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Diabetes: What You Need to Know as You Age

Overview

Diabetes is a problem that has many consequences: If you have the disease,
your body can no longer keep its blood sugar at a healthy level. But over
time, the effects of diabetes can become much more complicated. The disease
can lead to serious, even life-threatening problems from your head to your
toes.

Too much blood sugar (also called glucose) can damage the blood vessels and
nerves that run throughout your body. This can set the stage for many other
medical conditions:

  • stroke
  • heart disease
  • kidney disease
  • vision problems and blindness
  • damage to the feet or legs

However, there is good news for the 26 million Americans with diabetes—and
those at risk. Experts are learning more all the time about lifestyle steps
for diabetes control and prevention. New medications and devices can also
help you keep control over your blood sugar and prevent complications, says
Johns Hopkins expert

Rita Kalyani, M. D.

Prevention

Though type 1 diabetes usually develops in childhood or early adulthood, it
can develop later in life. However, it’s not currently known what the exact
risk factors are or how to prevent it.

Women can lower their risk of gestational diabetes by staying active and
keeping a healthy weight before they ever get pregnant, particularly if
they have other risk factors for diabetes.

The form of diabetes you can do a lot to prevent is type 2
diabetes. Usually, people first develop prediabetes before they go on to
have full-blown type 2 diabetes. If you know that you have prediabetes,
making changes to your lifestyle is an important way to keep from
developing diabetes, Kalyani says. Talk to your doctor about some ways to
reduce risk:

Lose (even a little) weight.
The Diabetes Prevention Program, a large-scale study of diabetes prevention
strategies in those at high risk for type 2 diabetes, found that
participants who engaged in 30 minutes of physical activity daily and lost
at least 7 percent of their body weight cut their risk of getting type 2
diabetes by 58 percent. How it works: Losing excess pounds through proper
diet and exercise can improve the body’s ability to use

insulin

and to process glucose more efficiently.

Move more.
To maintain an active lifestyle and reduce risk of diabetes, aim for at
least two and a half hours of exercise each week. You don’t have to work
out hard—even brisk walking can help, says Kalyani.

Enjoy a healthy diet.
Develop an eating plan that helps you lose weight and keep it off. You may
want to work with a dietitian to learn healthy eating habits that you can
follow long-term. Some smart steps: focusing on produce,

whole grains

, and

lean protein

, and cutting back on fat and red meat.

Try medical interventions.
You may need to take medication to lower your chances of developing
diabetes, especially if lifestyle changes aren’t helping enough, Kalyani
states. A drug that doctors often recommend in these cases for persons with

prediabetes

is metformin. It can help you better control your blood sugar by reducing
the amount of glucose that your liver makes.

Diagnosis

Common symptoms of type 1 and type 2 diabetes include:

  • unusual thirst or hunger
  • frequent urination
  • fatigue
  • blurry vision
  • weight loss

However, some people with diabetes don’t always notice symptoms,
particularly in the early stages.

At one time, being tested for prediabetes or diabetes took a little more
work: A health care provider took a sample of your blood, and you had to
either go without eating for eight hours or swallow a heavily sweetened
drink made for diabetes testing. However, the newer test doesn’t require
any special preparation. The hemoglobin

A1C test

measures how much glucose has attached to red blood cells in your blood.
This provides a view of your blood sugar levels over the past three months.
An A1C of 5. 7 percent to 6.4 percent is classified as prediabetes; 6.5
percent or higher is diabetes.

Treatment

People with type 1 diabetes need to treat it with regular injections of
insulin. People with type 2 diabetes can sometimes manage it with insulin
injections, non-insulin injections, pills, diet and/or exercise.

If you develop diabetes, your main task is still to keep your blood sugar
under control. But you also have a new goal: preventing complications.
Here’s how to use the many methods that are available to stay at your best
health.

Prevent complications.
Heart disease and stroke are the top causes of death among people with type
2 diabetes. To lower your risk of these threats and other complications,
your doctor might make these recommendations:

  • Lose weight.
  • Stop smoking.
  • Take aspirin regularly if you are at high risk.
  • Use medications to control high blood pressure or unhealthy
    cholesterol.
  • Keep your feet in good condition. Even small blisters or other small
    injuries on your feet can grow into serious problems.

Find the right medications.
Different non-insulin drugs lower your blood sugar by different actions:

  • They may encourage your pancreas to make more insulin.
  • They can help your body respond better to insulin.
  • They may mimic the action of a substance in your body called GLP-1,
    which lowers your blood sugar after meals.

Your doctor may suggest that you start taking just one medication, then add
more options over time if you can’t get your blood sugar under control.
However, if your A1C level—a measure of your long-term blood sugar—is
especially high when you’re diagnosed, your doctor may suggest that you
start taking more than one medication to control your blood sugar right
away.

You may also need to start using injections of insulin to control your type
2 diabetes right after you’re diagnosed. Even if you don’t have to take it
right away, most people with type 2 diabetes eventually need to start using
insulin, Kalyani says. But don’t consider the need to start insulin a
failure or setback—diabetes is a disease that can change over time and
require new treatment approaches. Starting insulin can help you better
manage your diabetes and lower your risk of complications.

Track your blood sugar.
Your doctor may want you to regularly check your blood sugar and report the
results. Ask your doctor or pharmacist to recommend a blood sugar monitor
that is easy for you to use. Some have backlighting and large numbers so
you can see the results more easily, Kalyani says, and some store multiple
readings over time so you can just download the results at your doctor’s
office.

Keep your blood sugar from going too low.
Some diabetes medications can cause your blood sugar to drop too
low. This problem is called hypoglycemia, and it can be serious. Know how
to recognize the symptoms of hypoglycemia (such as shakiness, sweating, and
confusion) and talk to your doctor about how to treat it.

Learn more about the

symptoms, diagnosis and treatment of diabetes

in the Health Library.

Living With…

“With proper self-management and good education, people with diabetes can
live long, healthy lives,” Kalyani says. “If well-controlled, it should not
detract from their quality of life but will require some adjustments to
their daily routine.”

However, diabetes is a chronic disease that isn’t curable. You’ll need to
control it for the rest of your life, which will require time, attention,
and good choices. Here are a few steps you can take to enjoy a healthy life
with type 2 diabetes.

Stick to your medication plan.
One reason people may not control their diabetes well is because they don’t
take their medications as directed. You may have many reasons that you are
not taking your medicines properly:

  • They have side effects.
  • You have to take a complicated array of many drugs.
  • You forget when it’s time to take a dose.
  • They cost too much.
  • You don’t like reminders that you have diabetes.
  • You’re not feeling any symptoms.

Talk to your doctor if these issues—or any others—are keeping you from
taking your medications properly. Your doctor may be able to help you find
solutions.

Build a team of medical partners.
You’ll probably need to regularly check in with a variety of health care
providers to make sure you’re controlling your diabetes and lowering your
chances of complications:

  • a primary care provider
  • an endocrinologist (a doctor who specializes in diabetes, usually
    referred by your primary care provider)
  • a pharmacist
  • a diabetes educator
  • an eye care provider to make sure your eyes are healthy and to treat
    any diabetes-related vision problems
  • a podiatrist to check your feet and prevent minor problems from
    becoming serious

Don’t forget about your lifestyle changes.
Even if you’re on one or more medications, it’s still important to eat
right, exercise regularly, and watch your weight.

Research

Johns Hopkins experts are always striving to understand more about
diabetes, its complications, and new methods for control and prevention.
Some notable research to check out:

Diabetes increases women’s heart disease risk.
Recently, Kalyani and her colleagues at Johns Hopkins studied how diabetes
affects women’s risk of heart disease. They included men and women under
the age of 60. Among people without diabetes, men were much more
likely to develop heart disease than women. But once women developed
diabetes, their risk increased by four times and to the same level as the
men who had diabetes—in other words, the risk of heart disease by sex
became equal.


Many with diabetes are not taking steps to preserve vision.

Despite recent advances in prevention and treatment of most vision loss
attributed to diabetes, a Johns Hopkins study found that fewer than half of
Americans with eye damage from diabetes were aware of the link between the
disease and visual impairment, and only six in 10 had their eyes fully
examined in the year leading up to the study.

For Caregivers

“Caregivers are very important for helping people manage their diabetes,”
Kalyani says. “We always encourage family members to be actively involved.”
If you have a loved one with diabetes, you may be able to assist with
certain tasks:

Prepare healthy meals.
Make and shop for foods that don’t cause the person’s blood sugar to surge.

Encourage exercise.
Invite your loved one with diabetes to get moving with you, such as on
walks and with other physical activities.

Remember and remind.
Help the person remember when to take medications and remind him to do
blood sugar checks on the proper schedule.

Keep watch.
Be on the lookout for symptoms of diabetes-related complications.

Attend checkups.
Accompany your loved one on regular doctor visits.

Definitions

A1C Test: A blood test used to diagnose and monitor diabetes. By measuring how much glucose (also called blood sugar) is attached to the oxygen-carrying protein in your red blood cells, this test gives you and your health-care provider a picture of your average blood glucose levels over three months. A normal result is below 5.7 percent. If you have type 2 diabetes, you should have this test done twice a year to check if your blood glucose is under control.

Blood glucose: Also referred to as blood sugar, the primary energy source for the cells in your body. Blood glucose levels rise after meals and fall the longer you’ve gone without eating. Your blood glucose level is a measure of how much glucose you have in your bloodstream. A normal fasting blood glucose level is between 70 and 100 mg/dl (milligrams per deciliter of blood).

Insulin (in-suh-lin): A hormone made by the cells in your pancreas. Insulin helps your body store the glucose (sugar) from your meals. If you have diabetes and your pancreas is unable to make enough of this hormone, you may be prescribed medicines to help your liver make more or make your muscles more sensitive to the available insulin. If these medicines are not enough, you may be prescribed insulin shots.

Lean protein: Meats and other protein-rich foods low in saturated fat. These include boneless skinless chicken and turkey, extra-lean ground beef, beans, fat-free yogurt, seafood, tofu, tempeh and lean cuts of red meat, such as round steaks and roasts, top loin and top sirloin. Choosing these can help control cholesterol.

Prediabetes: When blood glucose (also called blood sugar) levels are higher than normal and not yet high enough to be diagnosed with diabetes. That’s an A1C of 5.7 percent to 6.4 percent (a way to estimate your 3-month average blood sugar reading), a fasting blood glucose level of 100 to 125 mg/dl, or an OGTT (oral glucose tolerance test) two hour blood glucose of 140 to 199 mg/dl. Prediabetes is also sometimes called impaired glucose tolerance or impaired fasting glucose.

Whole grains: Grains such as whole wheat, brown rice and barley still have their fiber-rich outer shell, called the bran, and inner germ. It provides vitamins, minerals and good fats. Choosing whole grain side dishes, cereals, breads and more may lower the risk for heart disease, type 2 diabetes and cancer and improve digestion, too.

Diabetes and exercise: When to monitor your blood sugar

Diabetes and exercise: When to monitor your blood sugar

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

By Mayo Clinic Staff

Exercise is a crucial component of diabetes management. Exercise can help you:

  • Improve your blood sugar levels.
  • Boost your overall fitness.
  • Manage your weight.
  • Reduce your risk of heart disease and stroke.
  • Improve your well-being.

But diabetes and exercise pose unique challenges, too. To exercise safely, you’ll need to track your blood sugar before, during and after physical activity. This will show you how your body responds to exercise, which can help you prevent potentially dangerous blood sugar fluctuations.

Before exercise: Check your blood sugar before your workout

Before jumping into a fitness program, get your doctor’s OK to exercise — especially if you’ve been inactive. Ask your doctor how activities you’re contemplating might affect your blood sugar. Your doctor can also suggest the best time to exercise and explain the potential impact of medications on your blood sugar as you become more active.

For the best health benefits, experts recommend at least 150 minutes a week of moderately intense physical activities such as:

  • Fast walking
  • Lap swimming
  • Bicycling

Experts also recommend that children — even those with type 1 diabetes — participate in at least 60 minutes of moderate to vigorous activity every day.

If you’re taking insulin or other medications that can cause low blood sugar (hypoglycemia), test your blood sugar 15 to 30 minutes before exercising.

If you don’t take medications for your diabetes or you don’t use medications commonly linked to low blood sugar levels, you probably won’t need to take any special precautions prior to exercising. Check with your doctor.

Below are some general guidelines for pre-exercise blood sugar levels. The measurements are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

  • Lower than 100 mg/dL (5.6 mmol/L). Your blood sugar may be too low to exercise safely. Eat a small snack containing 15 to 30 grams of carbohydrates, such as fruit juice, fruit, crackers or even glucose tablets before you begin your workout.
  • 100 to 250 mg/dL (5.6 to 13.9 mmol/L). You’re good to go. For most people, this is a safe pre-exercise blood sugar range.
  • 250 mg/dL (13.9 mmol/L) or higher. This is a caution zone — your blood sugar may be too high to exercise safely. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. The presence of ketones indicates that your body doesn’t have enough insulin to control your blood sugar.

    If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead of exercising immediately, take measures to correct the high blood sugar levels and wait to exercise until your ketone test indicates an absence of ketones in your urine.

During exercise: Watch for symptoms of low blood sugar

During exercise, low blood sugar is sometimes a concern. If you’re planning a long workout, check your blood sugar every 30 minutes — especially if you’re trying a new activity or increasing the intensity or duration of your workout. Checking every half-hour or so lets you know if your blood sugar level is stable, rising or falling, and whether it’s safe to keep exercising.

This may be difficult if you’re participating in outdoor activities or sports. But, this precaution is necessary until you know how your blood sugar responds to changes in your exercise habits.

Stop exercising if:

  • Your blood sugar is 70 mg/dL (3.9 mmol/L) or lower
  • You feel shaky, weak or confused

Eat or drink something (with approximately 15 grams of fast-acting carbohydrate) to raise your blood sugar level, such as:

  • Glucose tablets or gel (check the label to see how many grams of carbohydrate these contain)
  • 1/2 cup (4 ounces/118 milliliters) of fruit juice
  • 1/2 cup (4 ounces/118 milliliters) of regular (NON-diet) soft drink
  • Hard candy, jelly beans or candy corn (check the label to see how many grams of carbohydrate these contain)

Recheck your blood sugar 15 minutes later. If it’s still too low, have another 15 gram carbohydrate serving and test again 15 minutes later.

Repeat as needed until your blood sugar reaches at least 70 mg/dL (3.9 mmol/L). If you haven’t finished your workout, you can continue once your blood sugar returns to a safe range.

After exercise: Check your blood sugar again

Check your blood sugar as soon as you finish exercising and again several times during the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood.

The more strenuous your workout, the longer your blood sugar will be affected. Low blood sugar is possible even four to eight hours after exercise. Having a snack with slower-acting carbohydrates, such as a granola bar or trail mix, after your workout can help prevent a drop in your blood sugar.

If you do have low blood sugar after exercise, eat a small carbohydrate-containing snack, such as fruit, crackers or glucose tablets, or drink a half-cup (4 ounces/118 milliliters) of fruit juice.

Exercise is beneficial to your health in many ways, but if you have diabetes, testing your blood sugar before, during and after exercise may be just as important as the exercise itself.

Dec. 22, 2020

Show references

  1. Grant RW, et al. Standards of medical care in diabetes —2018. Diabetes Care. 2018;41:S1.
  2. McCulloch DK. Effects of exercise in diabetes mellitus in adults. https://www.uptodate.com/contents/search. Accessed Nov. 9, 2018.
  3. Diabetes diet, eating and physical activity. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity. Accessed Nov. 9, 2018.
  4. Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/paguidelines/second-edition. Accessed Nov. 12, 2018.
  5. Hypoglycemia (Low blood glucose). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood. html. Accessed Nov. 9, 2018.

See more In-depth

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What is High Blood Sugar?

