 based on how quickly and how much they raise blood sugar levels after eating. Foods with a high glycemic index, like white bread, are rapidly digested and cause substantial fluctuations in blood sugar. Foods with a low glycemic index, like whole oats, are digested more slowly, prompting a more gradual rise in blood sugar.

• Low-glycemic foods have a rating of 55 or less, and foods rated 70-100 are considered high-glycemic foods. Medium-level foods have a glycemic index of 56-69.
• Eating many high-glycemic-index foods – which cause powerful spikes in blood sugar – can lead to an increased risk for type 2 diabetes, (2) heart disease, (3), (4) and overweight, (5,6) (7). There is also preliminary work linking high-glycemic diets to age-related macular degeneration, (8) ovulatory infertility, (9) and colorectal cancer. (10)
• Foods with a low glycemic index have been shown to help control type 2 diabetes and improve weight loss.
• A 2014 review of studies researching carbohydrate quality and chronic disease risk showed that low-glycemic-index diets may offer anti-inflammatory benefits. (16)
• The University of Sydney in Australia maintains a searchable database of foods and their corresponding glycemic indices.

Many factors can affect a food’s glycemic index, including the following:

• Processing: Grains that have been milled and refined—removing the bran and the germ—have a higher glycemic index than minimally processed whole grains.
• Physical form: Finely ground grain is more rapidly digested than coarsely ground grain. This is why eating whole grains in their “whole form” like brown rice or oats can be healthier than eating highly processed whole grain bread.
• Fiber content: High-fiber foods don’t contain as much digestible carbohydrate, so it slows the rate of digestion and causes a more gradual and lower rise in blood sugar. (17)
• Ripeness: Ripe fruits and vegetables tend to have a higher glycemic index than un-ripened fruit.
• Fat content and acid content: Meals with fat or acid are converted more slowly into sugar.

Numerous epidemiologic studies have shown a positive association between higher dietary glycemic index and increased risk of type 2 diabetes and coronary heart disease. However, the relationship between glycemic index and body weight is less well studied and remains controversial.

Glycemic load

One thing that a food’s glycemic index does not tell us is how much digestible carbohydrate – the total amount of carbohydrates excluding  fiber – it delivers. That’s why researchers developed a related way to classify foods that takes into account both the amount of carbohydrate in the food in relation to its impact on blood sugar levels. This measure is called the glycemic load. (11,12) A food’s glycemic load is determined by multiplying its glycemic index by the amount of carbohydrate the food contains. In general, a glycemic load of 20 or more is high, 11 to 19 is medium, and 10 or under is low.

The glycemic load has been used to study whether or not high-glycemic load diets are associated with increased risks for type 2 diabetes risk and cardiac events. In a large meta-analysis of 24 prospective cohort studies, researchers concluded that people who consumed lower-glycemic load diets were at a lower risk of developing type 2 diabetes than those who ate a diet of higher-glycemic load foods. (13) A similar type of meta-analysis concluded that higher-glycemic load diets were also associated with an increased risk for coronary heart disease events. (14)

Here is a listing of low, medium, and high glycemic load foods. For good health, choose foods that have a low or medium glycemic load, and limit foods that have a high glycemic load.

Low glycemic load (10 or under)

• Bran cereals
• Apple
• Orange
• Kidney beans
• Black beans
• Lentils
• Wheat tortilla
• Skim milk
• Cashews
• Peanuts
• Carrots

Medium glycemic load (11-19)

• Pearled barley: 1 cup cooked
• Brown rice: 3/4 cup cooked
• Oatmeal: 1 cup cooked
• Bulgur: 3/4 cup cooked
• Rice cakes: 3 cakes
• Whole grain breads: 1 slice
• Whole-grain pasta: 1 1/4 cup cooked

High glycemic load (20+)

• Baked potato
• French fries
• Refined breakfast cereal: 1 oz
• Sugar-sweetened beverages: 12 oz
• Candy bars: 1 2-oz bar or 3 mini bars
• Couscous: 1 cup cooked
• White basmati rice: 1 cup cooked
• White-flour pasta: 1 1/4 cup cooked (15)

Here’s a list of the glycemic index and glycemic load for the most common foods.

References

2. de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007;4:e261.

3. Beulens JW, de Bruijne LM, Stolk RP, et al. High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. J Am Coll Cardiol. 2007;50:14-21.

4. Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002.

5. Anderson JW, Randles KM, Kendall CW, Jenkins DJ. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr. 2004;23:5-17.

6. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA. 2007;297:2092-102.

7. Maki KC, Rains TM, Kaden VN, Raneri KR, Davidson MH. Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults. Am J Clin Nutr. 2007;85:724-34.

8. Chiu CJ, Hubbard LD, Armstrong J, et al. Dietary glycemic index and carbohydrate in relation to early age-related macular degeneration. Am J Clin Nutr. 2006;83:880-6.

9. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63:78-86.

10. Higginbotham S, Zhang ZF, Lee IM, et al. Dietary glycemic load and risk of colorectal cancer in the Women’s Health Study. J Natl Cancer Inst. 2004;96:229-33.

11. Liu S, Willett WC. Dietary glycemic load and atherothrombotic risk. Curr Atheroscler Rep. 2002;4:454-61.

12. Willett W, Manson J, Liu S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr. 2002;76:274S-80S.

13. Livesey G, Taylor R, Livesey H, Liu S. Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. Am J Clin Nutr. 2013;97:584-96.

14. Mirrahimi A, de Souza RJ, Chiavaroli L, et al. Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts. J Am Heart Assoc. 2012;1:e000752.

15. Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76:5-56.

16. Buyken, AE, Goletzke, J, Joslowski, G, Felbick, A, Cheng, G, Herder, C, Brand-Miller, JC. Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies. The American Journal of Clinical Nutrition Am J Clin Nutr. 99(4): 2014;813-33.

17. AlEssa H, Bupathiraju S, Malik V, Wedick N, Campos H, Rosner B, Willett W, Hu FB. Carbohydrate quality measured using multiple quality metrics is negatively associated with type 2 diabetes. Circulation. 2015; 1-31:A:20.

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How to Manage High Blood Glucose After Meals

Several years ago, I wrote an article for Diabetes Self-Management about the management of high blood glucose after meals. It was called “Strike the Spike” and no article I’ve ever written has led to greater reader response. To this day, I still receive calls and e-mails thanking me for offering practical answers to this perplexing challenge. I’ve even been asked to speak on the topic at some major conferences. So when presented with the opportunity to readdress the issue, I jumped at the chance.

A lot has changed in recent years: we know more than ever about the harmful effects of after-meal blood sugar spikes, but we also have a number of potent new tools and techniques for preventing them. And now that I know how meaningful this topic is to so many people, I’ll do my absolute best to provide some answers.

What’s a spike, and why do they happen?

After-meal, or “postprandial,” spikes are temporary high blood glucose levels that occur soon after eating. It is normal for the level of glucose in the blood to rise a small amount after eating, even in people who do not have diabetes. However, if the rise is too high, it can affect your quality of life today and contribute to serious health problems down the road.

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Learn More About Blood Glucose Management >>

The reason blood glucose tends to spike after eating in many people with diabetes is a simple matter of timing. In a person who doesn’t have diabetes, eating foods containing carbohydrate causes two important reactions in the pancreas: the immediate release of insulin into the bloodstream, and the release of a hormone called amylin. The insulin starts working almost immediately (to move glucose out of the bloodstream and into cells) and finishes its job in a matter of minutes. The amylin keeps food from reaching the small intestine too quickly (where the nutrients are absorbed into the bloodstream). As a result, the moment blood glucose starts to rise, insulin is there to sweep the incoming glucose into the body’s cells. In most cases, the after-meal blood glucose rise is barely noticeable.

However, in people with diabetes, the situation is like that of a batter with very slow reflexes facing a pitcher who throws 98-mph fastballs: The timing is all fouled up. Rapid-acting insulin that is injected (or infused by a pump) at mealtimes takes approximately 15 minutes to start working, 60–90 minutes to “peak,” or reach maximum effectiveness, and four hours or more to finish working. (Afrezza, an ultra-rapid-acting inhalable insulin, begins working within 12–15 minutes of inhaling it, peaks at about 30 minutes, and lasts for about three hours.) Meanwhile, amylin is either produced in insufficient amounts or not at all, so the movement of food from the stomach to the intestines is not slowed the way it should be. As a result, food digests even faster than usual. This combination of slower insulin and faster food can cause the blood glucose level to rise quite high soon after eating. Once the mealtime insulin finally kicks in, the high is followed by a sharp drop.

Why are blood glucose spikes a problem?

Even though after-meal blood glucose spikes are temporary, several spikes a day, day after day, can raise your glycosylated hemoglobin, or HbA1c level, and a high HbA1c level has been shown to raise the risk of long-term diabetes complications.

Your HbA1c test result reflects your average blood glucose level for all times of day (before and after meals) over the past two to three months, with the more recent weeks influencing the result more than earlier weeks. So if your pre-meal blood glucose average is 130 mg/dl for a given three-month period, and your post-meal average is 240 mg/dl, your HbA1c will probably reflect an overall average somewhere in the middle of these two numbers.

Interestingly, research has shown that for people with an HbA1c below 7.5%, post-meal blood glucose readings have a greater influence on HbA1c than pre-meal readings. In other words, lowering your pre-meal readings will only get you so far. If you want your HbA1c level to be as close to normal as possible, you need to pay attention to your after-meal numbers as well.