What is High Blood Sugar vs. Healthy Blood Sugar? 

If you’re frustrated that your high blood sugar, or HbA1c (A1C), hasn’t gone down despite your best efforts to exercise more, eat fewer carbs, and check your blood sugar more often, there may be one sneaky habit you haven’t noticed: what you consider an “okay” blood sugar is actually a “high” blood sugar that needs correcting with a bolus of insulin.

Your A1c is the culmination of your blood sugar levels over the course of the prior 2-3 months, which means an A1c of 8.0 percent translates to eAG” (estimated average glucose) of 183 mg/dL. If your blood sugar is 183 mg/dL, this means that for a large part of every day, your blood sugar is either a little lower or a little higher than 183 mg/dL. Meanwhile, an A1c of 7.0 percent translates to 154 mg/dL. Merely a 30-point different, sure. But it has a tremendous impact on your A1c and overall blood sugar levels!

High vs. High Blood Sugar

The trick, in this scenario, is to adjust the way you think of “high” BG. Sure, we all know 300 mg/dL is “high.” But, if you’re looking to get that 8.0% A1C down to a 7.0%, 183 mg/dL should now resonate with you as “high” as well. It sounds so easy! But when you try putting it into practice, it can actually be quite tricky. So you see a 183 mg/dL on your meter screen; what do you do to correct it? It’s not high like a 300 mg/dL high, but it’s still, technically, “high” if the goal is to get to 7.0%. But are you registering it as such? If not, it’s OK! Here are the steps to take to change that mindset, and reach your A1C goal. 

 

Step 1: Get to the root of the problem 

You can’t fix something until you know (and understand) what the root cause of the problem is. Ask yourself: “What have I been considering a ‘high’ blood sugar that deserves an insulin correction?” Perhaps you need a week of observing and getting to know your honest answer to this question. By the end of the week, you might learn that you’re often around 200 mg/dL after lunch, or you spend the majority of your entire workday around 150 mg/dL and you never take a correction for it, because you’re used to that being “your normal.”

 

Step 2: Set a new standard of success (aka high BG)

Decide on your new standard of “high blood sugar.” In an ideal world, we’d all aim for that perfect, non-diabetic range of 70 to 120 mg/dL all day long. But, as you and I know all too well, that is pretty darn stressful to maintain. And fairly unrealistic for everyday life with diabetes and high blood sugar. (The exception being those who are pregnant or eating The Bernstein Diet). Instead, you might decide that you’ll aim to correct any blood sugar over 140 mg/dL (based on the logic, of course, of how long it’s been since your last injection or bolus, to prevent “stacking” your insulin). Whatever your new goal is, write it down (tape it into your glucometer if you have to!) and embrace your new range as your new goal. 

 

Step 3: Establish your correction factor 

Establish your Correction Factor …and use it! Your correction factor (CF) is the number of points 1 unit of insulin will reduce your blood sugar. For instance, the common CF is 1:50 or 1:75. Once your CF is established as 1:50, for example, when you see a 150 mg/dL on your glucometer 3 hours after lunch (when your meal bolus is past its peak), you could take a ½ unit of insulin to bring your blood sugar down 25 points. (Remember that certain variables like exercise and stress can impact your CF in that moment. Exercise would cause you to need less insulin for that correction, whereas a stressful conversation or work event could cause you to need more.)

 

Step 4: Tighten up fasting BGs

Take a look at your overnight and fasting blood sugars.  If you’ve been seeing 160 mg/dL on your glucometer in the mornings and don’t do anything about it, that’s going to be a big contributor to your A1c frustration. 

That means you’ve spent all night with a blood sugar well above the range of your target A1C. That alone can explain why your A1C is so much higher than your goal, even if you’ve been staying closer to your goal range during the day. Nighttime is 8 hours of your A1C result! Nip that one in the bud by studying your overnight blood sugars more closely and adjusting your insulin and medication doses.

Step 5: Increase background insulin doses

If you aren’t getting enough background/basal insulin, your efforts to lower your A1C will be pretty pointless. When was the last time you did a little basal testing? Evan a small increase of 1 additional unit per day in your background insulin dose can have a huge impact on your overall blood sugars. If you’re seeing habitual spikes and/or long-term high patterns in your levels, rethink your basal settings. Consider that your overall background/basal insulin doses need an increase. It’s an easy fix!

Step 6: Pinpoint other BG trouble spots 

For example, if you usually exercise with your blood sugar around 200 mg/dL because you’re terrified of going low, that’s going to be a daily portion of the day when you’re well above your goal range (if you’re trying to achieve an A1c of 7.0 percent). Learning how to exercise with in-range blood sugars isn’t easy. In fact, it’s a lengthy process of trial and error and more learning, but it can be done! Here are a few resources to help you expand your knowledge around exercising with type 1 diabetes or type 2 diabetes using insulin: ● Fit with Diabetes eBook by Diabetes Strong ● The Diabetes Athlete’s Handbook by Sheri Colberg, PhD ● Fasted Exercise with Type 1 Diabetes by Ginger Vieira ● Bright Spots & Landmines by Adam Brown ● Dealing with Diabetes Burnout by Ginger Vieira

High Blood Sugar is an ongoing science experiment 

In the end, it’s all just learning, studying, improving and adjusting! The lifelong science experiment of life with diabetes. You may have recently come out on the other side of a stressful divorce or been managing the diagnosis of something incredibly stressful like breast cancer–and those stressors in life had caused you to let your blood sugars run higher for a period of time.

Hey, it happens! To any of us! (Mine, for example, was the addition of a 2nd child to keep alive on a daily basis! Parenting! Oy vey.)

But when you’re ready to focus on reducing your A1c, make sure that your idea of a “normal” blood sugar vs. a high blood sugar lines up realistically with your goals.

Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis

J Clin Med. 2020 Nov; 9(11): 3635.

Rajat Kapoor

1Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Lava R. Timsina

2Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Nupur Gupta

3Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Harleen Kaur

4Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Swapnil Khare

7Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Omar Rahman

1Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

1Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]2Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]3Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]4Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]7Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; [email protected]

Received 2020 Oct 13; Accepted 2020 Nov 10.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).This article has been cited by other articles in PMC.

Abstract

Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.

Keywords: intensive care unit, time in range, COVID-19, non-COVID-19

1. Introduction

Background

Uncontrolled hyperglycemia is associated with increased mortality, morbidity, in-hospital stroke mortality, secondary infections, and coronary artery disease in intensive care unit (ICU) patients [1,2,3,4,5,6]. Cortisol release due to stress and cytokine signaling leads to excess hepatic gluconeogenesis, impaired utilization of glucose, and insulin deficiency. Further, withholding outpatient antidiabetic medications, addition of inpatient medication (corticosteroids), and enteral and parenteral nutrition contribute to hyperglycemia [5,7]. Many studies tried to identify optimal blood glucose levels and the tools to achieve them in order to improve mortality within ICU [5,8,9].

The definition of optimal blood glucose control is contentious. The NICE-SUGAR study and meta-analysis linked intensive blood sugar control (<110 mg/dL) with hypoglycemia and higher mortality [9,10]. Lanspa et al. showed that achieving >80% time in range (TIR) of 70−139 mg/dL showed promising outcomes in multi-center ICU patients using a computerized e-Protocol. Achieving this TIR goal was independently associated with lower 30-day mortality in nondiabetic and diabetic with previous good control (HbA1 c ≤ 6.5%), but was not beneficial with prior poor diabetes control [8]. TIR is suggested to be the unifying metric to account for hypoglycemia, glycemic variation, and hyperglycemia events. While it is believed that controlling glucose in critically ill patients is beneficial, the optimal goal for patients with pre-existing poor glucose control is not well known. While the Society of Critical Care Medicine and American Diabetes Association guidelines suggest achieving glucose < 180 mg/dL in critically ill patients on an insulin infusion, lower goals (<150 mg/dL) may be used if a low incidence of hypoglycemia is maintained [5,11]. Insulin administration should be guided by validated protocols, and many have suggested computerized programs for consistency and safety [11].

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov2), causing coronavirus disease 2019 (COVID-19), is a threat to global health. The current understanding of SARS-CoV2 pulmonary pathology is invasion of the respiratory tract and lungs leading to viral pneumonia. The infected patients may develop hypoxic respiratory failure requiring mechanical ventilation, septic shock, along with multi-organ failure and death [12]. Predisposing conditions like type 2 diabetes mellitus along with poor glycemic control, chronic kidney disease, and obesity are associated with severe manifestation of COVID-19 disease [13,14,15]. Hyperglycemia resulting from the inflammatory response, insulin resistance, and pancreatic injury is described in severe COVID-19 infections [16]. Emerging evidence hypothesizes that hyperglycemia may trigger an altered immunologic response in COVID-19 resulting in increased morbidity [17]. The insulin resistance induced by COVID-19 and gluconeogenesis due to critical illness may make glycemic control challenging and potentially impact clinical outcomes. We compared percent time in range of glucose and insulin use as a surrogate for glycemic control amongst COVID-19 and non-COVID-19 ICU patients.

2. Materials and Methods

2.1. Study Design

The study was a single center retrospective data analysis for patients admitted to 130 ICU beds in the 600-bed Indiana University Health, Methodist Hospital (Indianapolis, IN, USA) from 1 March to 30 April 2020. The study was approved as exempt by the Kuali Coeus IRB (Protocol no. 2004500099). The institutional information technology (IT) team assisted with data extraction and time stamps for analysis.

2.2. Patient Selection

All subjects admitted to the ICU were identified based on the location and level of care orders. Patients were admitted to the ICU following an assessment by the primary team on the patient’s clinical condition and risk for imminent worsening. Hospitalist/Intensivists clinical judgement was relied upon for the transfer into or out of the ICU. Patients were excluded if they had an underlying diagnosis of hyperosmolar nonketotic hyperglycemia, diabetic ketoacidosis, and beta-blocker or calcium channel blocker overdose requiring an alternative protocol for insulin therapy.

The patient population was then divided into 2 cohorts—COVID-19-related ICU admission and non-COVID-19-related ICU admission based on the positive COVID-19 RNA PCR from nasopharyngeal–oropharyngeal swab.

2.3. Variables

Data were abstracted retrospectively from prospectively collected data in the electronic medical record (Cerner, Kansas City, MO, USA) including demographics, age, admission body mass index, and pre-existing conditions. Pre-existing comorbidities were captured from the provider documentation using the ICD-10-CM coding algorithms [18]. The glycosylated hemoglobin A1C (HbA1C) at the time of admission was used if available, or the most recent values within the previous 3 months as a marker for previous glycemic control. Home diabetic therapy was obtained from the medication reconciliation performed at the time of admission. The pharmacist performs reconciliation via an extensive discussion with the patient (if able), next of kin, healthcare power of attorney, insurance claims, and/or pharmacy fill records. Home diabetic therapy was categorized as—insulin, non-insulin glucose lowering agents (Hypoglycemic agents), and diet-controlled.

Patient’s respiratory status and level of support was reviewed during the ICU stay. Supportive interventions, including invasive ventilation, noninvasive ventilation, high-flow nasal cannula (Vapotherm, Optiflow), and nasal cannula, were documented. Use of proning post intubation, neuromuscular blockade, and extra corporeal membranous oxygenation (ECMO) was documented as separate events. Most patients required several of these interventions at some point and these were counted as unique events. ICU medication administration record (MAR) was reviewed, and use of corticosteroids, vasopressors, and COVID-19-related medications (remdesivir, tociluzumab, hydroxychloroquine) was identified for all patients during ICU stay. Drug administration was only documented in patients with confirmed drug delivery. Medications are scanned at the time of administration in over 90% of doses, and this enhances the accuracy of the medication administration record as a source of data. High-dose ascorbic acid therapy was not used as it is not a standard of care at our facility.

2.4. Glucose Management

The decision to order insulin via any route was made by the provider on admission and reevaluated daily. For persistent glucose values greater than 150 mg/dL, patients were started on an insulin infusion or subcutaneous insulin using a correction scale (blood glucose every 4−6 h) plus basal insulin when needed to achieve desired goals. Transition from subcutaneous to intravenous is based on the level of control or variability within the blood sugar levels. We were unable to capture the frequency of transitions between the subcutaneous and intravenous routes.

A computer-based insulin protocol is used for achieving blood glucose level < 150 mg/dL. The centralized insulin dosing software is based on the measurement of blood glucose level, specified insulin sensitivity, carbohydrate intake, and responsiveness to the previous insulin dosing [19,20]. This program is known as the “GlucoStabilizer”. It provides appropriate insulin coverage while minimizing the use of only sliding scale insulin, missed insulin dose adjustments, and calculation errors. The program calculates insulin dosing based on glucose measurements and carbohydrate intake for patients with hyperglycemia of any etiology. This program reminds the timing of glucose level checks and recommends insulin dosing based on the insulin sensitivity factor and carbohydrate ratio ordered by the primary provider team. The subcutaneous GlucoStabilizer program does not optimize its settings based on patients’ blood sugar responses to the insulin dose given. The intravenous GlucoStabilizer program learns and adjusts to meet the changing need of the patient. (The rate of the insulin infusion is calculated by rate = glucose − 60 × multiplier, where the default multiplier = 0.02. The default target blood glucose is 100−150 mg/dL and if after 1 h, the blood glucose is greater than 150 mg/dL, the multiplier increases to 0.03). This program is also equipped to manage the hypoglycemic treatment for the patients. It calculates in “ml” the volume of 50% dextrose solution to be given for blood sugar less than 70 mg/dL. This program has been the lifeline of blood sugar management for the Indiana University health campus for optimizing glycemic management.

The GlucoStabilizer standardizes intravenous and subcutaneous insulin therapy at our institute. Details of this program have been published previously, and it has been associated with high target achievement and low incidence of severe hypoglycemia [21]. We selected a threshold of 85% for the TIR, since our range was slightly higher (70−150 vs. 70−139 mg/dL) compared to the study by Lanspa et al. [8]. We used the range of 100–150 mg/dL, since the standard protocols used within our health care system are built to maintain the blood sugars <150 mg/dL.

Infusion pumps (BD Alaris, Franklin Lakes, NJ, USA) were located in the patient’s room and the GlucoStabilizer program is activated on the bedside computer/monitors on most occasions. The program reminds the bedside nurse to perform blood glucose checks at the recommended frequency (every 4 h, every 6 h (for subcutaneous), or hourly (for intra venous)). Blood glucose was measured using the Accu-Chek Inform meter system (Roche, Indianapolis, IN, USA) on capillary samples, whole blood samples, or with the Abbott i-STAT (Abbott Park, IL, USA) on whole blood, as determined by the bedside nurse. Data were not collected to describe the actual source/methodology. Glucose values are automatically uploaded to the electronic medical records.

Mean daily insulin use for all types and routes of administration was calculated with the use of the MAR time stamp for the insulin administration.

2.5. End Points/Outcomes

The primary endpoints were the percentages of time in range (<70, 70−150, 150−250, and >250 mg/dL) and average daily insulin use for patients in the ICU.

The secondary outcome measured was 28-day mortality among the cohorts. We also measured the glucose level variability and peak glucose levels. Mortality, days on ventilator, and respiratory support were compared in both the cohorts among patients with > 85% time in range (70−150 mg/dL) and <85% time in range (70−150 mg/dL).

2.6. Statistical Analysis

Descriptive statistics (mean with standard deviations and proportions) were computed to describe the study population using demographic, laboratory, and clinical characteristics. These patient characteristics were compared between COVID-19-positive and non-COVID-19 patients using bivariate Chi-square tests or Fisher’s exact tests for categorical variables and Wilcoxon rank sum tests for non-normally distributed continuous variables. We also grouped the patients using ≥85% vs. <85% of the percentage of times that the glucose level was in the range 70−150 mg/dL to identify the difference in their outcomes among COVID-19 and non-COVID-19 patients using Chi-square, Fisher’s exact, and Wilcoxon-rank tests, as appropriate. Two separate multivariable generalized estimating equations with mortality and glucose in range as the outcome variables and with logit link function, accounting for the correlation of repeated measurements over time with robust standard errors, were created to examine the effect of having COVID-19 infection compared to other critically ill patients admitted to ICU. The multivariable model included demographic, clinical/medical, and laboratory variables. Trends of glucose levels over time for COVID-19 vs. non-COVID-19 patients were computed to track the average time-in-range after days from ICU admission. This line plot was used to examine the number of times that the patients fell within the predefined glucose levels over the period of their ICU stay. Shapiro–Wilk tests were also used to examine the normality of various laboratory variables by the levels of COVID-19 status and we found that these were not normally distributed. Using the kernel density plot for linearity process, we also observed the linearity assumption was not true. Hence, we used a fractional polynomial model to fit the curvilinear (non-Gaussian) pattern of the laboratory variables repeated over time [22,23]. Time-to-event analysis was also performed using log-rank tests to examine the difference in the 28 days survival probability between COVID-19 and non-COVID-19 patients and was portrayed using a Kaplan–Meier curve. All hypothesis tests were done at the 0.05 level of significance using Stata/SE 14.2 [24].

3. Results

3.1. Baseline Characteristics

A total of 571 unique patients were admitted to ICU in the two months of study duration. Nine patients were excluded based on the exclusion criteria. Five-hundred-sixty-three patients were included in the analysis. Patients were divided into two cohorts based on COVID-19 status. Ninety-three patients were included in the COVID-19 cohort and 469 in the non-COVID-19-related illness cohort. The non-COVID-19 cohort comprised the majority of the patients from medical, surgical, and trauma ICU. Elective cardiovascular surgery and elective neurosurgical procedures were cancelled to maintain optimal resource utilization during the peak COVID surge at the facility. Only patients who required emergency interventions were admitted.

described the baseline characteristics of the patient population. The COVID-19 cohort had more African American and Hispanic patients as compared to non-COVID-19 (52.69% versus 28.78%; 12.90% versus 3.84%, p <0.001, respectively). The population of Marion County, where our hospital is located, is approximately 29% African American (9.9% in the state of Indiana) [25]. As of 30 April (last day for patient inclusion in the analysis), the state had documented 18,545 cases of confirmed COVID-19, with a cumulative mortality of 1154 [26]. Hospitalizations for COVID-19 have been predominantly in the 50+ year old cohort, consistent with the age group in both cohorts in our study [27,28].

Table 1

Baseline characteristics, respiratory support, and medication interventions.

Baseline Characteristics In Sample (562) COVID-19 (93) Non-COVID-19 (469) p-Value
Age (Years) median (IQR) a 59.5 (47–69) 61 (51–69) 59 (47–69) 0.2844
Sex—Male (%) 316 (56.23) 50 (53.76) 266 (56.72) 0.6
Body Mass Index kg/m2—Median (IQR) a 29.70 (24.95–36) 31.15 (26.8–36.9) 29.55 (24.65–35.2) 0.0253
Race n(%)
Caucasian 334 (59.43) 28 (30.11) 306 (65.25)
African American 184 (32.74) 49 (52.69) 135 (28.78)
Other 14 (2.49) 4 (4.30) 10 (2.13) <0.001
Hispanic 30 (5.34) 12 (12.90) 18 (3.84)
Comorbidities n(%)
Diabetes Mellitus 192 37 (39.78) 155 (33.05) 0.211
Hyperlipidemia 65 (11.57) 11 (11.83) 54 (11.51) 0.931
Stroke/Cerebrovascular disease b 57 (10.14) 3 (3.23) 54 (11.51) 0.014
Chronic Kidney Disease 135 (24.02) 30 (32.26) 105 (22.39) 0.042
Coronary Artery Disease b 15 (2.67) 0 (0) 15 (3.20) 0.149
Congestive Heart Failure 77 (13.70) 8 (8.60) 69 (14.71) 0.117
Arrhythmia 104 (18.51) 12 (12.90) 92 (19.62) 0.128
Chronic Lung disease 139 (24.73) 25 (26.88) 114 (24.31) 0.599
Charlson Comorbidity Index Score 0.666
0 166 (29.53) 142 (30.28) 24 (25.81)
1–3 317 (56.40) 261 (55.65) 56 (60.22)
4+ 79 (14.03) 66 (14.07) 13 (13.98)
DM Tx (home meds)
Diet Control (%) 43 (7.65) 12 (12.90) 31 (6.61) 0.037
Non-insulin Hypoglycemic Agents (%) 65 (11.57) 13 (13.98) 52 (11.09) 0.426
Insulin (%) 138 (24.56) 22 (23.66) 116 (24.73) 0.825
HbA1C (n = 403) median (IQR) a 6.2 (5.7–7.2) 6.8 (6–8) 6.1 (5.6–7.1) <0.001
<7% n (%) 288 (51.24) 36 (38.70) 252 (53.73)
7.1–8% n (%) 47 (8.36) 13 (13.97) 34 (7.24)
>8.1% n (%) 68 (12.09) 16 (17.20) 52 (11.08)
Respiratory Intervention n(%)
Nasal Cannula 385 (68.51) 78 (83.87) 307 (65.46) <0.001
High-Flow Nasal Cannula 110 (19.57) 50 (53.76) 60 (12.79) <0.001
Non-Invasive Ventilation 66 (11.74) 6 (6.45) 60 (12.79) 0.083
Ventilator 264 (46.98) 66 (70.97) 198 (42.44) <0.001
Proning 35 (6.23) 25 (26.88) 10 (2.13) <0.001
Paralytics 112 (19.93) 52 (55.91) 60 (12.79) <0.001
ECMO 13 (2.31) 7 (7.53) 6 (1.28) <0.001
Days of Ventilator Mean (SD) a 4.81 (11.76) 9.56 (9.98) 3.87 (11.86) <0.001
Medications n(%)
Steroids 205 (36.48) 57 (61.29) 148 (31.56) <0.001
Pressors 196 (34.88) 51 (54.84) 145 (30.92) <0.001
Remdesivir 4 (0.71) 4 (4.30) 0 (0) <0.001
Tocilizumab b 4 (0.71) 4 (4.30) 0 (0) 0.001
Hydroxychloroquine b 76 (13.52) 67 (72.04) 9 (1.92) <0.001

Bivariate descriptive analyses showed no significant differences in age, gender, comorbidities, and prescribed medical therapy for diabetes. However, body mass index of the patients with COVID-19 was higher than the non-COVID-19 cohort (31.15 versus 29.55 kg/m2, p = 0.0253). Higher frequencies of preexisting chronic kidney disease (32.26% versus 22.39%, p = 0.042) occurred in COVID-19 patients as compared to non-COVID-19 patients. Median glycosylated hemoglobin A1C (HbA1C) level on admission was higher in the COVID-19 cohort, suggesting inadequate pre-admission diabetes control (6.8% versus 6.1%, p < 0.001). A total of 403 patients (65 COVID-19 and 338 non-COVID-19) had an available HbA1C at the time of admission. A majority of the patients in both cohorts had HbA1C < 7%. A majority of the patients in both cohorts had HbA1C < 7%, as expected with the prevalence of diabetes by history. The Charlson Comorbidity Index compared for the COVID-19 and non-COVID-19 cohorts was similar (p = 0.666). Patients with COVID-19 required more aggressive respiratory support in the form of high-flow nasal cannula (HFNC) (53.76% versus 12.79%, p < 0.001), and mechanical ventilation (70.97% versus 42.44%, p < 0.001) compared to non-COVID-19 patients. Advanced supportive care such as proning, neuromuscular blockade, and extracorporeal membranous oxygenation (ECMO) was more prevalent in the COVID-19 population. Patients with COVID-19 stayed ventilated for a longer duration (9.56 days versus 3.87 days, p < 0.001). Supportive and therapeutic medications, such as corticosteroids (61.2% versus 31.5%, p < 0.001) and vasopressor (54.8% versus 30.9%, p < 0.001), were used more often in patients with COVID-19. Remdesivir and tocilizumab were exclusively used in COVID-19 patients, and hydroxychloroquine was used predominantly in COVID-19 patients (72.0% vs. 1.9%).

3.2. Time in Range of Blood Glucose Level and Insulin Utilization

Median number (Interquartile range) of daily blood glucose level checks among COVID-19 was 5 (0–14) and non-COVID-19 was 2 (0–23). shows COVID-19 patients spent 44.42% TIR of 70–150mg/dL, 43.48 percent TIR of 151–250 mg/dL, and 11.66 percent TIR of >250 mg/dL (p < 0.001). The non-COVID-19 cohort spent 68.52 percent TIR of 70–150 mg/dL. depicts the stagger variations of the glucose levels within the COVID-19 and non-COVID-19 ICU patients. The mean and median blood glucose level in COVID-19 patients was significantly higher compared to non-COVID-19 patients (170.59 and 157 mg/dL vs. 140.37 and 130 mg/dL). Mean and median peak glucose levels were significantly higher in COVID-19 patients in comparison to non-COVID-19 patients (243.07 and 215 mg/dL vs. 179.18 and 160 mg/dL). The glucose check frequency was consistent among both cohorts. Median number (interquartile range) of daily blood glucose level checks among COVID-19 patient was 5 (0–14) and among non-COVID-19 was 2 (0–23). Patients with COVID-19 required higher average daily doses of insulin compared to non-COVID-19 patients (8.37 units versus 6.17 units, p < 0.001).

Stagger diagram comparing glucose levels spread over time and range among the COVID-19 and non-COVID-19 study population.

Table 2

Outcome In Sample (562) COVID-19 (93) Non-COVID-19 (469) p-Value
Insulin use (daily average) a 7.63 (4.65) 8.37 (4.08) 6.17 (5.30) <0.001
Glucose Time in Range (%)
<70 mg/dL 0.44 0.44 0.44
70–150 mg/dL 60.13 44.42 68.52
151–250 mg/dL 33.31 43.48 27.88 <0.001
>250 mg/dL 6.12 11.66 3.16
Glucose mg/dL
Mean (SD) 150.89 (60.51) 170.59 (66.60) 140.37 (54.13) <0.001
Median (IQR) a 136 (112–174) 157 (124–205) 130 (107–159)
Coefficient of Variation in Glucose level 0.40 0.39 0.38
Peak Glucose mg/dL
Mean (SD) 190.31 (98.79) 243.07 (122.62) 179.18 (89.25) <0.001
Median (IQR) a 164 (130–218.5) 215 (146–323) 160 (128–201.5)
Mortality n (%) 85 (15.12) 20 (21.51) 65 (13.86) 0.06

A multivariate analysis examined variables associated with ≥ 85% TIR (). The COVID-19 status (OR, 0.455; 95% CI, 0.284–0.727), HbA1C (OR, 0.904; 95% CI, 0.839–0.974), BMI (OR, 0.974; 95% CI, 0.954–0.994), and history of peripheral vascular disease (OR, 0.327; 95% CI, 0.141–0.759) were associated with lower odds of having > 85% time in range (70–150 mg/dL). Higher odds of having TIR ≥ 85% were higher with history of congestive heart failure (OR, 1.652; 95% CI, 1.022–2.67) and cerebrovascular disease (OR, 1.652; 95% CI, 1.022–2.67).

Multivariate analysis with odds ratio (OR) and confidence interval (CI) for time in range (TIR) 70–150 mg/dL in the study population. Other variables adjusted but did not show significance were gender, age, race, myocardial infarction, arrhythmias, chronic lung diseases, and respiratory interventions during the hospital stay and medications like insulin, pressors and steroids. PVD—Peripheral Vascular Disease, CVD—Cerebro Vascular Disease, BMI—Body Mass Index, CHF—Congestive Heart Failure.

shows COVID-19 and non-COVID-19 cohorts’ patients with ≥ 85% TIR (70–150 mg/dL) were associated with less days on ventilators (p = < 0.001, p = < 0.001), respectively. COVID-19 patients requiring more aggressive respiratory support with the use of high-flow nasal cannula (p = 0.009) and mechanical ventilation (p = < 0.001) spent < 85% time in range (70–150 mg/dL) during their ICU stay. Patients in both cohorts who required use of neuromuscular blocking agents (paralytics) spent < 85% time in range (COVID-19 p = < 0.001 and non-COVID-19 p = 0.044). Patients requiring ECMO (COVID-19 p = 0.183, non-COVID-19 p = 0.238) and use of proning (COVID-19 p = 0.704, non-COVID-19 p > 0.99) did not have a significant difference among the patients with >/=85% time in range. Mortality was also noted to be significantly higher in the population with <85% time in range in the non-COVID-19 cohort.

Table 3

Respiratory support and outcome compared with glycemic control (n = 93).

Outcome In Sample
COVID-19 n = 93(%)
Non-COVID-19 n = 469(%)
>/=85% in Range: 70–150 mg/dL COVID-19
Non-COVID-19
<85% in Range: 70–150 mg/dL
COVID-19
NON-COVID-19
p-Value
Mortality n (%) a
COVID-19 20 (21.51) 2 (10) 18 (90) 0.085
Non-COVID-19 65 (13.86) 21 (32.3) 44 (67.69) 0.046
Days of Ventilator Mean (SD) b
COVID-19 9.56 (9.98) 1.84 (3.59) 12.40 (10.09) <0.001
Non-COVID-19 3.87 (11.86) 2.12 (5.48) 5.22 (14.93) <0.001
High Flow Nasal Cannula n (%)
COVID-19 50 (53.76) 19 (38) 31 (62) 0.009
Non-COVID-19 60 (12.79) 24 (40) 36 (60) 0.535
Ventilator n (%)
COVID-19 66 (70.97) 8 (12.12) 58 (87.87) <0.001
Non-COVID-19 198 (42.22) 72 (36.36) 126 (63.63) 0.006
Proning n (%) a
COVID-19 25 (26.88) 6 (24) 19 (76) 0.704
Non-COVID-19 10 (2.13) 4 (40) 6 (60) >0.99
Paralytics n (%)
COVID-19 52 (55.91) 6 (11.53) 46 (88.46) <0.001
Non-COVID-19 60 (12.79) 19 (31.66) 41 (69.34) 0.044
ECMO n (%) a
COVID-19 7 (7.53) 0 (0) 7 (100) 0.183
Non-COVID-19 6 (1.28) 1 (16.67) 5 (83.33) 0.238

Patients with available HbA1C levels were compared for time in range (70–150 mg/dL). The majority of the patients in all three subgroups (HbA1C < 7, 7.1–8.0, and > 8.1%) spent < 85% of time in range. ().

Table 4

Admission/preadmission HbA1C effect on time in range (70–150 mg/dL).

HbA1C In Sample
COVID-19 n = 65(%)
non-COVID-19 n = 338(%)
>/=85% in Range: 70–150 mg/dL
COVID-19
non-COVID-19
<85% in Range: 70–150 mg/dL
COVID-19
non-COVID-19
p-Value
<=7%
COVID-19 n (%) 36 (55.38) 7 (19.44) 29 (80.56) 0.014
Non-COVID-19 n (%) 252 (74.56) 103 (40.87) 149 (59.12) <0.001
7.1–8.0%
COVID-19 n (%) 13 (20.00) 0 (0) 13 (100) 0.329
Non-COVID-19 n (%) 34 (10.06) 3 (8.82) 31 (91.18) 0.002
>=8.1%
COVID-19 n (%) 16 (24.62) 0 (0) 16 (100) 0.18
Non-COVID-19 n (%) 52 (15.38) 4 (7.69) 48 (92.31) <0.001

3.3. Mortality

Among the COVID-19 patients, there was no mortality difference among patients ≥ 85% of the TIR (p = 0.085) (). Mortality difference was identified in the non-COVID-19 cohort among patients ≥ 85% of the TIR versus < 85% of the TIR (p = 0.046). The 28-day non-adjusted mortality among COVID-19 patients was higher than observed in non-COVID-19 patients and trended towards significance (21.51% vs. 13.86%, p = 0.06). The Kaplan–Meier plot demonstrated that the 28 days survival probability was not significantly different (). Multivariate analysis showed higher odds for mortality () with underlying COVID-19 diagnosis (OR, 22.199; 95% CI, 1.795–274.601), age (OR, 1.187; 95% CI, 1.061–1.328), use of ECMO (OR, 12.132; 95% CI, 1.029–143.02), and mechanical ventilation (OR, 14.458; 95% CI, 1.164–179.644). Use of HFNC was associated with reduced odds ratio (OR, 0.183; 95% CI, 0.035–0.955) for mortality.