The long-term effects of high blood glucose levels after meals have been studied extensively. For people with type 1 diabetes, significant after-meal rises have been shown to produce earlier onset of kidney disease and to accelerate the progression of existing retinopathy, the eye problem most commonly associated with diabetes. In people with type 2 diabetes, high blood glucose after meals is a risk factor for cardiovascular problems. Recently, post-meal spikes and glucose “variability” has been associated with diminished brain function and an increased risk of dementia.

But the problems are not limited to long-term complications. Any time blood glucose levels rise particularly high, even temporarily, quality of life suffers. Energy decreases, brain function falters, physical and athletic abilities become diminished, and moods become altered. An Australian study of young people with type 1 diabetes indicated that short-term high blood glucose negatively affects thinking performance, coordination, and emotions and moods. A study conducted on people with type 2 diabetes showed that sharp rises in blood glucose level slowed mental performance, lowered attention, reduced energy levels, and led to feelings of sadness and tension.

And don’t forget: What goes up must come down. The rapid blood glucose decline that usually follows a post-meal spike can cause false hypoglycemia symptoms. This is referred to as “relative hypoglycemia.” The sharp drop from a high blood glucose to a normal level can fool the brain into thinking that there is a crisis, and low blood glucose symptoms can result.

Additionally, the effects of a bout of post-meal high blood glucose do not go away immediately when blood glucose returns to normal. Each episode of high blood glucose can alter the way certain genes function, resulting in the production of harmful chemicals called free radicals, which cause inflammation and damage to the linings of the blood vessels for hours, if not days. So clearly, post-meal spikes represent a challenge worthy of attention.

Measuring spikes

The exact timing of a high blood glucose spike can vary from person to person and meal to meal. However, on average, after-meal peaks tend to occur about one hour and 15 minutes after the start of a meal. So checking your blood glucose (using a blood sample from a finger-stick) about an hour after finishing a meal should provide a good indication of how much of a spike is taking place. Check before and after breakfast, lunch and dinner several times to determine how much of a spike is taking place after each of these meals. It is most common to see significant spikes after breakfast, but check after each meal at least a few times just to see what is happening.

A better way to measure post-meal patterns is by using a continuous glucose monitor (CGM). These systems, available from Medtronic, Dexcom, Abbott and Senseonics, provide glucose readings every couple of minutes so you won’t miss the peak, whenever it happens to occur. They also produce trend graphs that make it easy to see exactly what is happening after meals. See example below:

Personal CGM systems can be purchased for long-term or ongoing use. Some specialized diabetes centers offer them on a temporary loaner basis just to get a sense of what is happening with your blood glucose at all times. CGM systems include a tiny disposable sensor filament placed just below the skin, a small transmitter attached to the sensor, and a receiver that displays your data. The receiver can take the form of a handheld device, an insulin pump, a smartphone, or even a smartwatch. The data from all of the systems is uploadable to a computer for analysis of the information.

Whether you use finger-sticks or a CGM, when interpreting your numbers, take your pre-meal readings into account. A high or low reading before the meal will usually contribute to a higher reading after the meal. For example, a pre-meal blood glucose of 210 mg/dl followed by a 1-hour post-meal reading of 240 mg/dl shows just a 30-point rise, whereas a 110 mg/dl followed by a 240 mg/dl shows a 130-point rise. Lows before meals usually affect rates of digestion and may trigger a hormonal “rebound” to produce much higher readings.

So exactly how high is too high after a meal? There is no universal consensus on this issue. The American Diabetes Association recommends keeping blood glucose below 180 mg/dl one to two hours after the start of a meal. The European Diabetes Policy Group recommends keeping it below 165 mg/dl at the peak, and the American Association of Clinical Endocrinologists and the International Diabetes Federation recommend keeping it below 140 mg/dl after eating. However, no specific guidelines are provided by any of these groups for type 1 versus type 2 diabetes, insulin users versus non-users, or children versus adults.

Based on my experience, I recommend the following after-meal goals for the following groups. These numbers are generally achievable, lead to a decent HbA1c level, and do not interfere with daily quality of life:

• Adults who take mealtime insulin: below 180 mg/dl
• Adolescents (12–18): below 200 mg/dl
• School-age children (6–11): below 225 mg/dl
• Preschool-age and toddlers (5 or younger): below 250 mg/dl
• People with type 2 diabetes who do not take mealtime insulin: below 140 mg/dl

After-meal readings that are consistently above these levels should be addressed by you and your healthcare team (see strategies in the sections below).

Another way to assess after-meal blood glucose control is with a blood test trade-named GlycoMark. The test measures the level of a specific type of sugar (1,5-anhydroglucitol, or 1,5-AG) that becomes depleted whenever the kidneys are spilling glucose into the urine; this typically occurs when blood glucose exceeds approximately 180 mg/dl. The test result reflects blood glucose levels over the prior one to two weeks. A low GlycoMark score means that you are spending considerable time with blood glucose levels above 180. So if your HbA1c is normal (or low) and your GlycoMark is also low, you are likely spiking quite a lot after meals.

Medical approaches to spike control

A common approach to lowering after-meal blood glucose spikes is to take more insulin. But unless blood glucose levels remain high for three to six hours after eating, taking more insulin is not going to solve the problem. In fact, increasing mealtime insulin will most likely result in low blood glucose before the next meal.

Here are some strategies that may work better:

Choose the right insulin.

The right insulin program can make or break your ability to control after-meal spikes. In general, insulins and other medicines that work quickly and for a short time will work better than those that work slowly over a prolonged period.

For instance, rapid-acting insulin analogs (brand names Humalog, NovoLog, and Apidra), which start working 10–15 minutes after injection and peak in about an hour, will cover the after-meal blood glucose rises much better than Regular insulin, which takes 30 minutes to begin working and 2–3 hours to peak.

Newer ultra-rapid insulins, such as Fiasp (insulin aspart), works even faster, with an onset and peak occurring 8–10 minutes earlier than traditional rapid-acting insulins.

The way insulin is administered can dramatically affect its speed of action. Afrezza (insulin human inhalation power) is an inhaled insulin formulation that can be used at mealtimes. Because the dry powder is absorbed through the lungs (rather than having to go through the fat layer below the skin), its onset and peak are much earlier than injected insulin (it takes 12–15 minutes to begin working and peaks in about 30 minutes).

Research has also shown that injected insulin can work much faster when the injection (or infusion) site is warmed. This can be accomplished by rubbing the site, immersing in warm water or exercising the muscle near the site. Warming the site causes the blood vessels near the skin to dilate, which allows the insulin to absorb more quickly. By the way, smoking causes the blood vessels to constrict, so quitting smoking might improve your post-meal blood sugar (in addition to helping you and those around you to live longer).

If you use a morning injection of NPH insulin to “cover” the carbohydrate eaten in the middle of the day, your blood glucose level after lunch and after any daytime snacks is likely to be very high. This is also the case if you take a premixed insulin (75/25, 70/30, or 50/50) twice daily. For fewer spikes, consider taking a rapid-acting insulin before each meal or snack and using a long-acting “basal” insulin such as Lantus, Levemir, Toujeo or Basaglar for coverage between meals.

Time your bolus insulin properly.

For people who take rapid-acting insulin at mealtimes, the timing of the bolus can have a huge impact on after-meal blood glucose levels. Boluses given too late to match the entry of glucose from dietary carbohydrates into the bloodstream can produce significant blood glucose spikes soon after eating. A properly timed bolus, on the other hand, can result in excellent after-meal control.

Unless you have gastroparesis (slowed stomach emptying, usually caused by nerve damage), it is best to give bolus insulin doses before eating. How long before? It depends mainly on what you are eating and on your pre-meal blood glucose level.

Figuring out the pre-meal blood glucose part is fairly straightforward: the higher your blood glucose, the earlier the bolus should be given. If your pre-meal blood glucose is well above your target, it is best to give the bolus and then wait at least 30 minutes before eating. Near your target blood glucose? Wait 15 minutes. Below target? Either take the bolus and eat right away, or take the bolus after eating to manage high blood glucose. 

Does earlier bolusing make a difference? Absolutely. Research has shown that simply giving mealtime boluses before eating rather than after eating can reduce the post-meal spike by about 45 mg/dl.

Bolus for the basal.

For people who use insulin pumps, one way to have more insulin working right after eating and less working several hours later is to give what John Walsh, coauthor of the “Pumping Insulin” books, calls a “super bolus.” This is done by substantially reducing the basal rate for three hours before eating, then adding the amount of insulin that wasn’t given as basal insulin to the normal pre-meal bolus. For example, if your normal basal rate in the morning is 0.6 units per hour, you could set a temporary basal rate of 10% (90% reduction), for the three hours before breakfast, then bolus an extra 1.8 units at breakfast.

Choose the right medication.

Two classes of injectable hormones, GLP-1 agonists (exenatide [Byetta, Bydureon], liraglutide [Victoza], albiglutide [Tanzeum], dulaglutide [Trulicity], lixisenatide (Adlyxin), semaglutide [Ozempic, Rybelsus]) and amylin mimetics (pramlintide [Symlin]), have powerful effects on post-meal blood sugar. Both GLP-1s and Symlin slow gastric emptying and keep carbohydrates from raising the blood sugar too quickly after meals. Symlin, which is a replacement for the amylin hormone (which is lacking in people with diabetes), also helps to diminish appetite and blunt post-meal glucagon secretion. GLP-1s blunt appetite and promote the growth of insulin-producing cells in the pancreas of those with type 2 diabetes. So both can contribute to better post-meal high blood glucose control.

Your choice of oral medication can also impact your after-meal control. Sulfonylureas (glyburide, glipizide, glimepiride) stimulate the pancreas to secrete a little extra insulin throughout the day, without regard to meal timing. Because these medications fail to concentrate the insulin secretion at times when it is needed most, after-meal blood sugars can run very high. There are alternative medications called meglitinides (epaglinide [Prandin], nateglinide [Starlix]) which also stimulate the pancreas but do so in a much faster and shorter manner. When taken at mealtimes, meglitinides produce better after-meal high blood glucose control than sulfonylureas.

Another class of oral diabetes medications (alpha-glucosidase inhibitors) improve after-meal control by partially blocking the transport of sugars across the intestines and into the bloodstream. However, these medications can sometimes cause gas, bloating and stomach upset, so the pros don’t always outweigh the cons.

Lifestyle approaches

Like much of diabetes management, medicine is only part of the story in preventing after-meal spikes: Diet and exercise can play a role as well. Here’s how:

Think lower GI.

As mentioned earlier, the glycemic index is a rating of how quickly a food raises the blood glucose level. While all carbohydrates (except for fiber) convert into glucose eventually, some forms do so much faster than others.

Many starchy foods (such as breads, cereals, potatoes and rice) have a high glycemic index; they digest easily and convert into blood glucose quickly. However, some starchy foods (such as pasta, beans and peas) have lower glycemic index values. Foods that have dextrose in them — such as glucose tablets and gel and candies such as SweeTarts, Smarties, Spree, Runts, Nerds, and AirHeads — tend to have a very high glycemic index, which could lead to high blood glucose levels. Table sugar (sucrose) and fructose (fruit sugar) have moderate glycemic index values, while lactose (milk sugar) is slower to raise blood glucose.

A number of books, notably Dr. Jennie Brand-Miller’s “Glucose Revolution” series, contain extensive information about the glycemic index, along with lists of glycemic index values for hundreds of foods.

As a general rule, switching to lower-glycemic-index foods will help to reduce your after-meal high blood glucose spikes. There are a number of characteristics that slow down the rate at which foods are digested and raise blood glucose. Here are some of them:

• Foods that contain soluble fiber (such as legumes, oats and psyllium) are digested more slowly than low-fiber carbohydrate foods and than foods that are high in insoluble fiber that has been finely ground, such as whole-wheat flour.
• High-fat foods are digested more slowly than low-fat foods.
• Solids are digested more slowly than liquids.
• Cold foods are digested more slowly than hot foods.
• Under-ripe and undercooked foods are digested more slowly than fully ripe or well-cooked foods.
• Whole foods (such as unprocessed grains, legumes, and dried beans) are digested more slowly than milled or processed foods.

Another food property that affects the rate of digestion is acidity. This is why sourdough bread has a much lower glycemic index value than regular bread. Research has shown that adding acidity to a meal in the form of vinegar (straight or consumed as part of a salad dressing or other condiment) can reduce the one-hour post-meal blood glucose rise by 50% or more.

This table shows some examples of lower-glycemic-index substitutes for common high-glycemic-index foods.

Split your meal.

The amount you eat has the greatest effect on your blood glucose level after you eat. One way to lower your high blood glucose rise after meals, therefore, is to eat less. But you don’t have to starve: instead, save a portion of your meal for a “snack” one or two hours later. That way, you get all the food you need, but it doesn’t raise your blood glucose all at once.

If you use mealtime insulin, you should still give yourself your full mealtime dose before eating any of the meal. For example, if you normally have a bowl of cereal and juice for breakfast, you would take enough insulin to cover both, but then just eat the cereal for breakfast, and postpone the juice until mid-morning to combat high blood glucose. 

Get moving.

Physical activity after eating can reduce post-meal spikes in a number of ways. If you took insulin before your meal or snack, the enhanced blood flow to the skin surface caused by exercise is likely to make the insulin absorb and act more quickly. Muscle activity also diverts blood flow away from the intestines, resulting in slower absorption of glucose into the bloodstream. In addition, the glucose that does enter the bloodstream is likely to be used by the working muscles, rather than stored for later use.

How much activity is required to experience these benefits? Not much. Ten or 15 minutes (or more) of mild activity will usually get the job done. The key is to avoid sitting for extended periods of time after eating. Instead of reading, watching TV or working on the computer, go for a walk, shoot some hoops or do some chores. Try to schedule your active tasks (housework, yardwork, shopping, walking pets) for after meals. Also attempt to schedule your exercise sessions for after meals to lower high blood glucose. On “date nights,” resist the urge to sit and talk for hours or to head straight for a movie. Instead, go out dancing, bowling or skating.

Prevent hypoglycemia.

Low blood sugar is problematic in many ways. One of the body’s typical responses to hypoglycemia is to speed up the rate at which the stomach empties. That means food digests and raises blood glucose even more rapidly than usual. While this is certainly desirable when you’re low, it does contribute to post-meal spikes. Preventing hypoglycemia before meals and snacks, therefore, is yet another effective strategy for controlling post-meal blood glucose levels.

Time to strike high blood glucose!

Given the many short- and long-term benefits of post-meal blood glucose control, it is certainly worth the effort to start measuring and evaluating your after-meal control. If your blood glucose levels are higher than they should be, talk with your healthcare team about new or different medical treatments that might help. And take a look at your personal choices in terms of food and activity. Even without a perfectly functioning pancreas, there is still a multitude of options for tackling those high blood glucose spikes!

Want to learn about additional strategies that may help reduce after-meal blood sugar? Read “Walking Significantly Reduces After-Meal Glucose,” “Vinegar Reduce After-Meal Glucose,” “Dealing With After-Meal Blood Sugar Spikes? Don’t Skip Breakfast,” and “Eat More Protein at Breakfast to Prevent After-Meal Blood Sugar Spikes.”

Originally Published February 1, 2021

High Blood Sugar Levels in the Morning: Causes and Prevention

What causes high blood sugar levels in the morning?

Commonly known reasons why your blood sugar may be high in the morning include high-carb bedtime snacks and not enough diabetes medications.

Yet two lesser-known reasons may be causing your morning blood sugar woes: the dawn phenomenon and the Somogyi effect. These causes of high morning blood sugar levels are a result of body changes and reactions that happen while you are sleeping.

What is the dawn phenomenon?

Your body uses glucose (sugar) for energy and it is important to have enough extra energy to be able to wake up in the morning. So for a period of time in the early morning hours, usually between 3 a.m. and 8 a.m., your body starts churning out stored glucose to prepare for the upcoming day.

At the same time, your body releases hormones that reduce your sensitivity to insulin. In addition, these events may be happening while your diabetes medication doses taken the day before are wearing off.

These events cause your body’s blood sugar levels to rise in the morning (at “dawn”).

What is the Somogyi effect?

A second possible cause of high blood sugar levels in the morning is the Somogyi effect, sometimes also called rebound hyperglycemia. It was named after the doctor who first wrote about it.

If your blood sugar drops too low in the middle of the night while you are sleeping, your body will release hormones in an attempt to “rescue” you from the dangerously low blood sugar. The hormones do this by prompting your liver to release stored glucose in larger amounts than usual. But this system isn’t perfect in a person with diabetes, so the liver releases more sugar than needed which leads to a high blood sugar level in the morning. This is the Somogyi effect.

How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sugar levels?

Your doctor will likely ask you to check your blood sugar levels between 2 a.m. and 3 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected. If the blood sugar is normal during this time period, the dawn phenomenon is more likely to be the cause.

Some additional clues that the Somogyi effect may be the cause include nightmares, restless sleep and overnight sweating as these are all signs of low blood sugar levels.

How can high blood sugar levels in the morning be controlled?

Once you and your doctor determine how your blood sugar levels are behaving at night, he or she can advise you about the changes you need to make to better control them. Options that your doctor may discuss depend on the cause of the morning high blood sugars.

For dawn phenomenon:

• Changing the timing or type of your diabetes medications
• Eating a lighter breakfast
• Increasing your morning dose of diabetes medication
• If you take insulin, switching to an insulin pump and programming it to release additional insulin in the morning

For Somogyi effect:

• Decreasing the dose of diabetes medications that are causing overnight lows
• Adding a bedtime snack that includes carbs
• Doing evening exercise earlier
• If you take insulin, switching to an insulin pump and programming it to release less insulin overnight

Good to Know: Factors Affecting Blood Glucose

Clin Diabetes. 2018 Apr; 36(2): 202.

Copyright © 2018 by the American Diabetes Association.This article has been cited by other articles in PMC.

Before you had diabetes, no matter what you ate or how active you were, your blood glucose (sugar) levels stayed within a normal range. But with diabetes, your blood glucose level can rise higher, and some diabetes medications can make them go lower than normal. Many factors can change your blood glucose levels. Learning about these factors can help you control them.

You can use your blood glucose levels to make decisions about food and activity. These decisions can help you delay or prevent diabetes complications such as heart attack, kidney disease, blindness, and amputation. Keeping your diabetes ABCs on track is the most effective way to prevent diabetes-related health problems.

WHAT CAN MAKE MY BLOOD GLUCOSE RISE?