Kaplan–Meier curve comparing 28-day mortality of COVID-19 and non-COVID-19 ICU patients.

Multivariate analysis with odds ratio (OR) and confidence interval (CI) for mortality in the study population. Other variables adjusted but did not show statistical significance were glucose levels, gender, race, underlying comorbid conditions, proning, paralytics, insulin use, corticosteroids, and vasopressors.

4. Discussion

Our study identifies COVID-19 ICU patients spent significantly less TIR (70–150 mg/dL) and utilized higher average daily insulin as compared to non-COVID-19 ICU patients. Charlson Comorbidity index was used as a surrogate for defining risk of patient mortality and was similar for both cohorts. While the comorbidity index did not show a difference, these findings are suggestive of more difficult to control blood glucose levels in critically ill COVID-19 infection. Patients with COVID-19 also had significantly higher blood glucose levels (both mean and median) compared to non-COVID-19 patients. Less time spent in range for BG (70–150 mg/dL) was associated with increased utilization of a ventilator and prolonged duration of mechanical ventilation, suggesting severe disease. Higher severity of illness could potentially contribute to variations in glucose levels. We did not compare the severity of these patients using the APACHE or SOFA score, since all the data points were not available for calculation. Multivariate analysis suggested that the presence of COVID-19 infection played a significant role in inability to maintain blood glucose levels in range 70–150 mg/dL.

COVID-19 patients with type II diabetes mellitus are more severe and critically ill on initial presentation [14,15,29,30]. Zhu et al. reported improved outcomes in COVID-19 patients with well-controlled type II diabetes mellitus [31]. The risk of mortality is higher in the uncontrolled diabetes mellitus II subgroup based on a British cohort of 5693 patients. HbA1C of 7.5% or higher has been associated with increased in-hospital mortality within COVID-19 patients [32]. On the contrary, our study shows no 28-day mortality difference between the two cohorts despite higher baseline HbA1C, a surrogate for uncontrolled type II DM, most likely since the average HbA1C did not reach the threshold of 7.5%. Mortality among patients with >85% TIR (70–150 mg/dL) in non-COVID-19 patients was better compared to non-COVID-19 patients with <85% TIR, which is consistent with published evidence, even though we had higher percentage (85% instead of 80%) and higher range (150 mg/dL instead of 139 mg/dL) [8]. The study by Zhu et al. reported inadequately controlled diabetes mellitus was associated with increased mortality [31]. A possible explanation for this observation is the study population. They included the entire hospitalized population, while ours was only limited to the ICU patients. The population reviewed in our study had a similar Charlson Comorbidity Index and a similar frequency of daily blood glucose checks. The former is suggestive of similar patient risk factors while the latter is suggestive of similar patient care and protocol follow up. The concern of reduced frequency of glucose checks being a possible risk factor for poor glycemic control is mitigated by the similar median and interquartile range.

A direct effect of SARS-CoV-2 on pancreatic β-cell function and survival has been suggested, causing worsening rapid and severe deterioration of metabolic control in people with pre-existing diabetes or leading to the development of new-onset diabetes [14]. Angiotensin-converting enzyme 2 (ACE 2) is potentially a crucial molecular link between COVID-19 severity and insulin resistance. ACE 2 is extensively present on the pancreatic beta cells [33] and the ligand through which coronaviruses such as SARS CoV-2 binds to its target cells [34]. Inhibition/blockage of ACE 2 causes a significant increase in angiotensin 2 and hyper-reactivity of the renin–angiotensin–aldosterone system, causing increased oxidative stress and reduced insulin sensitivity [35]. Our findings support this hypothesis as a significantly lower percentage of COVID-19 patients spent TIR of BG 70–150 mg/dL and higher time in > 250 mg/dL. Further, the average daily insulin dose was significantly higher in the COVID-19 cohort. This gives credence to the hypothesis of inherent insulin resistance within the patients affected by COVID-19, regardless of illness severity [16]. The alterations in the post receptor insulin signaling cascades result in the development of insulin resistance [36].

Higher glycemic variability along with more frequent hypoglycemia contributes to increased mortality in previous studies [8]. Our study did not report any association of mortality with TIR, possibly due to smaller sample size and less frequent hypoglycemia in both cohorts. This recapitulates the risk of increased mortality with severe hypoglycemia. Additionally, greater > 85% TIR was associated with lesser utilization and duration of ventilation. Hyperglycemia results in increased glucose concentration in epithelial secretion, disrupting the defense capacity of the airway epithelia, thus prolonging the duration of ventilation [37]. Another important confounder potentially is the presence of undiagnosed/unrecognized diabetes. HbA1C levels were not recorded in all patients, thus it is plausible that the COVID19 group had more patients with unrecognized diabetes and this contributed to the observed differences in glycemic control.

A recent study from Italy comparing hyperglycemia control in critically ill COVID-19 patients with pre-existing DM associated hyperglycemia without insulin infusion with higher risk of severe disease [38]. Although, the severity of disease was described by chest CT images. This study signals towards correlation of intensive glucose monitoring and aggressive insulin regimen to maintain TIR (70–150 mg/dl) with improved ICU outcomes in COVID-19 populations. Although, the causal association of hyperglycemia and severity of disease remains unanswered. The unwanted consequence of intensive regimen is hypoglycemia. IV insulin infusion necessitates frequent glucose monitoring, a challenging task due to isolation and personal protective equipment requirements. Continuous Glucose Monitoring (CGM) devices present a viable solution for frequent monitoring in this clinical scenario [39].

Limitations

Our study has several limitations. This is a retrospective, cohort-based, single center study. Given the design of the study, where outcomes were already observed in this chart review study, post hoc power analysis will not add much. While a priori power calculation would be an indispensable component of a clinical study, post hoc power analysis of a study, when all eligible subjects are pooled in a study and where outcomes are already observed, will be conceptually flawed and analytically misleading [40,41]. To overcome this limitation, the figures with the results from the multivariable analysis presents the confidence interval of the estimates.

We did not actively monitor the patient’s response to insulin dosing and calculate the insulin resistance pattern using the HOMA or the QUICKI methods [42,43]. We did not collect the SOFA or APACHE score for the patient population. The study was not powered to capture mortality benefit from higher time spent in range (70–150 mg/dL). Even though we noted a trend towards improved mortality, it did not reach predefined statistical significance (p < 0.05). The proportion of medical, surgical, and trauma ICU patients within the non-COVID-19 cohort is not available. Trauma and elective surgeries were at a minimum during the imposed lockdown due to the COVID-19 surge. Multiple physicians directed insulin dosing and insulin intravenous infusion/subcutaneous transitions were not standardized. This was difficult to capture in the data analysis. We acknowledge the possible limitation that some patients may have been newly diagnosed with diabetes mellitus during their admission and hence, were not identified as diabetic in the pre-existing diagnosis, although this knowledge would not have altered our treatment strategies.

5. Conclusions

The study identifies the difficulty of blood glucose level control in critically ill COVID-19 patients. A higher proportion of COVID-19 patients spent <85% time in range, utilized more insulin per day compared to the non-COVID-19 ICU patients. The findings confirm the difficulty in maintaining blood glucose levels in range and hypothesizes the presence of insulin resistance within critically ill COVID-19 patients. Intensified insulin dosing along with more frequent BG monitoring or potentially using continuous glucose monitoring devices varied from non-COVID-19 patients could assist in maintaining adequate time in the range of blood glucose level (70–150 mg/dL) and thus, improve ICU outcomes.

Acknowledgments

Authors would like to acknowledge Chris C. Naum for his assistance with payment of the article processing fee. The individual participant data (including data dictionaries and study protocol) that underlie the results reported in this article will be shared with investigators who provide an IRB-reviewed/approved protocol and methodologically sound proposal. The data will be made available beginning 3 months and ending 36 months following article publication. To gain access, the data requestor needs to sign a data access agreement with Indiana University Health.

Abbreviations

TIR time in range;
COVID-19 Coronavirus disease 2019;
non-COVID-19 non-coronavirus-related disease 2019;
BG blood glucose; ICU—intensive care unit;
CI confidence interval;
OR odds ratio;
ACE2 angiotensin converting enzyme 2.

Author Contributions

Conceptualization, R.K., A.J.V., S.K. and A.M.P.; methodology, R.K., A.M.P., N.G., S.K. formal analysis, R.K., L.R.T.; data curation, L.R.T.; writing—original draft preparation, R.K., N.G., L.R.T., A.J.V., J.J.; review and editing, R.K., N.G., O.R., S.K., H.K., J.J.; visualization—R.K., L.R.T., N.G., J.J.; supervision—J.J., O.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

R.K., L.R.T., H.K., A.J.V., A.M.P., S.K., and O.R. report no relevant conflicts of interest. J.J. is a Consultant for La Jolla, Advisory Board member AcelRx, Merck, Pfizer Hospital Products, Honorarium for review of Sepsis module from WebMD Health Corp/Postgraduate Healthcare Education, LLC. N.G. is medical director of DaVita home dialysis unit and received honoraria from DaVita.

Footnotes

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Hyperglycemia (high blood sugar) with diabetes

What to know about high blood sugar (hyperglycemia) when living with diabetes:

What is hyperglycemia?

After eating a meal, the body signals the release of insulin. Insulin is like a key that unlocks the cells in order to store glucose for later use. This process reduces the amount of glucose in your blood stream. In people with diabetes, this process does not work as well because either there isn’t enough insulin being produced, or because the body is resistant to the effects of the insulin. As a result, levels of glucose in the blood stream can reach high levels, causing hyperglycemia or high blood sugar.

Scale of normal blood sugar range

  • Hyperglycemia occurs when the blood sugar is above 130 mg/dL while fasting, or greater than 180 mg/dL after eating a meal.
  • American Diabetes Association Glucose Goals for people with Diabetes:
    • Before meals or fasting: 70 to 130 mg/dL
    • 1-2 hours after the start of a meal: Less than 180 mg/dL

Hb A1C
If blood glucose is regularly higher than the “normal” ranges, then this will reflect in the Hemoglobin A1C test that your doctor will run. The Hemoglobin A1C gives your care team an idea of what your blood sugar typically is at.

Symptoms of hyperglycemia

  • High blood sugar
  • Frequent urination
  • Increased Thirst
  • Increased Hunger
  • Blurred Vision
  • Fatigue
  • Weight loss
  • Poor Wound Healing
  • Dry Mouth
  • Drowsiness

Common Causes of hyperglycemia

  • Too much Food
  • Illness, colds, infections, injuries, surgeries
  • Emotional stress
  • Not enough Diabetes Medication, or skipped doses of medication
  • Too little exercise

How to treat hyperglycemia

  • Check your blood sugar, if it’s at the level where your doctor would suggest you call or get treatment, then do so. You may also want to check for ketones if your doctor suggests this
  • Exercise. However do not exercise if you are feeling ill or dizzy or if your blood sugar is very high

When to call your doctor or seek emergency treatment:

  • If you notice a pattern in your blood sugar readings being high, for example 3 or more days with blood sugars higher than 150, notify your doctor.
  • Seek medical attention right away if you suspect high blood sugars and you are:
    • Drinking or urinating a lot more than usual
    • Having nausea or vomiting
    • Deeply, rapidly breathing
    • Finding ketones in your urine or blood

REMEMBER: DO NOT DRIVE yourself if you think you may have very high blood Sugars or Diabetic Ketoacidosis

When Blood Sugar Is Too High (for Kids)

Glucose, or sugar, is the body’s main fuel source. That means your body — including your brain — needs glucose to work properly. But even though we need glucose for energy, too much glucose in the blood can be unhealthy.

What Is Hyperglycemia?

Hyperglycemia (say: hi-per-gly-SEE-me-uh) is the medical word for high blood sugar levels. The hormone insulin is supposed to control the level of glucose in the blood. But someone with diabetes doesn’t make enough insulin — or the insulin doesn’t work properly — so too much sugar can get into the blood and make the person sick.

If you have high blood sugar levels, you may need treatment to lower your blood sugar. Your parents and your diabetes health care team will tell you what your blood sugar levels should be and what to do if they get too high.

Managing diabetes is like a three-way balancing act because you have to watch:

  1. the medicines you take (insulin or pills)
  2. the food that you eat
  3. the amount of exercise you get

All three need to be balanced. If any one of these is off, blood sugar levels can be, too. Your parents and doctor can help you with this balancing act.

Page 1

The Causes of High Blood Sugar

In general, higher than normal blood glucose levels can be caused by:

  • not taking your diabetes medicine when you’re supposed to or not taking the right amounts
  • eating more food than your meal plan allows (without adjusting your insulin or diabetes pills)
  • not getting enough exercise
  • having an illness, like the flu
  • taking other kinds of medicines that affect how your diabetes medicines work

Keeping blood sugar levels close to normal can be hard sometimes, and nobody’s perfect. Grown-ups can help you stay in balance if you have diabetes. Sometimes blood sugar levels can be high because you’re growing and your doctor needs to make some changes in your diabetes treatment plan.

Signs That Blood Sugar Levels Are High

People with high blood sugar may:

  • pee a lot. When blood sugar levels get too high, the kidneys flush out the extra glucose into your urine (pee), which is why people who have high blood sugar levels need to pee more often and in larger amounts.
  • drink a lot. Because you’re losing so much fluid from peeing so much, you can get very thirsty.
  • lose weight. If there isn’t enough insulin to help the body use glucose, the body starts to break down your muscle and fat for energy — and you lose weight.
  • feel tired. Because the body can’t use glucose for energy properly, you may feel really tired.

High blood sugar levels don’t always cause these symptoms. Sometimes you can have high blood sugar levels without even knowing it. But if left untreated, they can cause serious health problems. That’s why it’s important to work with your parents and diabetes team to keep your blood sugar levels in a healthy range. This can mean checking your blood sugar levels a few times a day, even when you feel fine.

Page 2

How Are High Blood Sugar Levels Treated?

To treat high blood sugar, it helps to know what is causing it. You might need to take more insulin or diabetes pills because you’re growing and eating more food, or you might need to get more exercise each day.

Having high blood sugar levels every once in a while isn’t a big deal. It happens to everyone with diabetes from time to time. But if your blood sugar levels are high a lot, your diabetes health care team will have to help you figure out how to get them back to a healthy level.

What Is Diabetic Ketoacidosis (DKA)?

Someone who has high blood sugar can develop a serious problem with a serious-sounding name: diabetic ketoacidosis (say: kee-toh-ah-sih-DOH-sis). This happens if the body gets desperate for a source of fuel. The body wants to use glucose (sugar). But without insulin, that glucose stays stuck in the blood — and isn’t available to the cells — so the body uses fat instead.

But that can sometimes cause problems. Why? Because when the body uses fat, chemicals called ketones (say: KEE-tones) are produced. These ketones get into a person’s blood and urine (pee) and they can make a person very sick. DKA is a very serious problem for people with diabetes, but the good news is that it can be prevented and treated.

Symptoms of DKA

The symptoms of DKA usually don’t develop all at once — they usually come on slowly over several hours. Be sure to tell a parent or another adult if you have these symptoms of high blood sugar, which usually happen before a person develops DKA:

  • You’re really tired.
  • You’re really thirsty or peeing way more than usual.
  • You have a very dry mouth.

If the person doesn’t get treatment to help get their blood sugar levels down to where they should be, he or she may go on to get the following symptoms of DKA and could even pass out:

  • belly pain
  • nausea or throwing up
  • fruity-smelling breath
  • trouble breathing
  • confusion

Sometimes DKA can feel like the flu or another illness, so your parent or another adult will check you for ketones to see if you might have DKA. Checking for ketones is easy — you can test some of your urine (pee) – or sometimes your blood – to see if your ketones are too high.

page 3

How Is DKA Treated?

DKA can be treated but you must go the doctor or hospital right away. To feel better, a person with DKA needs to get insulin and fluids through a tube that goes into a vein in the body.

Can High Levels and DKA Be Prevented?

These two problems don’t sound like much fun, so you’re probably wondering how to prevent them. The solution is to keep your blood sugar levels as close to normal as possible, which means following your diabetes management plan. Checking your blood sugar levels several times a day will let you and your parents know when your blood sugar level is high. Then you can treat it and help prevent DKA from happening.

What else can you do? Wear a medical identification bracelet that says you have diabetes. Then, if you are not feeling well, whoever’s helping you — even if the person doesn’t know you — will know to call for medical help. And the doctors will be able to get you better more quickly if they know you have diabetes. These bracelets also can include your doctor’s phone number or a parent’s phone number. The quicker you get the help you need, the sooner you’ll be feeling better!

Questions and Answers on blood sugar in diabetes — Diabetes Action

 

Q: Why is my fasting reading higher first thing in the morning?
A: This early morning rise in glucose, known as the “dawn phenomenon” is normal and happens when our bodies produce a surge of hormones to help us wake up. During the day, activity tends to keep sugars under control if following a healthy, active lifestyle. If using insulin, it may help to adjust your nighttime dosage.

Q: Why does my blood sugar level go up when I do yard work? I drink water all the time and eat my meals on time, but when I do yard work, like digging and planting and cutting the grass, my sugar levels rise. 
A:  The first 30-60 minutes of exercise, especially in warmer weather, can raise levels. They should come down after that. Try checking right after your yard work, then again in around 90 minutes and see if you have a drop.

Q: What is the normal range that your blood sugar should be if you test it at home?
A: For a basically healthy person, a good fasting is under 100, and 80-90 is even better for most people. If you test two hours after a meal, under 120 is ideal.

Q: Why is my fasting reading around 110 in the morning but only around 90 two hours after lunch?
A: Fasting blood sugar levels are generally higher in the early morning due to the increase hormonal activity during the night, then tend to decrease to more normal levels during the day.

Q: Why does my blood sugar increase after exercise? I had a blood sugar reading of 135 first thing in the morning but after a 3 mile walk my reading was 155. I had nothing to eat or drink during this time. I repeated this test and got the same results a few days later.
A: Wait an hour after you exercise and see if you get the same results. Exercise is a stressor, so blood sugar will be higher immediately after your session. Also, blood sugars tend to be higher in the mornings because of hormonal activity during the night.

Q: I have lost a good amount of weight using intermittent fasting and low-carb eating but I can’t get my blood sugar levels lower. I seem to be stuck in the 130-140 range. It doesn’t matter if I’ve been fasting for 16 hours, or two hours after eating, it iss always between 130 and 140.
A:
Good job!  As you get closer to lower body fat levels, you can plateau for a time.  The morning fasting levels are higher due to surge of nocturnal hormones that help you get up and join the day. With daytime activity, it is not uncommon to have normal levels with whole foods and regular activity.  You still have a level of insulin resistance.  Overtime, as you continue to decrease visceral body fat, you may see levels drop further, with your pancreas’s ability increasing to better handle glucose surges.  

Q: I am a type 1 diabetic and have been trying to lose weight by cutting back on what I eat. How come the less I eat, the higher my blood sugar readings?
A:
If your diet now consists of less protein, that could be a reason for the spikes.  Carbs will trigger that response, even if the total intake is lower.  Try tracking your foods with levels for at least a week to see patterns and where changes may need to be made.  

Q: Can taking antibiotics increase blood sugar levels? 
A:
Some antibiotics have been shown to cause elevated blood sugar levels, particularly for those who already have diabetes.  You’d have to check about your particular antibiotic to see what the cautions may be.  How high the elevation is will depend on the individual.  In general, antibiotics can change the microbiome of the gut, interfering with insulin sensitivity and glucose delivery to the cells.

Q: I have finally gotten my A1C back in the normal range, do I still have diabetes or am I cured?
A: Congratulations!  If you are not on medication for diabetes, then you now have it in control. However, it is important for you to continue with the lifestyle changes you made to achieve this. Reverting back to old habits would most likely result in elevating glucose levels once again.

Q: I have a normal A1C but recently, 4 hours after dinner I started sweating and my blood sugar was 74. But another time, 2 hours after dinner my blood sugar was 194. What is going on?
A:
If your diet consists of more carbs and fruits, this would account for the highs after meals, followed by a low which is likely the reason for your sweating and other symptoms.  A hypoglycemic diet would appear to be a good start for you: try eating 3-5 small meals with some source of protein. You may also request from your physician an Oral Glucose Tolerance Test, showing how your body processes carbs over a 2 hour period.

Q: I failed the one hour glucose screening scoring 197, however, I test myself a few times a day and my blood sugar is always within range, I even experiment with high carb meals and they have never gone over 140. Fasting is always at around 80-85. Is there any explanation for the high results on glucose screening? I am also anemic and wonder if that could be cause for a false positive?
A:
There can be false positives.  Given you were 7 points above the cut-off, a repeat may be considered, particularly if you did not follow the prep guidelines for the test.  Another alternative would be taking a 3 hour glucose tolerance test to get a more complete picture of how you process your carbs.  As with any of these tests, it is important to follow the prep guidelines.  Anemia can increase an A1C otherwise it is usually more associated with hypoglycemia.  With all these potential variables and the fact that you are diligently testing with good results, a second testing is certainly a reasonable request, assuming your anemia is being addressed.

Q: I tested my blood sugar 2 hours after eating fried food and stir-fried vegetables and the reading was 167. My dietician said the high reading was because of the oil used to fry the food. Should I be concerned? 
A:
Fried foods and high carbs, especially refined grains and sweets will increase blood sugar levels.  Sometimes you need to experience how other types of foods affect your levels so you have a clearer understanding of how to better control them going forward.  

Q: I have Type 2 diabetes and have been trying to manage my BG through diet and exercise for the last 4 months. I am no longer taking any insulin supplements but still take 2000mg of metformin per day. I eat less than 50g of carbs per day and exercise regularly. My weight has gone from 158 to 142. My blood ketones average 1.5 indicating that I am in ketosis and probably have no glycogen stores left. My BG, however, averages 140. Why can’t I get my BG down? The lowest fasting BG I have recorded was 103 and that was after going 2 days with zero carbs.
A:
If your fasting levels tend to be the reason for your higher average, with daytime levels being < 140-150, you may want to review the timing of your metformin to better target your fasting levels. This is something you can revisit with your physician. Eating whole foods high in nutrients is important to support the reactions in your body that facilitate increased uptake of glucose from the bloodstream.  

Q: Any blood sugar level below 100 gives me headache and nausea. I seem to feel best when its in the 140-150 range. I also cant feel highs until it gets in the 200 and above range. How can this be?
A:
If you have long standing diabetes with glucose levels that ran high for some time, your system can adapt to this level, causing symptoms of low blood sugar if you try to lower to a more normal range too quickly.  If you are on medication, this may need adjustment. Perhaps your diet needs a better balance as well, slowing down the rate of food conversion to glucose.  An Oral Glucose Tolerance Test can give you a picture of how your body is processing carbs. Discuss all these with your physician.

Q: Besides drinking water, what can I quickly do to reduce a high blood sugar test result (212)? 
A:
A high test result does not mean there is a one quick fix. For the short-term, I suggest that you do not consume any carbs, and instead eat small amounts of healthy fat/protein.  Exercise may raise blood sugar in the short run, but lower in the long run.    

Q: Do I have pre-diabetes? About five months ago I started checking my glucose levels after meals because I was consistently experiencing brain fog. I found that after an especially high carb, zero protein meal, my 1 hour glucose would be as high as 180. I immediately reduced my carb intake significantly, lost weight, and increased my exercise. I recently had labs drawn and my A1C was 4.7. However, even 2 tablespoons of barbecue sauce will raise my one hour glucose to 145, but it will be well blow 120 at 2 hours. Am I pre-diabetic? My doctor told me to stop checking 1 hour glucoses and only worry about my 2 hour levels. I can’t stand the brain fog that comes with glucose levels a live 120 though.
A: Elevated glucose levels aren’t the only reason for brain fog. Changes in hormonal levels could be another factor to consider.  If you consistently notice brain fog after eating refined carbohydrates, try eating an unrefined diet with most of your carbs coming from veggies and legumes.  Perhaps only check your glucose levels when you feel “foggy”.  You may have the genetic tendency for diabetes, but are in control as you have taken charge of your lifestyle.

Q: Why do I sometimes feel extremely angry when my blood sugar level is high?
A: Anger can be an emotional response to high glucose levels, and perhaps more so if one has underlying feelings of anger (it is not uncommon to feel anger when dealing with diabetes management as well).  It is positive that you recognize this in yourself, perhaps working to best of your ability to not get to those levels that push those buttons.  

Q: Can an anxiety attack or severe anxiety raise blood sugar levels?
A:
It is possible.  Anxiety is a stressor that can elevate hormones, especially cortisol, the fight or flight hormone.  This rallies glucose to the bloodstream to prepare you to run or defend yourself.  Hopefully, you are working with anti-anxiety techniques such as deep breathing being a good place to start.  

Q: I have been told that I have diabetes, or “pre-diabetes”, or that I am in the “honeymoon period” . My readings are all over the place: sometimes in the 120’s, others in the 90’s, sometimes, but rarely in the 150-170’s. My doctor does not want to put me on medication yet. I exercise regularly and am not overweight though my diet is variable. I certainly like sweets, pizza, and pasta. What is the long term effect of these continued high blood sugar levels?
A: Firstly, kudos for your physician for giving diet/lifestyle changes a chance to work. Reduction of body fat often is the first best start. This may or may not be true in your case but certainly sweets, pizza, etc. are affecting your numbers. If you can discipline yourself at this time to eat unrefined foods and be more active, your beta cells that produce insulin may get the rest they need to become efficient again. Our diabetes management booklet has many referenced foods/supplements that may help to stabilize your glucose levels. In time, your favorite foods may be reintroduced in moderate amounts. You appear to be more in the pre-diabetes range at this time. Complications are a long process. If your daytime levels stay under 120-140, that is good. Fasting levels are higher due to hormonal activity nighttime; these levels are a much slower road towards any complications. Continue working on lifestyle/diet, as both can always be a bit better, and in time, you may start seeing continued improvement.

Q: What would cause my blood sugar to drop over 200 points over the course of a day? My morning sugar was 252 when I got up, an hour after breakfast (w/ 73 net. carbs) sugar hit 390. A 138 point spike. An hour later 306. At lunch I had a “cutie” orange, and I checked an hour later my sugar was still dropping, the cutie didn’t raise it any. I’ve also drunk 48 ounces of water thus far today. 390 an hour after breakfast at 8:50AM, to 188 at 3:30PM. No meds either. I’m curious as to the 202 drop over 8 hours with no med and 73 net carbs that set the spike. 
A:
Carbs certainly drive your glucose up faster. The first change I would suggest is to eat healthy protein/fat for breakfast.  This creates a slower rise with a longer digestion time.  An Oral Glucose Tolerance Test over a two hour period can help confirm where your spikes occur.  Getting better control of your fasting levels will set the tone for lower levels during the day. Nocturnal hormonal activity is what can drive up our fasting levels.  During daytime activity, these hormonal surges wind down until night/sleep cycle kicks in.   Revamping your diet and keeping as active as can are your first lines of defense.  

Q: I’m taking insulin and Trulicity but my sugar keeps spiking all day and night long. This morning I started out at 190 but after coffee my blood spiked to over 300. I just can’t get control of this and every diet I try to follow I get spikes.
A:
You may want to only eat protein and lots of green veggies for several days to see if this helps you to stabilize your blood sugars and then slowly adjust once stabilized. This means no high carbohydrate foods such as grains, potatoes, or fruit. Your only carbs will come from low carb veggies. Use olive oil/coconut oil as fat source.  There are many diet theories out there now but no one diet is good for all.  If you can manage without coffee for this time, that may also have an impact as you may be super sensitive to it.

Q: hi, I’m 24 weeks pregnant, my blood sugar in the morning ranges from 97 to 106. I’ve been monitoring my blood sugar level for a couple of weeks now. I only eat half cup of rice every meal with snacks in between, of course. My blood sugar sometimes drop below 100, 2 hours after meal. is that normal? I’ve been on a low carb, high fiber and less sugar diet for a couple of weeks now.
A:
Getting enough fuel for both you and your growing child is important.  It is typical for blood sugar to be higher in the morning, due to activity of hormones during the night.  Rice is a “race horse” carb meaning it converts quickly to glucose with a quick spike and dip.  If your lows are occurring more towards afternoon, focus on morning food being more protein/healthy fats because they take longer to convert to glucose and may help with sustaining a more normal glucose the rest of the day.  Perhaps switch your grains to something with higher plant protein, like quinoa.  Again, check that you have adequate caloric intake.  If yogurt agrees with you, this may be a good addition for bringing levels up in better balance.   And of course, never hesitate to pose these questions to your physician.

Q: My fasting blood sugar level is 155. After a 30 minute morning work out on an empty stomach it reaches 167. How to manage this? 
A:
Your levels are higher in the morning anyway due to hormonal activity during the night.  After exercising, you may have elevated blood sugar levels for one hour or more before lowering.  Exercise in the short run is a stressor, which causes the liver to release glucose to blood stream to “fuel up” for the activity.  A goal will be to have lower fasting levels, which often will be result of dietary and activity changes.  

Q: Can sunbathing and high temperatures increase blood sugar levels?
A: High heat can lead to dehydration, which in turn can cause high blood sugars. It takes 6 molecules of water to move one molecule of sugar from the blood stream, so the higher the sugar, the more water you need to drink. Extreme hot or cold temperatures can cause changes in the vascular system that can affect blood sugar and cause reactions.

Q: Do I have diabetes? My most recent A1C test was 5.4. But this last Sunday, four hours after dinner I started sweating and checked my blood sugar and it was 74. Yesterday my blood sugar was 167 two hours after eating.
A:
You may want to get an Oral Glucose Tolerance Test that measures your levels over a 3 hour period after a drinking a prescribed sugar syrup.  Decreasing carbs and increasing healthy fats and proteins while eating smaller, more frequent meals may help these swings if you are on the path of hypoglycemia which can in time become diabetes if left unchecked.  It would be a good idea for you to track your food intake for week, checking your levels one hour after eating to see where the shifts are.

Q: I was diagnosed with type 2 diabetes at 13 after I fell into a diabetic coma with a 1200 blood sugar level but I lost 90 pounds and was pretty much diabetes free. I haven’t taken medication in 7 years or so. I’ve recently gained a lot of weight and am concerned that my blood sugar levels now range from 90-107 after fasting for 8+ hours. During the days and after meals they are in the normal range.
A:
Regaining weight, if too much, may be a key factor here, as that can impair your body’s insulin to effectively take up sugar from your blood stream.  Even though your blood sugar was under control for years, changes in your lifestyle are starting to manifest with elevated fasting levels. This would be a good sign for you to re-evaluate what you eat and your activity levels. You may have a decline in insulin production that is now manifesting.  Hopefully, you are discussing this with your physician if you continue to see your levels elevating.  He/she may want to conduct testing to see what your insulin output is.  