• Too much food, such as a meal or snack with more carbohydrates than usual

• Not being active

• Not enough insulin or oral diabetes medications

• Side effects from other medications, such as steroids or antipsychotic medications

• Illness—your body releases hormones to fight the illness, and those hormones raise blood glucose levels

• Stress, which can produce hormones that raise blood glucose levels

• Short- or long-term pain, such as pain from a sunburn—your body releases hormones that raise blood glucose levels

• Menstrual periods, which cause changes in hormone levels

• Dehydration

WHAT CAN MAKE MY BLOOD GLUCOSE FALL?

• Not enough food, such as a meal or snack with fewer carbohydrates than usual or a missed meal or snack

• Alcohol, especially on an empty stomach

• Too much insulin or oral diabetes medications

• Side effects from other medications

• More physical activity or exercise than usual—physical activity makes your body more sensitive to insulin and can lower blood glucose

HOW CAN I TRACK MY BLOOD GLUCOSE?

There are two ways to keep track of your blood glucose levels:

• Using a blood glucose meter to measure your blood glucose level at that moment

• Getting an A1C test at least twice a year to find out your average blood glucose for the past 2 to 3 months

This hand-out was published in Clinical Diabetes, Vol. 36, issue 2, 2018, and was adapted from the American Diabetes Association’s Diabetes Advisor handout “Factors Affecting Blood Glucose.” Visit the Association’s Patient Education Library at http://professional.diabetes.org/PatientEd for hundreds of free, downloadable handouts in English and Spanish. Distribute these to your patients and share them with others on your health care team. Copyright American Diabetes Association, Inc., 2018.

Blood Sugar and Insulin at Work

Understanding how sugar (glucose) and insulin work in your body is the foundation for knowing how diabetes works. By knowing what can affect your blood sugar levels, you can better manage it.

The basics of high blood sugar

Diabetes is a problem with your body that causes blood sugar (also called blood glucose) levels to rise higher than normal. This is also called hyperglycemia.

When you eat, your body breaks food down into sugar and sends it into the blood. Insulin then helps move the sugar from the blood into your cells. When sugar enters your cells, it is either used as fuel for energy right away or stored for later use. In a person with diabetes, there is a problem with insulin. But, not everyone with diabetes has the same problem. 

There are different types of diabetes—type 1, type 2 and gestational diabetes. If you have diabetes—type 1, type 2 or gestational—your body either doesn’t make enough insulin, can’t use the insulin well, or both.

Learn more about blood sugar     Learn more about insulin

Type 1

In type 1 diabetes, your immune system mistakenly treats the beta cells in your pancreas that make insulin as foreign invaders and destroys them. This can happen over a few weeks, months, or years.

When enough beta cells are gone, your pancreas stops making insulin or makes so little insulin that you need to take insulin to live. Type 1 diabetes develops most often in young people but can also appear in adults. 

Type 2

If you have type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, the beta cells make extra insulin to make up for it. But, over time your pancreas can’t make enough insulin to keep your blood sugar at normal levels. Type 2 diabetes develops most often in middle-aged and older adults but can appear in young people.

Some people can manage type 2 diabetes with healthy eating and exercise. However, your doctor may need to prescribe oral medications (pills) and/or insulin to help you meet your target blood sugar levels. Diabetes is a progressive disease. Even if you don’t need to treat your diabetes with medications at first, you may need to over time. 

Gestational diabetes

Gestational diabetes is diabetes that develops during pregnancy. For most women, blood sugar levels will return to normal after giving birth. And if you’ve had gestational diabetes, you will need to be tested regularly since you are at much higher risk for developing type 2 diabetes later in life. 

So, what affects my blood sugar levels?

It is important to understand what can make your blood sugar rise or fall, so that you can take steps to stay on target.

Things that can make blood sugar rise include:

• A meal or snack with more food or more carbohydrates than usual
• Inactivity
• Side effects of medications
• Infection or other illness
• Changes in hormone levels, such as during menstrual periods
• Stress

Things that can make blood sugar fall include:

• A meal or snack with less food or fewer carbohydrates than usual
• Extra activity
• Side effects of other medications
• Missing a meal or snack
• Drinking alcoholic beverages (especially on an empty stomach)

Find out about tests for diabetes

90,000 Topic 1. What is diabetes mellitus?

Key questions:
Definition and concept of SD.
Normal blood glucose numbers.
Glucose in urine.
Glycated hemoglobin and fructosamines.
C-peptide and other assays.

Diabetes mellitus is a group of diseases in which chronically blood glucose levels increase. Normal blood glucose levels are maintained between 3.3 and 5.5 on an empty stomach; after meals – up to 7.8 mmol / l.

There are other units of blood glucose measurement: mg / dl.To convert to mmol / l, the indicator in mg / dl must be divided by 18.

In the body, the blood glucose level is reduced by the hormone insulin , which is produced in the pancreas.

If little insulin is produced, or it is not produced at all, or low-quality insulin is produced, or a person has had the pancreas removed, etc., the level of glucose in the blood rises and the person is diagnosed with diabetes mellitus.

Depending on the cause of the disease, the type of diabetes is established (type 1, type 2, pancreatogenic, etc.)).

In type 1 diabetes, insulin is not produced at all, or very little is produced.

In type 2 diabetes mellitus at the initial stage of the disease, insulin can be produced even in excessive amounts, but its effect is weakened (due to a decrease in the body’s sensitivity to insulin or “low-quality” insulin).

In pancreatogenic diabetes, insulin is not produced after suffering from pancreatitis or removal of the pancreas.

These are the most common types of diabetes, but not all.

A separate condition is gestational diabetes mellitus, which develops in pregnant women and disappears after pregnancy.

Outcome one: high blood glucose levels.

How are types 1 and 2 diabetes different?

Type 1 diabetes develops more often in young people, most often it is an autoimmune disease. Symptoms of diabetes often appear suddenly (thirst, dry mouth, high urine output, sudden weight loss).However, more than 90% of the pancreatic beta cells have already died. This type of diabetes is treated only with insulin.

type 2 develops in older people (although recently more and more young people with type 2 diabetes), overweight, obese people. It often develops without any symptoms and therefore is late detected. For the timely diagnosis of type 2 diabetes, a glucose screening test is carried out for people from risk groups. Type 2 diabetes is treated with a diet, normalization of body weight and pills, i.e.because at the beginning of the disease, insulin is produced. But in the future, the pancreas is depleted, insulin stops being produced, and then insulin is prescribed.

Sometimes situations arise when it is difficult to determine what type of diabetes a person has. For example, there is type 1 diabetes mellitus with a slowly progressive course, when the disease is detected at a more mature age, but the patient is not obese and insulin is immediately required.

What is the basis for the diagnosis of diabetes mellitus?

Diabetes mellitus is established on the basis of blood glucose measurements. The upper limit of the normal blood glucose level from finger on an empty stomach is 5.5 mmol / L , in blood from a vein – 6.0 mmol / L .

If the fasting glucose level ≥ 6.1 mmol / L in the blood from a finger , or ≥ 7.0 mmol / L in the blood from a vein, or after a meal ≥ 11.1 mmol / L in any blood is diagnosed diabetes.

It should be noted that although when determining blood glucose with a glucometer, blood is taken from a finger, most modern glucometers are calibrated for plasma, therefore, when determining blood glucose with a glucometer, one should be guided by the indicators for plasma.

The level of fasting blood glucose in the blood from a finger from 5.6 to 6.0 mmol / L (in the blood from a vein from 6.1 to 6.9 mmol / L) is an intermediate state between normal and diabetes mellitus (“prediabetes”) …

The term “prediabetes” is used as an informal name.

The official name for this condition includes two diagnoses: impaired glucose tolerance and impaired fasting glycemia.

A glucose test can be assigned to the patient to clarify these conditions.BUT! If the fasting glucose level is ≥ 6.1 mmol / L in the blood from a fingerstick, or ≥ 7.0 mmol / L in the blood from a vein, or after meals ≥ 11.1 mmol / L – DO NOT PERFORM THE GLUCOSE TEST!

A very important indicator is glycated hemoglobin. Glycated hemoglobin shows the average blood glucose level over the last 3 months.

Blood glucose binds to hemoglobin, which is contained in the erythrocyte (erythrocyte is an insulin-independent blood cell).When there is a lot of glucose in the blood, then it binds more to hemoglobin. The erythrocyte lives for 120 days, so glycated hemoglobin shows what the average blood glucose level was over the last 3 months.

The level of glycated hemoglobin up to 5.7-6.0% is normal. A glycated hemoglobin level ≥6.5% is a criterion for the diagnosis of diabetes mellitus.

With a glycated hemoglobin level of 5.7-6.4%, one can speak of “prediabetes” (in the absence of criteria for diagnosing diabetes mellitus by the level of blood glucose).

Glycated hemoglobin is used not only as a criterion for diagnosing diabetes mellitus, but also as a criterion for compensating for diabetes mellitus (assessment of compensation for the last 3-4 months).

To assess compensation for the last 3 weeks, an analysis for fructosamines is assigned.

Glucose in urine. Normally, there is no glucose in the urine, because when urine is formed, the kidneys reabsorb all glucose. Glucose in urine occurs when blood glucose levels exceed a certain level (renal threshold) and the kidneys cannot reabsorb all of the glucose.The “renal threshold” for blood glucose is 8-10 mmol / L. Those. when the blood glucose is above this level, the kidneys begin to pass glucose into the urine. If there is glucose in the urine, then during the period of time during which this portion of urine was collected in the bladder, the blood glucose level exceeded the renal threshold. If you measured blood glucose in the morning and it is 5 mmol / l, but there is glucose in the urine, then the glucose level was high at night.