Q: As a type II diabetic my normal blood sugar readings are between 120 and 160. Unusually low reading of
94 is that of any concern?
A:
If your 94 is a fasting reading, that’s a good level if there are no contraindications such as cardiac issues.  If this is the reading you are getting daytime, make note of any signs of hypoglycemia.  Perhaps you ate less that day?  If you begin to routinely get lower daytime readings, then visit with your physician about lowering your medication doses.  That would be a good goal!  

Q: Do I need to test every new container of test strips with the red liquid or can I match the code on my tester with what’s on the lid of a new container?
A:
The recommendation from FDA is to use control solution with every new test vial, after codes are matched and discard after 90 days.  This may be costly for many on a tight budget.  One guideline to adhere to would be to test a strip from your vial if your numbers start to suddenly change.  Use your best judgement; you can also cross reference with your physician.

Q: I took my blood sugar test and it was 182 and two minutes later it was 136. What would cause such a difference in testing levels for just 2 minutes apart?
A: Smaller variances are not uncommon. If you normally test towards the higher number, the lower number would appear off.  Try some more tests close together for comparison and if you see this pattern repeat, contact the meter company for advice.

Q: My fingers are sore. Is there any other place on my body I can use to check my sugar?
A: Forearms are the next place you may be able to go. However, you may want to discuss this with both your meter company and your physician to see what the difference may be between finger/forearm. I trust you are testing the sides of your finger pads, and not directly on them.

Q: I have not been diagnosed with diabetes and my A1c is only 5.0. However, I am concerned that when I wake up my blood sugar is sometimes as high as 140. Do I have diabetes? If I do, why is my A1c normal?
A:
An A1C reflects an average so it may be possible that you are experiencing lows throughout the day that would average out some of the highs.  It would benefit you to get a 2 hour Glucose Tolerance Test done to see just where lows and highs are occurring. Two tests with a fasting glucose of 126 or greater is considered a diabetes diagnosis.

Q: My husband with type 2 diabetes is trying to get his blood sugar down by eating a low carbohydrate diet and skipping lunch. He is having problems with an increased evening reading. Should he eat regular meals? 
A:
Skipping meals can send glucose levels on a bit of a roller coaster ride.  The liver can actually release too much glucose into the bloodstream when no food has been eaten, perceiving a “hunger” situation.  He may be better off eating smaller meals with lower carb/healthy foods that will convert to glucose at a more reasonable rate, generally resulting in better levels. 

Q: I was diagnosed as a pre-diabetic several years ago and I am taking Metformin 500mg one tab a day.
My fasting blood sugar is between 110 and 125. My friend said my fasting level should be under 100.  What fasting and A1C level should I maintain for the rest of my life to best prevent complications.
A: The “ideal” blood sugar level is around 80 fasting but the guidelines provide a wider range. The range you are in may, over many years, have an effect on your nerve endings but this is often dependent upon what other conditions you may have. Taking Metformin in the evening may target a lower faster blood sugar. The first best guideline is to maintain as healthy a lifestyle as you can with food, activity and lower stress levels. I always suggest focusing more on improving lifestyle before getting overly focused on the number.

Q: Why do I still have high blood sugar readings even after a super low carb dinner? I’m currently on 500mg metformin twice daily. I have already lost 30 pounds and now weigh 300 lbs. 
A:  A set dose of medication doesn’t guarantee good control, even with diet improvement. You have started a good path with losing body fat, but you still carry enough to contribute to insulin resistance. Other medical conditions and medications you may be taking can also be a factor. In addition, foods eaten at earlier meals may not fully metabolize until later in day. If you are diligent with lifestyle changes, you should continue to see improvements over time.

Q: I have been told that the older you are the higher the blood sugar readings can be. At 82 years of age my fasting reading is 140-152 with no medications. Is this cause for concern?
A: It is elevated enough for you to perhaps reexamine your carbohydrate intake, the timing of foods, as well as your overall lifestyle.  Other health concerns may also be playing into elevated fasting levels.  With advancing age, we can experience decreased efficiency of our organ systems, pancreas included.  Perhaps more so, the liver – the major clearinghouse for so much of our digestion/absorption – goes on a decline.  Increasing your phytonutrients through higher intake of greens is supportive, as are many other foods that more naturally help to detoxify the liver.  Staying as active as possible is always key.  

Q: Why does my blood sugar jump from 115 to 165 after eating breakfast?
A: All food turns into sugar and carbs turn the fastest. It is normal for everyone’s blood sugar to rise after a meal though folks without diabetes don’t go over 140 as a rule. If your blood sugars had been closer to 100 before your meal, you would have been closer to a normal range. Also, it may have been the types of foods you ate. A breakfast that includes protein, such as an egg, and whole grains, such as a higher fiber toast may help to keep your numbers down. Check your blood sugars 2 hours after eating for a while so that you see how you are the rest of the day. This will help your physician in adjusting any medications you might be on. Keeping a very healthy lifestyle is your best ally for keeping those numbers down.

Q: I was recently diagnosed with gestational diabetes and have been controlling it very well with diet. However, last night I had pizza for dinner, I know not the best choice! Two hours after eating, my blood sugar was 130. I know sugar should be under 120 after two hours, but is it acceptable since my sugar never went about 140?
A: With gestational diabetes, the goal is tighter control to help ensure better health to your child.  Isolated instances will occur, but choosing foods to keep you closer to goal is a good target.  I suggest you also visit this question with your medical team who has your entire health history to influence best answers.  

Q: Every two hours after I eat, I take my blood sugar reading. I assume that if two hours post-meal my reading is 120 or below, I have good control of my sugar. However, if I have a small snack 30-60 minutes before I test, will that affect my blood sugar when I take it at two hours post-meal? 
A: It may, depending on what you eat. Simple carbs will react pretty immediately and certainly within the 30-minute timeframe. Protein and fats take longer in the digestive process. You may want to check just before your snack. The highest peak blood sugar levels generally occur 1 hour after a meal if carbs were eaten. At 2 hours, protein begins to break down into blood sugar so one may begin to see some food effect. Test both before and after your snack and see what differences in readings you may notice.

Q: My morning and afternoon blood sugar readings are fine but the reading before my evening meal is still really high, even though I have only been drinking black coffee and water during the afternoon. I try to walk between two and four miles a day, so I am sure I am getting enough exercise. I do seem to be stressed most of the time, and wondered if this could have something to do with it. 
A: Stress can play a part; you may want to have your cortisol levels checked to see if they stay elevated later in the day. Caffeine can also elevate levels in the short run. If you exercise right before you take your reading that can also be a factor. Try waiting 1/2-1 hour and see if that makes a difference.

Q:  I recently had a scary situation where my blood sugars dropped to a low number. An EMT was called and he measured my blood sugar with a meter at 46. He told me to eat some cookies. I ate four or five cookies and immediately had blood check again but it wasn’t going up yet, so was administered a tube of some type of glucose. Once again my blood sugars were measured within a minute or two and the level was now up to 125. The EMT left but within minutes I was experiencing extreme confusion, my legs were very shaky, and I finally fainted for a short time. I had nausea, and an extreme headache for hours. What could have been happening to me? 
A:  Your blood sugar levels rose too quickly. 46 is very low, and it sounds as though within the space of 10 minutes or so you were back into the diabetes range. The protocol to follow for low blood sugar when that low would be to administer 15 grams of carbs, then re-measure. Starting with the tube would have brought you into a better range more immediately, wait 15 minutes, then retest. You would probably have been in a range where the next “food” would be a protein/carb combo: milk if you drink it, yogurt, nut butter on crackers, etc. Always stay well hydrated; this will help avoid some of those after-effects of low sugars. Better yet: be sure you are understanding how to eat for blood sugar control. This is even more important if also on medications. 

Q: I suffered what I believe was a low blood sugar attack with extreme dizziness and nausea. I take medication for type 2 diabetes. What should I do next time this happens?
A: It sounds like you did have a low blood sugar attack. It could be that you are not requiring as much medication, and/or you waited too long between meals. You should be checking your blood sugars and make sure that you know what ranges your physician wants you in. The idea is not to eat more to feed the medication, but to hopefully lower the medicine dose. Glucose tablets are good to carry with you in emergencies as the dose is then measured. Lifesaver candies can also work. The usual amount is 15 grams of carbs every 15 minutes until blood sugars come up.

Q: My friend’s meter is giving me a different reading than my meter. I use the control solution BUT is that really accurate?
A: It is not uncommon to get some difference in readings between meters, but it should not be too broad a span. You might consider taking your meter to your physician’s office at your next visit and see if you can test it against one of theirs. I suggest you also call your meter company and discuss your concerns. They do calibration studies and should be able to give you some solid answers.

Q: Why are blood sugar monitors so inconsistent. I thought my first one was broken because of the wide discrepancy in readings so I ordered another and calibrated it according to the instructions and it seems to be the same. I can get a reading of 160 and seconds later do another test and get a reading of 125. They call that accurate?! 
A:
True, machines are never pinpointing the actual number, which is somewhat of a constant change.  The current FDA ruling is 95% of time there is no more than 15% variance and 99% of the time there is no more than 20% variance.   A meter value of 120 would reflect a range of 102-138.  What “seasoned” testers start to see over time are more numbers closer together as long as lifestyle/management is consistent. Work out a testing schedule just to see where your greater discrepancies lie; discuss this with your physician as needed if adjusting medication based on numbers.  

Q: Can the hot weather have an effect on a persons blood sugar readings? 
A: High heat, particularly warm weather, does not directly affect your glucose levels, but it can lead to changes in your daily habits: eating less and not adjusting medication, being less active, and possibly over exerting yourself. These situations can lead to either higher or lower levels. Dehydration can set in more readily; don’t wait for thirst to be your clue. Carry water at all times. Sunburn is stressful to the body and can elevate glucose, so plan your sun exposure and exercise for earlier or later in the day. Remember also that high heat can affect meter strips and medications, especially insulin. Be smart with the heat, and you will manage your glucose much better this summer.

Q: After 8 years of successfully controlling my type 2 diabetes, my fasting numbers are starting to creep up into the 200+ range and my doctor wants to put me on insulin. What am I doing wrong?
A: Many variables can cause this change. One factor is that as we age (I like to refer to this as “chronological maturity”), hormones change as well. Another very common variable is that we often eat the same way, not increasing our intake, but neither do we increase our activity levels. Taking insulin for a time may give the beta cells the rest they need, with perhaps returning to your lower levels. Conversely, many do experience a decline of insulin output over time, regardless of lifestyle management. Your gene pool may have you on this path. Do what you need to get back into good management. Managing one’s stress levels is a “must”; yoga, Tai Chi, dance are just a few examples of very positive supports. Find what works for you.

Q: I have type 1 diabetes and whenever my blood sugar is low I feel as if my thinking process is different and I tend to feel anxious. Then once my sugar gets back up I don’t feel that anxiety anymore. Does that have to do with blood sugar levels affecting my thinking? 
A: These are symptoms that occur with most people with low blood sugar. Remember, food is fuel for the body, and the form of our food is sugar, which you need to have enough of in your body for your brain to function normally. With low blood sugar levels, anxiety, lack of focus, gloom-to-doom thought patterns can manifest. This is very true with hormonal imbalances as well. Many kids begin to show signs of this with puberty and poor lifestyle/eating patterns that abound in today’s society. The important thing here is that you know how to fix these symptoms. Better yet, keep yourself from getting to that point by always having something with you to elevate your blood sugar. Keeping a pack of glucose tabs with you at all times gives you a set dose of carbs to take when you first feel signs coming on. Dry roasted nuts also carry well to hold off hunger.

Q: I am an elementary school nurse. I have a 10 yr old student with type 1 diabetes. He typically comes in low before lunch (50-70), eats lunch, retakes his blood glucose 30 minutes later and it is up to 120-140. However, at that time the parent recommends the full compensation of insulin for carbs ingested at lunch. Invariably he comes back in less than an hour dropped back down to 50-70. My thought is they need to compensate for the low number that they are starting with before they give him a dose based on carb ingestion only. What are your thoughts? 
A: You are on the right track with seeing there is a deficit here in food/insulin. This is an active growing child. As with anyone with diabetes, it is important to have the right amount of protein/fat in place to create a more stable baseline for levels. Being around 110 pre-meal would be good unless his physician has established different numbers. The goal is not to keep feeding carbs to manage the insulin, but to reduce the insulin overall because the glucose levels are in better range. If he eats eggs for breakfast, they should provide a more stable morning. If the child begins to show fatigue and his performance is affected in school, this may be the documented route you need to have them revisit the protocol with their physician. Nobody wants him to suffer hypoglycemic episodes, which it sounds like he could be a candidate for. 

Q: I have had type 2 diabetes for 15 years. Although my fasting levels are generally higher in the morning, two weeks ago I noticed a few levels approaching 240 fasting before breakfast. For example, last week my morning level was 235. I ate a meal that had eggs and turkey sausage and coffee without sugar. My blood sugar dropped to 196 after one and a half hours. I took a walk for 20 minutes and my sugar level was 127. Then I had another coffee and an hour later my sugar was 190 again. Why would this happen?
A:
  Food intake is a most powerful player here. It is common for blood sugar levels to be elevated in the early morning due to hormonal activity during the night, then begin to drop during the day with usual daytime activity. Then, assuming eating is well-controlled, daytime levels can be in normal ranges. You should clarify with your physician what the target glucose goals are for you for both fasting and 1-2 hours post meals. The morning protein meal you ate converted into glucose at a far slower rate than if you had eaten a carbohydrate based meal, so it is not surprising that you saw a drop in levels as you did after that meal. Coffee is often listed as a “free food” that does not affect blood sugar levels but you can see this may not be the case. It does stimulate the central nervous system and can cause some short term rise in levels. 

Q: I was diagnosed with type 2 diabetes five months ago. I have been testing and trying to determine what is working and what is not. I’ve noticed recently I could have a double cheeseburger and fries and have a reading of roughly 140 two hours after. Yesterday I vigorously tested and found, 1.5 hrs post was 122, 2 hrs post was 142, 2.5 hrs post was 168, 3 hrs post was 189 and finally 3.5 hrs post was 85. A 104 pt drop in 30 minutes. Should I still be testing two hours after a meal when I was apparently at my highest three hours after?
A: This all depends on what you are eating. A double cheeseburger will show its greatest impact in that 3-4 hour time frame because proteins and fats start to peak into glucose 3-4 hours post meal. Most carbs peak by 1 hour after eating and are pretty much through the entire digestive process 2 hours after eating. If you eat few carbs and primarily meat and fats, then you will peak later. This is why in most structured meal planning, you will see meat intake to be about 3oz./serving, gradually increased for high calorie meal plans required by larger individuals. Get a good balance with your foods to where you include lots of veggies/higher fiber foods and smaller amounts of refined carbs/very low fiber starches (white breads ,etc). Testing after different times with different foods will give you a better idea of what raises your glucose levels more quickly.

Q: When my type 1 diabetic son goes low….under 70, if we give him 15 grams of carbs, how much does it bring his levels up by? 
A: 10-15 grams is targeted to elevate glucose levels 30-45 mg/dL. Assuming this is from quick acting choices such as 4 oz juice, 3 glucose tabs or 6 oz. of milk, his levels should come up quickly and be tested at 15 minute intervals until the target is reached. For those on insulin, it is especially suggested to treat once blood sugars drop below 72mg/dL. I suggest you enroll in diabetes management class if you have one in your area, or at least be very clear from your medical team what the basic targets and management skills are for your son.

Q: I just got a new glucose monitor and my numbers are lower than with my old monitor – as much as a 23 point difference. I am curious if you know why this would be? 
A: I’m assuming you have made sure your old strips are up to date and calibrated if necessary? I suggest you call both companies for an explanation, then perhaps assume the newer meter is giving more accurate readings. You can verify this by bringing your meter to your physician’s office next time you go and test against their machine if they do this in the office. There is often some difference between meters, but that is a very wide range.

Q: I think I may have diabetes because my fasting glucose is 140 but my doctor said I do not have diabetes. I get light headed, dizzy, blurry eyed, and my hands shake if I don’t eat a snack with sugar in it between meals. Please help, my doctor says Im fine. 
A: You clearly have blood sugar imbalances, going from some moderate highs to lows. The shakiness, etc. is hypoglycemia. Has your doctor done a glucose intolerance test on you yet? I suggest the one that shows your glucose levels at 4 intervals 2-3 hours apart. You may be higher in the morning and then going low daytime. Eating unrefined foods, lean protein, and more veggies than starches are really important for you right now. Eating 5-6 small meals/snacks should be your pattern. An apple and 1 oz. of cheese or 1 tbs. of nut butter is an idea for a snack. Learn where protein comes from and include it more. Beans have a good source of plant protein and fibers that stick with you longer and break down into sugar (as all food eventually does) in your blood stream more slowly. This is a good thing, as you won’t get a low blood sugar nearly as quickly. Candy, juices, etc. are all turned into blood sugar very fast; they don’t stick with you. Think of these simple sugars as very short term fuel. You may need a 2nd opinion. Eating correctly will help you straighten this out.

Q: My Dr. said my glucose number should be between 65-99. I am a 77 1/2 year old female who recently started experiencing low blood sugar episodes, especially at night. If my number when tested is 103 and lower, I shake, sweat and am generally miserable till I drink orange juice, etc. Is it possible that my count needs to be higher? 
A: I do think you need to revisit this with your physician, as clearly you seem to be requiring a higher blood sugar level. A textbook normal fasting glucose is closer to 80; 65 would be too low for many people. Keep close track of your intake, and be sure to eat protein at each meal.

Q: I was recently diagnosed with type 2 diabetes and manage with diet and medication. My primary care doctor told me when my blood sugar gets low and I get shaky I should take a pinch of table sugar. My question is, should I eat something like an orange or something other than table sugar to raise my blood sugar? It just seems counterproductive to watch what I eat all day, every day, then take some sugar to even out my blood.
A: Low blood sugars are better treated by drinking 4-6 ounces of milk if you are a dairy consumer, 4 ounces of juice, or some sugar equivalent to equal 15 grams. 3-5 Lifesaver candies often does the job. However, the goal is not to have to eat more, but to lower your medication requirements. As you continue to take charge of your lifestyle and how different foods affect your levels, episodes will be less frequent. When you are just beginning to show the signs of low blood sugar, milk is a good choice (this includes soy milk) because it has the right carbs to get into your bloodstream quickly, but also has some protein to digest at a slower rate. I suggest you try to find some diabetes classes in your area to learn all you can on how to manage, especially eating.

Q: I’m a type 1 diabetic and going though menopause. My blood sugars are consistently high whereas before they were on target. Does menopause cause my body to resist insulin? 
A: Hormonal changes can affect your glucose levels, as you are experiencing, which is not exactly insulin resistance. It is important during this time that you eat foods as unrefined as possible and stay active to reduce any potential symptoms like sweats and hot flashes. This will help to reduce glucose fluctuations as a result of less fluctuation at the nerve levels. You may want to eat the exact same diet every day to see what is due to hormones versus diet, etc. In addition, nutritional compounds for menopause may help with balance.

Q: I am on an 800-1000 calorie diet and my blood sugar readings are still 104-109. Shouldn’t they be lower?
A:  I would first suggest that you are eating too few calories; this is not effective fat loss. It will most likely serve to alter your metabolism more than give you any long lasting results. Fasting blood sugars of 100-125 constitute a diagnosis of pre-diabetes. You would fall into this range. A goal would be to be less than 100 fasting. I suggest you get some guidance with a healthy eating plan for yourself, be active, and target long term body fat loss at a gradual pace as the way to effectively achieve your goals.

Q: What finger should I use when testing? On two occasions I’ve had different readings from two different fingers.
A:  It should not matter which finger you use as long as you test on the side of the finger.  Do not milk the finger; hold it upside down to let the blood flow to the tip.  Readings may vary slightly.  If the spread is wide, be sure you tested correctly in both situations.  If you still get discrepancies, I suggest you call the 800 number on your meter and ask their advice.

Q: What are the risks when blood sugar is 400 to 500?
A: The intensity of the symptoms will vary between individuals. If these high blood sugars persist, some symptoms that may be experienced include dizziness, nausea, headaches, frequent urination, and hunger. In some cases, one may even experience Diabetic Ketoacidosis, a condition that if left unchecked, can lead to coma. This is generally more associated with type one diabetes. High blood sugars over the long-term precipitate complications such as organ and nerve damage.

Q: I had a blood test but did not realize that I was supposed to fast beforehand. I had two cups of the coffee in the morning, and a sandwich and chips for lunch. My results came back at 293. Is this an accurate test? Do I have diabetes? My doctor wants to put me on medication.
A: 293 would still constitute a diagnosis of diabetes, since it is over 200 – the limit for a random blood sugar, even without fasting. In my experience working with endocrinologists, the next step after “discovering” the high blood sugar would be to order an A1C test to measure an average over the last 3 months. An Oral Glucose Tolerance test may also be order to see how the blood sugars go over the course of 3 hours after a high carb load. If you have no other symptoms or uncontrolled conditions, a course of 3 months of focused diet/lifestyle changes may be put in place to see how far your numbers come down before starting medications. It is most important for you to get educated on eating for diabetes management. Exercising and working towards reduced body fat is usually also at the top of the list.

Q: What is the normal blood sugar levels for a pregnant person fasting, immediately following a meal and 2 hours after? How many carbs can I eat?
A: The guidelines for gestational diabetes have gotten tighter. Those practitioners who manage their patients more tightly prefer a fasting glucose of less than 90 and 110 one-two hours post meal. The best rule of thumb for carbs is NOT to eat them in the morning if you do experience elevated blood sugars. This often means saving your fruit for lunch or later. How many carbs is dependent on your nutritional needs and caloric needs for your pregnancy. It would be helpful for you to have a consult with a nutritionist who understands gestational diabetes patterns. Once you and your physician have determined your blood sugar guidelines, a management plan should follow. Meanwhile, eat unrefined foods as much as possible, lean “flesh”, and minimize sweets and juices.

Q: Can having diabetes cause your blood alcohol levels to go up? 
A: Yes, though generally this is more pronounced for those with insulin dependent diabetes. When the cells can’t suck in the blood sugar due to insufficient insulin, the body breaks down fat for fuel and produces ketones, which can cross-react with both blood and alcohol tests to produce a positive result, even without a drink. Lots of ketones can cause a fruity breath, mistaken for alcohol, and cause a person to have symptoms of being intoxicates such as slurred words and dizziness. ALWAYS HAVE ID ON YOU THAT IDENTIFIES YOU ARE DIABETIC TO AVOID UNNECESSARY HASSLE AND GET TREATMENT YOU MAY NEED IN A TIMELY FASHION!

Q: Is a 132 glucose level, after a ten hour fast, high enough to be concerned about? 
A: Two fasting levels of 126 or greater is a diagnosis of diabetes. If this was a lab test, your physician should order another fasting glucose to confirm, and an A1C to get your average level over a 3 month period. Meanwhile, start practicing a very healthy lifestyle, understanding what food choices to focus on. In a nutshell, focus on eating lots of veggies, some fruit, legumes, lower starch, and fish or smaller amounts lean meat. BE ACTIVE! That is the best key to control.

Q: My fasting blood glucose is normal, but the A1c was 6.5. What would you recommend?
A: I suggest to closely review what you eat the entire day, and increase your activity level if necessary. If your fasting is between 80-90, great! If higher, then lifestyle habits certainly are what need to be addressed first. You may also request an Oral Glucose Tolerance Test to see what your blood sugar response is post-meal.

Q: Why does my blood sugar get highest 3 hours after eating? One hour after eating my blood sugar is around 160-180, after 2 hours it is around 100-125. What’s confusing is it goes up again after 3 hours post-meal to reach 140 then drops down again to 100, and stays at that level. Readings taken after fasting are between 90 to 110. Is this usual?
A: Most of what you describe is usual, particularly depending on what you are eating. Is the 3 hour rebound the same daily? Do you monitor that often? If you are exercising or particularly active before that 3 hour measurement, that could account for a slight rise, followed by the drop. That is a normal pattern for the immediate effect of exercise on blood sugar. Are you on insulin? It sounds as though you may need to revisit your eating habits and tweak your medication program to help you start with an even lower fasting blood sugar.

Q: I have type 2 diabetes and am having problems keeping my morning blood sugar to desired levels. My afternoon levels are usually in the normal range. I’m overweight, but I’ve lost about 27 pounds hoping to reduce my average blood sugar. However, this has not happened. What could this mean? Is my disease progressing?
A: There are several factors that affect morning blood sugars. Often, with reasonable control of diet and exercise resulting in weight loss as you indicate, you do experience a drop. Is your diet as “impeccable” as you can make it? Nutritional supplements also can be helpful when professionally guided. Don’t give up; keep up with your good work. Insulin resistance can be just that: resistive! For some people, if they don’t follow a disciplined program, blood sugars will keep rising. Sticking to a healthy lifestyle will only be a win-win situation for you in the long run.

Q: I sometimes experience a rise in blood sugar levels whenever I am under a great deal of stress or am ill. Even if I’m strict about my diet, is there any way of keeping the sugar levels down without having to take insulin? Will they return to “normal” levels without medication, or will I still require insulin shots?
A: In general, illness and stress do elevate blood sugar, and if you are already requiring insulin when you are otherwise healthy/unstressed, you may need more at these times. If your blood sugars fall into normal levels without needing medications, then triggers such as an illness may or may not raise them, and if so, may not raise them high enough or long enough to warrant medication. Be sure you understand the nature of the disease, and monitor yourself in all situations as closely as you can. No one will be able to manage this better than yourself.

Q: What is a good blood sugar reading after eating a meal?
A: In an entire day, we generally say your blood sugar should not go over 140 even after eating a large meal. Ideally it would not go over 120 two hours after eating. With diabetes, one’s physician may have a higher goal, depending on the health of the person, in order to avoid hypoglycemia (low blood sugar).

Q: Does maintaining a level glucose mean that I should constantly keep my sugars the same, or will the numbers go up and down?
A: There are ranges to maintain your glucose within. Ideally, you will target to be under 100 before breakfast (fasting), and under 140 after meals. You are trying to avoid the extremes of high and low blood sugars. Ask your physician what his/her blood sugar goals are for you immediately and over the long term.

Q: Does high blood sugar cause your blood to get thick and sticky? 
A: Very high blood sugars can accelerate dehydration, which could contribute to “thick” blood. Other medications may also lend to dehydration. It takes six molecules of water to move one molecule of sugar through the blood stream. With all the emphasis on food and lifestyle changes, drinking enough water is basic to good management. Generally, 8 glasses per day is a good start for most people, realizing some will need more, some less. If your first morning urine is not reasonably pale, you are probably not getting enough water.

Q: Do I need to be concerned that my blood glucose runs about 106 fasting every morning? The rest of the day it is fine. I run and lift weights regularly, and my diet is good while watching my carbs. I do not drink. I am also careful with snacks at night.
A: It is good that you are normal during the daytime. The biggest wear and tear on the body seems to come from fluctuating daytime levels rather than a stable but slightly high fasting level. Yes, it would be good to get under 100, ideally between 80-90, but if you truly are most diligent in your lifestyle, you should be able to maintain good health. Certain hormones elevate nighttime levels, contributing to morning highs. Research is out there on many nutraceuticals that may lower fasting blood sugar levels. Water soluble cinnamon in capsule form is one of the most recent that is showing good results.

Q: What should my blood sugar be before meals and 90 minutes after a meal to be an acceptable level? I am pre-diabetic.
A: In general, you do not want to be over 140 post-meal at any time of day. Staying closer to 120 post-meal is an even tighter goal and mimics the non-diabetic state better. Pre-meal blood sugars will vary depending on the last time food was consumed; a goal is to stay between 80-120. Maintaining consistent exercise and monitoring carbs and food quantity will assist in keeping your 2 hour post meal blood sugars under 140.

Q: However, I can have a normal blood sugar reading of about 90 before breakfast and then after a moderate cereal-toast breakfast, my blood sugar will go over 200. I am not diabetic according to medical tests.
A: Have you had an Oral Glucose Tolerance Test? Newer research is placing more emphasis on the after meal glucose elevations as opposed to just monitoring fasting glucose. You are experiencing hyperglycemia, which as an initial diagnosis, generally manifests as slowly elevating fasting glucose. Ideally, your fasting glucose should be closer to 80. 100 is pre-diabetes. I would suggest that your breakfasts now consist of more protein and less carbs. Good choices include egg, yogurt, nut butter, cheese, meat, oatmeal, etc. Target for 20-30 grams of protein at each meal. Any carbs you eat should have fiber: whole grain toast, fresh fruit, etc. Breakfast cereals generally don’t fit these criteria unless you search for a type with higher fiber. I suggest an overabundance of plant foods now, to clean out your system a bit, giving your liver a work break. This should help to fine tune your metabolism. Make sure you have essential fatty acids in your intake: fish/plant foods are main sources.

Q: My husband is on an insulin pump but after a severe low blood sugar, he will struggle for several weeks to get his blood sugars under control again. The blood sugars go low and then high for no reason, regardless of diet, exercise, insulin.
A: I suggest you work a bit more closely with the pump trainer on how to cut back on insulin depending on time of day, activity level, etc. With the abilities of today’s pumps, there are many options for programming different dosages throughout a 24 hour cycle. In my experience, most pumpers need at least 2-3 different program rates. If you begin to notice a pattern of lows, that would be the time of day or activity relationship to begin cutting back with. This may mean both bolus and basal rates. If lows do occur, try to avoid over treating. Four ounces of juice may be enough if he is really low. Tablets may be a better choice to control the carb amounts, re-administering every 15 minutes until a desired blood sugar level is reached. With perseverance and lifestyle consistency, he should reach a more stable pattern.

Q: Do cold temperatures affect blood sugar? My blood sugar numbers have gone up since the building turned the air conditioning down. The cold air vent is directly above my desk, blowing cold air directly on me. 
A: Extreme temperature changes can create a stress reaction, elevating blood sugars. If you are cold, I’m sure you are “bundling up”. Hopefully, you will adjust with time. And is it possible to shift your desk?

Q: How often should pen needles be used before discarding?
A: Pen needles technically are to be used once. In reality, most people who do more than one injection per day immediately cap their needles after use, discarding at the end of the day. Most pens are prefilled, so when finished, discard and start another pen.

Q: My wife is having problems with her blood sugar levels. She has been watching her carbohydrate intake but when she sleeps for at least 8 hours, her sugar levels are higher. Why?
A: It is good she is monitoring her carbs closely, but it is also about the total intake of food and her activity level. Glucose is generally higher in the early morning due to hormonal activity during the night. If she is also elevated during the day, it again may be the types and quantities of foods. Perhaps her medication needs reevaluating. I would suggest she pose these questions to her physician.

Q: I have had type 1 diabetes for about 16 years now. My A1C was 8.6 for a while but now I have it down to 7.6 and lower now. The problem is that now I feel like I am having low blood sugar even when I am in the good range.
A: For many who have adapted to functioning on higher sugars for many years, then in a reasonably short period drop into more normal ranges, low blood sugar symptoms may persist for a time. This means that your insulin is functioning far more efficiently in removing sugar from your bloodstream. At 7.6, you are still in a higher range, but certainly closer to numbers that are more protective for complications. If you are on other medications, particularly for CAD, these may also contribute to symptoms. Make sure you know from your physician what range you should be in. If the symptoms persist, perhaps something else would be the cause not directly related to glucose lowering in the bloodstream. Hormonal changes as part of the life cycle can also play a role.