Immunoreactive insulin in blood and C-peptide can be determined to assess pancreatic insulin secretion.

If a person is receiving insulin therapy, then the immunoreactive insulin will show a false value, so in such cases only the C-peptide is detected. C-peptide is part of the insulin molecule.

C-peptide shows how much insulin is produced by the pancreas. Its definition is important in cases where there are doubts whether a given patient needs insulin therapy. Determination of C-peptide is not included in standard examination protocols.

If the C-peptide is reduced, then insulin is indispensable.But with type 1 diabetes, as a rule, it makes no sense to determine the C-peptide, because clinical manifestations usually leave no doubt about the need for insulin therapy.

From other analyzes, one can stop at antidiabetic antibodies . They are detected in patients with type 1 diabetes several years before the onset of the disease, but usually disappear within a few years after the person becomes ill. In the majority of patients, their definition has no practical meaning.

Control and measurement of low and high blood sugar levels

Blood glucose measurement

¹

Blood glucose measurement, also known as Self-Monitoring Blood Glucose, is a method of checking how much glucose (sugar) is in a person’s blood using a glucometer anytime, anywhere.Your doctor may also find out your glucose level by drawing a blood sample that is analyzed in a laboratory.

Normal glucose values ​​for men and non-pregnant women

^*

Your doctor uses a so-called HbA1c test (glycosylated hemoglobin test), which measures the average blood glucose level over the past 3 months.Used for all types of diabetes, this test shows you and your doctor how well you are responding to your treatment regimen. The recommended goal is to keep your level below seven percent (7%), but your doctor will discuss with you which goal is right for you. The HbA1c test is sometimes called the HbA1c hemoglobin test, or glycated hemoglobin.

The importance of self-test

An HbA1c test result will not show the daily effect of food choices and physical activity on blood glucose levels.That is why the meter is one of the best solutions for regularly monitoring fluctuations in blood glucose levels depending on diet, physical activity and other changes. Using a meter allows you to take urgent action to bring your glucose levels back to the levels recommended by your doctor. Your doctor may also rely on meter readings in addition to your HbA1c test to evaluate and adjust your treatment plan.

Relationship between A1c and average blood sugar.

Based on Standards of Medical Care in Diabetes, American Diabetes Association – 2018.

When to Measure

^* and What to Look for – Practical Guide

Use this simple chart to help you know when to measure and what to watch for in order to monitor your blood glucose on a daily basis, especially if you are taking insulin for diabetes.

You may need to test your blood glucose more often than usual ^* if:

• you have hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose)
• You start taking a new prescribed diabetes drug (s)
• The dose of your diabetes drug has been changed
• You are introducing new foods
• you are sick or not feeling well.

* Always check with your doctor when and how often you need to measure your blood glucose.

Record blood glucose results:

• You can keep a Self-Monitoring Diary where you manually record your blood glucose readings.
• You can also ask your doctor for the Self-Monitoring Diary or on the Internet. (Download logbook here)
• Always update your blood glucose records and take them with you when you go to your doctor.They can be used by health care providers to determine the treatment plan you need.

¹ American Diabetes Association. (ADA) Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41, Suppl. 1. Online version May 6, 2018 at http://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf

Diabetes School

Diabetes school

School of diabetes mellitus in questions and answers

What should be done in case of diabetes mellitus? How to properly treat, eat, take care of yourself? And what is required on the part of other adults (parents, teachers, educators, coaches in the sports section and many other people) who have to intersect in life with such children? These and many other questions are answered by the pediatric endocrinologist of the State Budgetary Healthcare Institution “DGP No. 143 DZM” Irina Viktorovna Berezhnova….

What is diabetes mellitus?

Diabetes mellitus is a disease in which blood glucose levels rise significantly. The increase in glucose is associated with a lack of insulin. The most common cause of insulin deficiency is the death of beta cells in the pancreas.

High levels of glucose (sugar) in the blood can harm the body, which is why diabetes is treated to lower and maintain blood sugar close to normal.Currently, diabetes cannot be cured at all, but it is possible and necessary to learn how to live with diabetes.

Insulin is the main agent for maintaining blood glucose levels. Insulin is a hormone. It is produced by the beta cells of the pancreas. The main property of insulin is to lower blood glucose levels. If insulin is no longer produced in the body, it is replaced in the form of a drug. Medicines (insulins) differ in duration of action: ultra-short or short-acting (administered before meals or to correct high blood glucose levels) and medium-duration or long-acting (administered 1-2 times a day, the administration of these insulins does not depend on the intake food).There are several ways to administer insulin: insulin pens and insulin pumps.

Children with diabetes: special?

No. Children with diabetes simply require a little more attention from parents and other adults. During school, in the sports or arts section, the child should be able to measure his blood glucose level and, if necessary, inject himself insulin. An educator, teacher, trainer must understand what diabetes is, that one should not be afraid of it and how to behave correctly if a child needs adult help.

Can a person feel their blood glucose levels?

More often than not, no. This is why it is very important to regularly check your glucose level with a meter or sensor.

What to do in case of hypoglycemia?

1.Measure blood levels with a glucometer

2. Take “fast” carbohydrates (2-5 lumps of sugar, or 1 glass of fruit juice or lemonade, or 1-2 tablespoons of honey or jam, or 4-5 large glucose tablets).

Always carry glucose, sugar cube or juice with you to help with low blood glucose.

3. Measure blood glucose after 10-15 minutes to make sure hypoglycemia is gone.

4. Never go home alone if your glucose levels are low or if you are not feeling as usual. Call your parents or tell the adults who are with you.

5. You should always have information with you (for example, on a card, necklace or bracelet) stating that you have diabetes.

6. Postpone your workout / exercise if your blood glucose is low.

If the child has lost consciousness, lay him on his side, do not put anything in the child’s mouth, call an ambulance. Parents can introduce glucogone.

High blood glucose – hyperglycemia.

High blood sugar is caused by insulin deficiency (high carbohydrate intake, insufficient or missed insulin dose). Remember not to skip the insulin injection! If a child goes to a friend’s party for a holiday, find out in advance about the treats – a large dose or injection of insulin may be needed.For an accurate calculation of the insulin dose, it is better to use the carbohydrate ratio.

Hyperglycemia can also appear with infectious diseases. If the child is sick, it is necessary to measure the blood sugar before meals or after 2 hours. If blood sugar is high (more than 14 mmol / L persists for more than 4 hours, blood or urine ketones should be measured).

What to do with hyperglycemia?

1. Additional insulin injections may be required

2.It is important to observe the drinking regime – at least 1.5-2 liters of liquid per day.

3. If ketones in the blood rise above 3 mmol / liter or if it is impossible to cope with high blood sugar on your own, contact your attending endocrinologist or call an ambulance.

It can sometimes be difficult to distinguish between symptoms of low and high blood glucose. Therefore, it is extremely important, even if you are well, to monitor your blood glucose levels several times a day.And if any complaints appear, take additional measurements.

Preventive measures: what to do?

Not a single prophylactic or therapeutic prescription for diabetes mellitus, including drugs, can replace compensation for carbohydrate metabolism. Every child and his parents should be familiar with a set of preventive measures to reduce the risk of leg injury.

With diabetes mellitus, nerve fibers and blood vessels that supply blood to the legs can be affected.It is caused by high blood glucose (sugar) levels. This damage is called neuropathy (nerve damage). One of the first signs of neuropathy is sensory impairment in the legs. The child may lose the ability to feel touch, pressure, pain and warmth. The ability to feel pain is very important to the body as it warns us of danger. When pain sensitivity is lost, it is very easy to injure the feet without noticing it.

In addition, children with diabetes have a high risk of blood vessel damage.This damage is called angiopathy (vascular damage). This process can occur throughout the body, but most often the vessels of the lower extremities are affected. As a result, any wounds or cuts in the skin can take a long time to heal.

The child may not notice the moment when he injures his leg or rubs a corn. Cuts and wounds may take a long time to heal, and they take a long time to become infected. Children with diabetes are more likely to have infections, especially when their blood glucose levels are high.Constant pressure on a specific area can cause calluses, such as when wearing tight shoes. If the calluses are left untreated, the skin is damaged in this place, and ulcers form in their place.

Here are a few simple rules, strict adherence to which will allow you to get rid of damage and prevent their manifestation.

1. Daily care. Wash your feet daily and dry them, especially between your toes. Examine the skin on your legs carefully. If a child or parents notice any changes in the skin of the legs or believe that its sensitivity has changed, it is necessary to inform the attending physician.Use a moisturizer to soften your skin. The signs of an ideal cream are well known: easy to apply, quickly absorbed, leaves no sticky or greasy residue. Study the composition before buying. If you see parabens or phthalates on the list, leave the cream on the store shelf. But natural ingredients, plant and herbal extracts are what you need. Mint, lavender, calendula, chamomile, tea tree – the list is far from complete, manufacturers use new and new natural ingredients. If you are afraid to make a mistake, look for the label “suitable for people with diabetes” on the packaging.Most importantly, do not forget to test the cream for allergies. Apply a small amount to the back of your forearm and make sure there is no irritation. Soft skin is less prone to cracking. But don’t put moisturizer between your toes, or it will lead to a fungal infection. Remember, do not use any of the following foot products: callus remover, warts remover, rough skin or ingrown toenail remover. If your child has ingrown toenails, see a doctor.

2. Do not use scissors to trim your nails, a nail file is suitable for this purpose. This will help the baby to avoid damage to the skin. And no metal files or scrapers, only gentle pedicure tools.

3. When taking a bath, run cold water first and check the temperature of the water with a special thermometer before diving.

4. No matter how beautiful the rubber slates are, no matter how the rhinestones of leatherette sandals shine in the sun, remember how painful corns and calluses are and give preference to shoes made of natural materials.Leather, cotton or linen are the best choices. Remember that the shoes do not need to be worn out, and if the child experiences discomfort during the fitting, it is better to refuse the purchase. What is convenient is beautiful! Check the seams inside the shoe, as protruding seams can chafe your feet. Lace-up shoes with a soft top provide good support and protection for your feet. If the shape of the child’s feet is deformed, special orthopedic shoes may be required. Check regularly that the soles of your child’s shoes are thick enough to protect the feet.Do not wear slippers for too long as they do not protect your feet properly. The child should wear tight-fitting socks. Too tight socks will interfere with normal circulation, while too loose and wrinkling can cause wounds on the feet.

Complications of diabetes mellitus: what?

There is another problem that children with diabetes mellitus face – retinopathy.This is a complication of diabetes mellitus caused by damage to the retinal vessels. The cause of diabetic retinopathy is long-term decompensation of diabetes, the retinal vessels become more fragile, permeable, and lose elasticity. Over time, this leads to changes in the entire retinal tissue, which can lead to loss of vision. One of the problems in identifying retinopathy is its asymptomatic onset. If your child notices any of the following signs of visual impairment, you should see an ophthalmologist for a timely examination.The presence and severity of diabetic retinopathy can only be determined by an ophthalmologist. These complaints include: blurred vision or double vision, difficulty reading signs or books, pain in one or both eyes, a sharp deterioration in vision in dim lighting, redness of the eyes that does not go away.

Due to a decrease in the body’s defenses in children with diabetes mellitus, inflammatory eye diseases are persistent and long-lasting. Unfortunately, bacteria thrive when there is an excess of nutrient sugar in the blood and tissues.Blepharitis, conjunctivitis, keratitis, multiple barley occur regularly and are difficult to treat. And any injuries and burns to the eyes heal slowly and hard.

How to reduce the risk of diabetic retinopathy.

1. Strict control of blood glucose is a basic rule.

2. Healthy balanced diet.

3. Regular physical activity.

4. It is necessary to observe safety rules during any work: wear protective goggles and do not touch your eyes with dirty hands.Proper eyelid hygiene is essential. After washing your face with warm water, you should cleanse the skin around the eyes from the remnants of cosmetics, household dust and other contaminants using cotton pads, using special hygienic solutions for the eyes. Try, if possible, to limit the time your child spends at a computer, smartphone or tablet. Walk more, take care of your eyes.

Physical activity

Diabetes is not a contraindication for physical education and sports.

Physical activity has a beneficial effect on all types of metabolism. It also has a significant effect on carbohydrate metabolism. With intense physical activity, the sensitivity of the body’s cells to insulin increases, which leads to a decrease in blood glucose levels and a decrease in insulin dosages.

The child can participate in sports competitions and other activities where there is physical activity. But, getting started with classes, you need to understand well how the load affects the blood sugar level and monitor the blood glucose levels.When many muscle groups are involved, they absorb large amounts of glucose, blood sugar levels drop, and the injected insulin continues to work and hypoglycemia may occur.

To prevent its development when playing sports or physical education, a number of conditions must be met:

– compensation of carbohydrate metabolism (physical activity must be postponed both with blood glucose below 5 mmol / l and above 15 mmol / l)

-exhausted diet and insulin therapy

– do not start exercising if you feel unwell or sick

– know the symptoms of hypoglycemia well

– the presence of easily digestible carbohydrates

Remember that hypoglycemia can develop not only during exercise, but also several hours after it ends.

In addition, you need to know that with a lack of insulin in the blood and intense physical activity, cells starve. The liver, having received a signal about cell starvation, releases additional glucose into the blood. But even this glucose does not reach the goal, since it can get into the cells only with the help of insulin, which is just not enough. The more intense the load, the more the liver releases sugar into the blood, the higher the blood sugar level.

Therefore, it is imperative to determine the blood glucose level before exercise, during exercise (especially if it is prolonged) and after its end.

How to optimally distribute physical activity during the day, what kind of sports to do, it is better to discuss with your attending endocrinologist.

Rest and travel.

There are no fundamental restrictions for the recreation of children with diabetes mellitus. In general, children with diabetes can travel and relax just like everyone else. The most important thing is that you should be very familiar with many problems of diabetes mellitus, regularly and competently carry out self-control, if necessary, adjust the dose of insulin in time.If your child is traveling with the class on an excursion or camping trip, it is important that the teachers and parents accompanying the group know what to do if the child feels unwell during the trip due to low or high blood glucose levels. Do not forget to give your child a blood glucose meter, test strips, a pen for injecting insulin, a lancet on the road. In case of hypoglycemia, it is imperative to have sugar, glucose, or juice and additional food with you, so as not to disrupt the food intake.If there is a lot of food on an excursion or holiday that can lead to high blood glucose levels, the child may need an increase in insulin dose or an additional injection. A good solution in this situation is to contact the adult who is organizing the event and find out what kind of food will be.

Since, regardless of the rest, insulin will be needed constantly, you should remember the rules for storing insulin.

· When traveling by plane, it is always worth keeping injector pens with you or in your hand luggage.Under no circumstances should insulin be checked in baggage. Low temperatures in the cargo area will cause the insulin to freeze.

· Keep insulin with you when traveling by public or private transport. Do not place your insulin bag on the rear window shelf or on the console under the windshield, where high temperatures can cause the insulin to lose its properties.

· During summer holidays, insulin should always be protected from direct sunlight and heat over 40 degrees.Under these conditions, insulin remains active and can be used for up to 4 weeks. To protect the pen from direct sunlight, you can wrap it in a damp handkerchief and put it in the shade on the beach.

The rules for storing insulin in the winter are different. In order to prevent the freezing of insulin, it is necessary to wear a syringe-pen under outer clothing. The same rules apply to storing test strips. It is necessary to measure blood sugar at room temperature (about 20 degrees).

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90,000 Let’s beat diabetes together – Official website of the Administration of St. Petersburg

In 2016, at the initiative of WHO, World Health Day will be held under the slogan “Defeat Diabetes”. Diabetes is currently on the rise in many countries, with particularly sharp increases in low- and middle-income countries. In 2012, the disease was the direct cause of about 1.5 million deaths, with 80% of these in low- and middle-income countries.According to WHO forecasts, diabetes will become the seventh leading cause of death by 2030.

Diabetes mellitus is a chronic disease, the main symptom of which is an increase in the level of glucose (sugar) in the blood (or, scientifically, hyperglycemia). Glucose (sugar) is in the blood of every person, since it is the main source of energy. The normal fasting blood glucose level is 3.3–5.5 mmol / l, and 2 hours after a meal – up to 7.8 mmol / l.

There are many mechanisms of diabetes mellitus occurrence and they are quite complex.But the two most common types of diabetes mellitus are type 1 diabetes mellitus and type 2 diabetes mellitus. Despite almost the same name, these are completely different diseases.

There are 2 ways for glucose to enter the body: the first is intake from food containing carbohydrates, the second is the production of glucose by the liver (this is the reason that in diabetes mellitus, even if the patient did not eat anything, the blood glucose level can be increased) …

However, in order to be used as energy, glucose from the blood must go to the muscles (to do work), adipose tissue or the liver (the glucose store in the body).This is due to the action of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as after a meal the blood glucose level rises, the pancreas instantly releases insulin into the blood, which, in turn, binds to receptors on the cells of muscle, adipose or liver tissue and “opens” these cells for glucose to enter them, after which it the blood level returns to normal. Between meals and at night, if necessary, glucose enters the bloodstream from the liver depot, so at night insulin controls the liver so that it does not release too much glucose into the bloodstream.If a violation occurs at any of the stages of this process, diabetes mellitus occurs.

Why is high blood glucose bad? Glucose, which does not enter the cells of muscles, liver and adipose tissue, enters other organs and tissues, for access to which insulin is not needed: vessels of the eyes and kidneys, nervous tissue, walls of large vessels, contributing to the development of complications of diabetes mellitus – retinopathy, nephropathy , neuropathy, atherosclerosis. It is complications that make patients with diabetes disabled and shorten their lives.Thus, maintaining a normal blood glucose level is a guarantee of reducing the risk of developing and progression of complications, in other words, a guarantee of a long and fulfilling life.

If we talk about type 1 diabetes, unfortunately, medicine is currently powerless to prevent this disease.

However, it is quite possible to prevent the development of type 2 diabetes.

Of course, you cannot change your age or family history of prediabetes and type 2 diabetes, but one thing you can do is change your lifestyle by increasing your physical activity and changing your diet, which will lead to weight loss.This, in turn, will reduce the risk of developing prediabetes and type 2 diabetes. These seemingly simple measures – increasing physical activity and losing weight – have proven to be extremely effective. Of course, you will have to make an effort and remember that lifestyle changes are not a temporary measure, but permanent.

Most patients with type 2 diabetes are overweight or obese. You can find out if you are overweight or obese by using the body mass index (BMI) formula.

Body mass index, kg / m2 and correspondence between human body weight and height

16 or less – Severe underweight

16-18.5 – Insufficient (deficiency) body weight

18.5-25 – Norm

25-29.9 – Overweight (pre-obesity)

30-34.9 – Obesity of the first degree

35-39.9 – Second degree obesity

40 and more – Obesity of the third degree (morbid)

The most unfavorable distribution of fat is its deposition on internal organs (the so-called abdominal or visceral obesity), as evidenced by the waist circumference in men 102 cm or more, in women 88 cm.and more.

Some people panic when they hear a diagnosis from a doctor – diabetes mellitus: what to eat and what not. The table of prohibited foods seems endless to them. Meanwhile, it only includes foods high in carbohydrates. Or, as doctors say, with a high glycemic index. Such food is the greatest danger for diabetics, in the body it turns into glucose (sugar).

On the other hand, carbohydrates are an irreplaceable source of energy. A person cannot do without them.Therefore, patients with diabetes mellitus are forced to follow the “golden mean” rule. Give preference to foods with a glycemic index less than 50 units:

– Bread: special diabetic, black rye, whole grain, with bran. And also protein-wheat, “Peasant” (from peeled flour). Not rich flour products: bread, crackers, biscuits.

– Groats: oats (“Hercules”), greche, pearl barley, millet, brown rice.

– Soups: vegetable vegetarian, in a weak broth (meat, fish), on mushroom broth.For example, sorrel cabbage soup, borscht with fresh or sauerkraut.

– Lean red meat, chicken, rabbit, turkey. By-products: tongue (pork, beef), liver. Diet cooked sausage and hot dogs.

– Eggs (chicken, quail). For example, a protein omelet with green onions and tomatoes. – Fish: lean sea and river (cod, notothenia, pike). Seafood (squid, shrimp, crabs). Canned fish (without oil or in tomato sauce).

– Milk, kefir, fermented baked milk, yogurt, varenets, natural yogurt.Grain cottage cheese and cheeses with a low percentage of fat (for example, Adyghe cheese).

– Almost all vegetables, except carrots, beets, green peas, beans and potatoes. Due to its high starch content, its use is limited. Greens: dill, parsley, cilantro, lettuce, celery, spinach, sorrel. And edible wild-growing herbs (nettles, wild garlic, sleepy).

– Unsweetened fruits: apples, citrus fruits, quince, pineapple. Sour berries: cranberries, blueberries, currants, cherries, rose hips, chokeberry.

– Fats of vegetable and animal origin (sunflower, olive, linseed, sesame, butter and ghee).

As you can see, the list of what you can eat with diabetes is not so small. It almost completely coincides with the diet of healthy people who carefully monitor their weight. They want to look good and have a slim figure. It is also very useful for diabetes to drink monastery tea, this herbal tea helps a lot.

“A disease is easier to prevent than to cure” – this statement is true for most diseases.

It is possible and necessary to live a full life with diabetes mellitus.

Take care of yourself and be healthy and happy.

Branch No. 5 FBUZ “Center for Hygiene and Epidemiology in St. Petersburg” in Primorsky,

Petrogradsky, Kurortny, Kronstadt districts

Diabetes | Tervisliku toitumise informatsioon

Diabetes (diabetes mellitus) is a chronic disorder of energy metabolism caused by a low level of insulin synthesis by the pancreas, as well as a weakening of the action of insulin or insufficient supply of it into the blood.

Diabetes is characterized by long-term high blood sugar levels and disorders of carbohydrate, lipid and protein metabolism. After eating, the carbohydrates trapped in the gastrointestinal tract break down to glucose, which is absorbed into the blood. In response to an increase in glucose levels, the pancreas of a healthy person produces insulin.

Insulin is a hormone that allows glucose to enter cells, thus maintaining normal blood sugar levels.With an excessive drop in the level of glucose, in order to provide the body with the necessary amount of it, the glycogen stored there begins to decompose in the liver under the influence of the hormone glucagon. In a healthy person, the blood glucose level drops to the level that was before eating, 3-4 hours after eating; this often does not happen in diabetics.

In the case of insulin resistance or insulin deficiency, glucose does not enter the cells, and the body begins to break down fats and proteins for energy, which, however, is not suitable for all cells.Ketone bodies accumulate in the body, ketosis occurs. In severe cases, the breath may smell like acetone. The body tries to get rid of the excess glucose accumulated in the body through urine.

Two types of diabetes

Type I and Type II diabetes are the most common.

1. The cause of type I diabetes is damage to the insulin-producing beta cells of the pancreas. It is an autoimmune disease, the causes of which are still not completely clear.With this pathology, the human immune system begins to attack its own beta cells. A certain risk factor is heredity. Excessive consumption of sweets is not associated with the risk of diabetes, but in this case there is a risk of becoming overweight, and this is one of the risk factors for type II diabetes. Type I diabetes is usually diagnosed in children and adolescents. Symptoms include thirst, rapid weight loss, and frequent urge to urinate. The disease is currently incurable and requires daily injections of insulin or connecting an insulin pump throughout life.
2. Type II diabetes occurs as a result of disturbances in the mechanisms of action of insulin. In type II diabetes, enough insulin can be produced, but it doesn’t work the way it should.

Type II diabetes occurs in 90% of cases of diabetes. If earlier it was considered a disease of those over 40, today the age of people suffering from it has decreased. Increasingly, this type of diabetes is diagnosed in overweight children. The decline in the age of people with type II diabetes is associated mainly with the Western style of diet and life.Risk factors for type II diabetes are hereditary predisposition, overweight, a sedentary lifestyle and poor diet.

If blood glucose remains high for a long time, or if diabetes is not adequately treated, complications such as a decrease in nerve sensitivity and damage to blood vessels in the eyes, kidneys, legs and other parts of the body can occur.

Gestational diabetes is also distinguished, i.e.e. diabetes during pregnancy, which may, but should not, go away after the baby is born.

Normal and elevated plasma glucose

Diagnosis

7.811.0

You can read more about diabetes diagnostics here.

Excessively low glucose, or hypoglycemia

With diabetes, blood glucose can sometimes drop to too low a level. Hypoglycemia can be caused by too high a concentration of insulin or long intervals between taking some oral medicines for type II diabetes and a meal or injection, strenuous exercise or alcohol abuse.

Usually a person with diabetes feels hypoglycemia is approaching. Hypoglycemia is accompanied by hunger and weakness, increased sweating and imbalance.In severe cases, the patient may lose consciousness, there may be convulsions – then you must immediately call a doctor. In milder cases, it is enough for the diabetic to drink a glass of juice or other sugar-containing drink, eat a few sweets, or take a glucose tablet. It is very important that the people around the person with diabetes are aware of their condition and can provide assistance if needed.

Symptoms of diabetes, and how to live with diabetes

If the blood sugar level rises to high values ​​and this situation persists for a long time, the body begins to excrete excess glucose in the urine.The sugar content in urine can be determined with a simple test. Glucose excreted through the kidneys carries away a lot of water, which makes the amount of urine more than usual. In addition to increased urine volume and increased urge to urinate, diabetes manifests itself as intense thirst as the body tries to replenish fluid.

The key to successful treatment is the correct choice of nutrition, along with which insulin injections (for type I diabetes) or tablets that improve and increase insulin sensitivity (for type II diabetes) are used.In certain cases, and in type II diabetes, insulin injections are required.

Reducing body weight when it is overweight and sufficient physical activity help to mitigate the course of the disease. A diabetic’s diet is suitable for any adherent of a healthy diet, the consumption of easily digestible carbohydrates should be limited, of which there are many, for example, in soft drinks, sweets, sweet rolls, cakes, foods with a high content of starch, such as potatoes, white rice and pasta.

The number of meals depends on the severity of the disease and the treatment regimen.Preference should be given to whole grains, vegetables, lean meats, and low-fat dairy products. It is recommended to satisfy cravings for sweets with fruits and berries. It is better to stew or cook food, rather than fry, vegetable oil in this case is better than hard fats, you can not get carried away with salty ones.

Normal blood glucose

The importance of maintaining normal blood glucose levels

Unlike all other tissues, the brain is not able to synthesize and store glucose and therefore entirely depends on its supply from the blood to meet its energy needs.For the normal functioning of the brain, it is necessary to maintain the blood glucose level at a minimum level – about 3.0 mmol / l. This is very important, but remember that the blood sugar concentration should not be too high. Glucose is an osmotically active substance. This means that with an increase in its content in the blood, following it (in accordance with the laws of osmosis), water from the tissues enters the bloodstream, which leads to relative dehydration. To compensate for this potentially damaging effect, the kidneys begin excreting glucose in the urine when the level exceeds a certain value called the renal threshold (usually 10.0-11.0 mmol / L).In this case, the body loses an important source of energy, which is glucose. Therefore, normally, the concentration of glucose in the blood should not exceed the threshold value, otherwise the body will lose an important source of energy, but also should not fall below a certain level, ensuring the normal functioning of the brain.

How is blood glucose maintained at normal levels?

Despite significant fluctuations in the intake and utilization of glucose during the day, its blood level usually does not rise above 8.0 and does not fall below 3.5 mmol / L.In fig. 3.3 shows typical daily fluctuations in blood glucose concentration.

Immediately after a meal, blood glucose rises as the sugar in food is absorbed from the intestines. Glucose is taken up by the cells of the body to meet their energy needs. Liver cells and myocytes store excess glucose in the form of glycogen molecules. Between meals, the blood glucose is lowered and it is mobilized from the depot to maintain the minimum required blood glucose.If required, glucose can also be obtained from non-carbohydrate sources (for example, proteins) in the process of so-called gluconeogenesis. Both the uptake of glucose by cells and all of its metabolic transformations (glycogenesis, glycogenolysis, etc.) are under the control of hormones, the secretion of which depends on the level of sugar in the blood.

DETERMINATION OF GLUCOSE LEVEL
IN WHOLE BLOOD OR BLOOD PLASMA

Patient preparation

If fasting blood glucose is being tested, the patient should not eat for at least 12 hours prior to blood collection.In other cases, no special patient preparation is required.

Time of blood collection

The blood glucose level changes during the day: it is highest within an hour after a meal, and the lowest in the morning before breakfast. For correct interpretation of the results, the time of blood sampling must be indicated on the direction. Samples can be taken “accidentally” (without reference to food intake), on an empty stomach (after an overnight fast) or 2 hours after eating.

Sample Preparation

2 ml of venous blood is collected in a special test tube containing a glucose preservative (sodium fluoride) and an anticoagulant (potassium oxalate). Fluoride is an enzymatic poison that effectively prevents glycolysis in erythrocytes, thereby maintaining the concentration of glucose in the blood. An anticoagulant prevents blood from clotting. Mix blood with these reagents gently by gently inverting the tube. Glucose can be measured directly in whole blood or in plasma (the fluid that remains after blood cells are removed).

Standards:

Attention! Plasma glucose levels are 10-15% higher than whole blood.

Critical values ​​

These are values ​​<2.2 mmol / L and> 25.0 mmol / L. Severe hypoglycemia, especially in infants, is associated with a high risk of brain damage. Severe hyperglycemia can result from acute life-threatening complications of diabetes, diabetic ketoacidosis, or hyperosmotic (non-ketone) coma.

Terms used in the interpretation of test results:

• normoglycemia – normal blood or plasma glucose levels;
• hyperglycemia – increased blood or plasma glucose levels;
• hypoglycemia – low blood or plasma glucose.

90,000 What is diabetes mellitus

What is diabetes mellitus

What is diabetes mellitus
Diabetes is a disease associated with high blood sugar (glucose) levels.

Why is blood sugar needed and where does it come from?
First, sugar enters the bloodstream from food; secondly – from the sugar reserves, which are contained in the liver. Glucose is the main source of nutrition for all cells (the smallest building blocks of the body).Inside the cell, glucose is converted into energy, which allows the cells to work, and, accordingly, the entire body (as a car cannot drive without gasoline, so a cell cannot work without fuel, which is sugar for it). However, glucose can penetrate into the cell only with the help of insulin.

What is insulin and where is it produced?
Insulin is a hormone produced in the pancreas (beta cells). Beta cells register an increase in blood sugar and respond by sending a certain amount of insulin into the bloodstream, thereby lowering blood sugar levels.

What causes type 2 diabetes?
1. Obesity is the main reason for the development of type 2 diabetes (about 80% of patients with type 2 diabetes are overweight)
2. Heredity (if one parent is sick, then the likelihood of developing diabetes is about 40%, if both parents are 75%)

What happens with type 2 diabetes?
In this disease, the pancreas produces insulin, but it is either insufficient or it does not work well (in most cases, this is due to an excess of adipose tissue in the body, which interferes with the action of insulin, while the insulin content in the blood can significantly exceed the norm).As a result, a large amount of sugar accumulates in the blood and its level rises.

Who has type 2 diabetes?
Previously, it was believed that this type of diabetes mainly affects people over 40-45 years old. However, in recent years, type 2 diabetes mellitus has noticeably “younger”, which is associated with a high prevalence of obesity, incl. and in young people

How is diabetes mellitus diagnosed
Diabetes mellitus is diagnosed when fasting blood sugar (glycemia) is more than 6.1 mmol / L (fasting glycemia means the blood glucose level measured in the morning before breakfast after preliminary fasting for 8 hours).
Also, the diagnosis of diabetes mellitus can be established after the detection of glycemia more than 11.1 mmol / l at any time of the day.
Occasionally, an oral glucose tolerance test is performed to clarify the diagnosis.
(In the morning on an empty stomach, blood is taken for sugar, after which the patient drinks 75 grams of glucose and after 2 hours the blood sugar level is re-examined). If the glycemic level is more than 11.1 mmol / L, repeated measurement is used to establish the diagnosis of diabetes mellitus.

What is the difference between type 1 diabetes mellitus and type 2 diabetes mellitus?
In type 1 diabetes, the pancreas stops producing insulin.The disease occurs at a young age (usually before the age of 40). For these patients, the only treatment is lifelong insulin

How is type 2 diabetes treated?
1. Diet
2. Exercise
3. Anti-sugar pills
4. Sometimes insulin is prescribed

Why do you need to control your blood sugar?
Regular monitoring of sugar levels is the key to successful treatment and prevention of the development of complications of diabetes !!!
It is important to know that periodic measurement of blood sugar in the clinic is not sufficient for good control.It is imperative to regularly measure your blood sugar yourself.

How often should measurements be taken?
Patients with type 2 diabetes mellitus who receive antidiabetic pills should take several measurements per week (at different times of the day). Once every 2 weeks, it is advisable to test blood sugar 4-6 times a day (throughout the day: before meals and 2 hours after meals).

What are blood sugar targets?
These are the sugar levels you should aim for to avoid complications:
• Fasting (before meals) 3.3-6.0 mmol / l
• 2 hours after meals up to 7.8 mmol / l

What is hypoglycemia?
This is a condition in which the blood sugar drops below 3.3 mmol / L. At the same time, you may feel tremors, chills, sweating, hunger, irritability, headache, pallor, palpitations.

What to do in case of hypoglycemia?
You need to eat 4 lumps of sugar or drink 1 small packet of juice (200 ml). Do not use chocolate, sweets, confectionery, bread and fruits to relieve hypoglycemia – they slowly increase blood sugar !!!

How to eat properly with type 2 diabetes?
• Food should contain a sufficient amount of carbohydrates (about 60%), i.e.because they are the main source of nutrition for the cells of the body. Carbohydrates include: bread, potatoes, pasta, buckwheat, rice, oatmeal and other grains, as well as fruits and vegetables. It is important to understand that although these foods increase blood sugar, they do it slowly!
• Exclude fast-digesting carbohydrates (honey, jam, juices, sugary drinks, sugar, sweets), because they raise blood sugar very quickly!
• Weight loss is an integral part of diabetes care. To this end, it is necessary to limit the amount of fat in food as much as possible to 15%.Fats do not increase sugar, they lead to weight gain !!! Fatty foods include: caviar, fatty fish (salmon, salmon, carp, sturgeon, herring) and any fatty meat, canned food in oil, all sausages, sausages and small sausages, lard, cheese with a fat content of more than 40%, seeds and nuts, fatty dairy products, mayonnaise). It is important to know that both butter and all types of vegetable oil are fats and contribute to weight gain, so you need to limit any of its types!
• The daily diet should contain about 30% protein (low-fat fish (perch, cod, icefish), lean meat and poultry; dairy products with a fat content of less than 1.5%; cheese with a fat content <30%). Proteins do not increase blood sugar !!!!

Tips for reducing calorie intake
• Do not fry! Use other cooking methods: baking, boiling, steaming, on a grill, on an open fire
• When cooking meat, poultry, remove the skin and remove all visible fat before cooking
spices, mustard, vinegar, lemon juice) instead of oil and mayonnaise
• Start your meal with a glass of mineral water and vegetable salad, ie.O. You will be able to “trick” the stomach and the satiety process will occur faster
• Try to eat in small portions 4-6 times a day

Is it possible to drink alcoholic beverages in case of diabetes mellitus?
1. Alcohol lowers blood sugar and can lead to the development of hypoglycemia (lowering sugar below 3.3 mmol / l), therefore, you should always eat (bread, potatoes, cereals, pasta, fruits) before drinking it. Remember that in the case of alcohol consumption, the symptoms of hypoglycemia may be “blurred”
2.Drinking alcohol should be moderate !!! (no more than 1 glass of dry wine (or brut) or 50 g of strong alcoholic drink per evening)
3. Eliminate sugary alcoholic beverages
4. Remember that drinking alcohol (especially in large quantities) while being treated with certain drugs to reduce sugar is unsafe (e.g. metformna)

What is glucose-lowering therapy?
Anti-hypoglycemic therapy refers to the various drugs prescribed in diabetes mellitus to lower blood sugar levels.Which pills to prescribe to the patient is decided in each case individually by the doctor.

Exercise
• Regular exercise is extremely beneficial for all patients with diabetes mellitus. they lower blood sugar, help reduce weight, reduce the risk of complications
• Exercise should be individualized according to your age, diabetes complications and comorbidities
• Moderate exercise is recommended for most patients, such as walking instead of driving , climbing stairs instead of elevator
• Remember to exercise regularly (daily walks for 30 minutes, swimming for 1 hour 3 times a week).
• With blood sugar levels above 13-15 mmol / L, physical activity is not recommended – this can lead to an additional increase in blood sugar
• In the absence of serious complications and concomitant diseases, patients with type 2 diabetes can engage in any sports
• Necessary remember that during physical exertion, as well as within a few hours after it, sugar can drop, therefore, in order to prevent hypoglycemia, it is necessary to refuel before and after exercise (for example, with fruits).
• If the intensity of exercise is high (jogging, aerobics, etc.), it is better to drink sweet water during exercise. Before and after exercise, be sure to check your sugar level !!!

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