Q: Do I use the first or the second drop of blood when testing my blood sugar?
A: With most strips now, you can touch them with the first drop. It takes far less blood than it used to to get a good sample. One drop is all that is needed.

Q: I’ve been taking my blood sugar readings for 2 years. The highest reading was 200 after a meal by 1 hour. Fasting blood sugar is almost between 80 to 100. With such readings, should I be concerned about being diabetic?
A: You are showing readings of hyperglycemia. There is a greater movement among diabetes management practitioners to emphasize the importance of post meal control. This is because blood sugar excursions contribute to higher oxidative stress, which in turn may cause increased tissue damage leading to greater risk of complications. This seems to be more true than chronic sustained high blood sugars, such as only high fasting levels.

The ideal fasting blood glucose reading is less than 100. The ideal post-meal blood glucose reading is less than 140. 140-200 post meal/random reading is considered pre-diabetes. I suggest you carefully reevaluate your daytime eating, perhaps being more careful of carb intake and type and follow up with your health care practitioner.

Q: I am a 74 year old male whose glucose level has gone slightly but steadily up over the past year and a half: 99, 104 and today 106. My doctor seems not concerned as I have none of the usual diabetes symptoms, have loads of energy, exercise a great deal at recreational sports, and eat wisely. Given the glucose level and fact that many in my family have diabetes, I am concerned and wonder what I could do?
A: It sounds like you are on a good path geared towards a healthy lifestyle. You may want to seek professional nutritional counseling to fine tune if you are not already very aware of such issues as the impact of carbohydrates. You are still maintaining a low pre-diabetes status. There are nutritional supplements such as cinnamon that may also be helpful in keeping your blood sugars down. Be certain too that you stay well hydrated by drinking lots of water. If you maintain these numbers and don’t go any higher, you should do well.

Q: My blood glucose runs about 106 fasting every morning. The rest of the day it is fine. I run and lift weights regularly, and my diet is good while watching my carbs. I do not drink. I am also careful with snacks at night. Is this morning level a reason for concern and why is it high in the morning?
A: It is good that you are normal during the daytime. The biggest wear and tear on the body seems to come from fluctuating daytime levels rather than a stable but slightly high fasting level. Yes, it would be good to get under 100, ideally between 80-90, but if you truly are most diligent in your lifestyle, you should be able to maintain good health. Certain hormones elevate nighttime levels, contributing to morning highs. Research is out there on many nutraceuticals that may lowering fasting blood sugar levels. Cinnulin PF, from cinnamon, is one of the most recent that is showing good results. It can be found in capsule form.

Q: I have been overweight for years and have been having my blood sugar checked at bi-annual doctor’s appointments, always to be told it was “fine” or “normal”. Five months ago the A1c was 6.3. Now it has gone to 10.1 with a fasting blood sugar of 329. While at my first diabetic management appointment, the nurse showing me how to test my blood sugar got a 428, stuck a needle of insulin in me, and sent me home with vials and needles. Is it normal for someone to go from fine to insulin diabetic so rapidly?
A: I would hope you had a bit more instruction than what you are conveying. With blood sugars over 300, it is now the thought of many endocrinologists to start a person on insulin to detox the beta cells of the pancreas. This may only be for a short period if lifestyle changes are diligently made. Sometimes, it is a shift to oral medication, or none at all. Over the years, one may need a return to insulin and/or other medications. Take charge of you lifestyle habits and get all the education you can on managing this disease.

 

Blood Glucose Meter | Medtronic Diabetes Russia

By regularly checking your blood sugar, you will be able to see in which direction it is changing and take the necessary steps to keep it in the desired range.

How do I check my blood sugar?
A blood glucose meter is used to check your blood sugar. All devices are slightly different from each other, so always read the instructions before use.The analysis requires just a few simple steps. Usually they are as follows:

  • Wash your hands first
  • Turn on the meter
  • Insert new test strip
  • Using a lancet, pierce the tip of your finger and draw out a small drop of blood
  • Place blood on the test strip of the meter

The device will need a few seconds for a blood test, after which the result will be displayed in mmol / L or mg / dL.

What to strive for?
In most cases, your goal is to keep your blood sugar as close to that of a healthy person as possible. Ideally, it should be 4 to 7 mmol / L (72–126 mg / dL) before meals and about 5–9 mmol / L (90–162 mg / dL) after meals (after 90 minutes). The blood sugar range shown is only a guideline; Your target range may differ. Consult with your medical team to determine your target range.It is determined individually and often depends on:

  • duration of diabetes
  • 90,010 age / life expectancy

  • concomitant diseases
  • identified cardiovascular diseases or serious microvascular complications
  • Impaired sensitivity to hypoglycemia
  • individual factors relevant to the patient

There is no consensus on the ideal range to strive for.Because this metric is completely different for each person, the patient needs to agree on the target level with their diabetes care team.

The following blood sugar (glucose) target ranges are provided as guidelines only.

Children with type 1 diabetes (NICE 2015)

  • upon waking and before meals: 4-7 mmol / L (72-126 mg / dL)
  • after meals: 5-9 mmol / L (90-162 mg / dL)

Adults with type 1 diabetes (NICE 2015)

  • upon waking: 5-7 mmol / L (90-126 mg / dL)
  • before meals at other times of the day: 4-7 mmol / L (72-126 mg / dL)
  • 90 minutes after a meal: 5-9 mmol / L (90-162 mg / dL)

Type 2 diabetes (NICE 2008)

  • before meals: 4-7 mmol / L (72-126 mg / dL)
  • two hours after a meal: less than 8.5 mmol / L (153 mg / dL)

Pregnant women with diabetes (NICE 2015)

  • fasting: below 5.3 mmol / L (95.4 mg / dL) and
  • 1 hour after meal: below 7.8 mmol / L (140.4 mg / dL) or
  • 2 hours after eating: below 6.4 mmol / L (115.2 mg / dL)

What do the results mean?
Controlling your blood sugar is about balancing your diet, activity, and medication or insulin intake.This is not an easy task, but by carefully monitoring your blood sugar levels, you will understand how each of these factors affects your body.

Simply put, if your blood sugar is low (hypoglycemia), you will need to take the necessary steps to bring it back to the target range, and if it is too high (hyperglycemia), you will need to take action to stop it rising and lower it. blood sugar to a safe value.

When you have finished checking your blood sugar, write down the number that appears on the meter.It is helpful to keep a diary to keep track of how your blood sugar changes over the course of the day, week, or month. You can track the dependence of indicators on nutrition, activities and other aspects that can affect the indicators throughout the day. If you notice certain trends, such as consistently high or low values, you may need to adjust the treatment program. Work with your doctor or diabetes care team to determine what the results mean for you.Please be patient, this may take a while. Try not to measure individual metrics, but simply analyze them to make sure everything is in order.

Remember that blood sugar measurements often have a strong psychological effect. Metrics outside the target range can upset you, confuse you, annoy you, make you angry, or just make you feel bad. It is very easy to judge yourself with the help of these numbers, especially if you think that you have done everything necessary.Remember that your blood sugar is a way to track the effectiveness of your diabetes program, it is not an assessment of you as an individual. If the results deviate from the target range, this is just a warning that you need to change something in your diabetes care program.

90,000 3 Indian spices will lower blood sugar in type 2 diabetes and normalize cholesterol

Diabetes is a serious medical condition that causes high blood sugar levels and impairs the quality of life of patients.Just 3 spices added to the must-have list of weekly purchases will normalize glucose levels and improve the condition of type 2 diabetics, according to British scientists.

Photo: pixabay.com

According to the NHS, type 2 diabetes accounts for about 90 percent of all diabetes cases. It is caused by the body not producing enough of the hormone insulin or the body not responding to it. Diabetic patients should be closely monitored for their blood sugar levels, as the condition increases the risk of some fatal complications.

One of the easiest ways to maintain normal blood sugar levels and avoid the unwanted symptoms of diabetes, according to UK scientists, is to change your daily diet.

Nutritional scientist Dr. Amitawa Sarkara believes that certain Indian spices may reduce the risk of diabetes complications. The doctor assigns a key role in the management of diabetes and blood cholesterol levels to black pepper.

The second important spice, the nutritional scientist calls cardamom, has antioxidant anti-inflammatory properties, which are especially in demand in diabetes.Ginger taken on an empty stomach significantly lowers blood sugar levels.

“Treating diabetes is a lifelong process,” Sarkar told SastaSundar. The doctor believes that in the fight against diabetes, every step associated with changes in diet, daily workouts, about which the Uchitelskaya Gazeta website wrote, becomes extremely important.

“Did you know that a generous serving of several Indian spices can help control diabetes?” – the scientist asks the readers of the British edition.And he adds that Indian cuisine that uses spices works wonders for health. And the benefits of spices in the fight against diabetes are invaluable.

Healthy eating and physical activity will help diabetic patients control their blood sugar, NHS believes. British doctors are also convinced that a person with diabetes can include almost anything on the menu. Of course, there are restrictions on a number of products, but they exist even in healthy people.

Scientists call for expanding the diet with fruits, vegetables, even some foods containing starch.And they remind you of the most important postulate, which must not be forgotten: before you change your diet, include new foods in it, switch to a new system of daily training, you must definitely consult with your doctor.

Earlier, the online publication Uchitelskaya Gazeta told readers how dangerous the coronavirus is for the human psyche, about skin cancer caused by aggressive ultraviolet light, as well as three signs of vitamin B12 deficiency that can be identified by the face, and six symptoms of a stroke.

Glucose

Glucose is a simple carbohydrate (monosaccharide) that is the main source of energy in the body. The concentration of glucose in the blood is regulated by the hormone insulin, which is produced by the pancreas and delivers glucose to cells. But, if insulin is not enough or the sensitivity of cells to it is reduced, then glucose is absorbed worse by the cells and its concentration in the blood increases.

Doctors strongly recommend having a glucose test every six months for men and women over 40, as well as regardless of gender and age – everyone who is overweight or has a hereditary predisposition to type 2 diabetes.In our country, more than 5% of the population suffer from this disease.

It is important to remember that the blood glucose concentration rates differ for capillary (“finger”) and venous blood. Before the analysis, you must refrain from any food or sugary drinks for 8 hours.

Glucose is the main indicator of the metabolism of carbohydrates in the blood, the main energy substrate of the body. The level of glucose in the blood (blood sugar test) is regulated by the activity of the neuroendocrine system, parenchymal organs (liver, kidneys).The main hormone responsible for glucose utilization in tissues is insulin. Along with it, counterinsular hormones take part in the regulation of blood glucose levels: glucagon, cortisol, adrenaline, growth hormone, thyroxine.

To determine the level of glucose (sugar) in the blood, it is necessary to take a blood sugar test (blood glucose test). The concentration of glucose in the blood is variable and depends on muscle activity and the interval between meals. These fluctuations increase even more when the regulation of blood glucose levels is impaired, which is typical for some pathological conditions when the blood glucose level can be increased (hyperglycemia) or decreased (hypoglycemia).

Hyperglycemia is most often detected in patients with diabetes mellitus. Diabetes mellitus is a disease characterized by hyperglycemia resulting from absolute or relative insulin deficiency. Initial diagnosis can be done by taking a blood sugar test (blood glucose test). As a result of insulin deficiency, the concentration of glucose (sugar) in the blood increases, since the transport of glucose to the cells of organs and tissues (with the exception of the liver and brain) is impaired.There are three main types of diabetes mellitus: type 1 diabetes mellitus (insulin-dependent), type 2 diabetes mellitus (insulin-resistant), gestational diabetes mellitus. Other types of diabetes have also been described: diabetes with genetic defects in pancreatic β-cell function, genetic defects in insulin, diseases of the exocrine pancreas, endocrinopathies, drug-induced diabetes, infection-induced diabetes, unusual forms of immune-mediated diabetes, genetic syndromes associated with diabetes.

Hypoglycemia is detected in some pathological conditions, including severe respiratory failure syndrome of newborns, toxicosis of pregnant women, congenital enzyme deficiency, Raye’s syndrome, liver dysfunction, insulin-producing pancreatic tumors (insulinomas), antibodies to insulin, non-pancreatic insufficiency of chronic tumors, septicemia … If a blood sugar test shows a decrease in blood glucose (hypoglycemia) to a critical level (up to about 2.5 mmol / L), then this can lead to dysfunction of the central nervous system.This is manifested by muscle weakness, poor coordination of movements, and confusion of consciousness. A further decrease in blood glucose levels can lead to hypoglycemic coma.

General practitioner, therapist, endocrinologist, pediatrician, gastroenterologist, surgeon.

expert advice – articles from the specialists of the clinic “Mother and Child”

– What is gestational diabetes mellitus (GDM) and how is it different from regular diabetes?

– GDM is a newly emerged and detected increase in blood sugar during pregnancy.As a rule, the failure occurs due to the sugar-increasing action of pregnancy hormones. This diagnosis differs from type 1 and 2 diabetes mellitus in that it passes after childbirth.

– At what time and at what examinations is diabetes detected in pregnancy?

– In the first half of pregnancy, according to the level of fasting blood sugar (normally it should be up to 5 mmol / l), from the 24th to the 32nd week – using an oral glucose tolerance test with 75 g of glucose (OGTT-75), which is performed for all women if their fasting blood sugar is below 5.1 mmol / l. If sugar is already 5.1 and higher on an empty stomach, then the test can be skipped – this indicator is already enough to establish a diagnosis.

– Do I need to somehow prepare for the test?

– No, you need to stick to your usual diet. The last meal should contain carbohydrates – cereals, pasta, or stewed vegetables.

– Who is at risk?

– Pregnancy itself is a risk factor for GDM, as pregnancy hormones increase sugar.The high-risk group automatically includes women with GDM, manifested in a previous pregnancy, overweight and obesity, as well as those who have close relatives with type 2 diabetes. In addition, the birth of a child in a previous pregnancy weighing more than 4 kg also indicates a tendency to develop GDM.

– Why is the fast sugar rate different for pregnant women and “ordinary” people?

– During pregnancy, the nocturnal production of glucose by the liver decreases, because the developing fetus takes from the mother the glucose and amino acids necessary for its synthesis in the liver.Therefore, the sugar rate for pregnant women is lower. The norms were recently revised, as as a result of monitoring 25,000 pregnant women, a twofold increase in fetal complications with sugar during pregnancy above 5 mmol / l was revealed.

– What is the danger of uncorrected GDM for mother and child?

– On a short-term basis – the immaturity of the baby’s organs at birth, premature birth, hypoglycemia of newborns. In the long term, the mother’s nutrition and her blood sugar levels affect the formation of an already prenatal predisposition to obesity, increase the risk of developing type 2 diabetes and cardiovascular diseases by 50%.Left untreated, gestational diabetes increases the risk of preeclampsia fourfold.

– What is special about the GDM diet and what if it doesn’t work? Are many pregnant women afraid that insulin will become addictive and they will not be able to give it up after childbirth?

– The diet depends on the individual characteristics of the woman, but in general, it is important for everyone to remove foods with a high glycemic index, rich in saturated fats, from the diet, evenly distribute carbohydrates throughout the day, limiting their intake in breakfast.In the absence of normoglycemia against the background of a diet, insulin preparations are prescribed, since they do not cross the placenta and are the safest during pregnancy. After childbirth, insulin is immediately canceled, no addiction to the drug occurs. One should not be afraid of insulin, but dangerous numbers of blood sugar for the development of the child.

– How to choose a meter and when to measure sugar?

– The doctor will help you determine the model of the glucometer. Sugar control in pregnant women is done on an empty stomach and one hour after the main meals.If necessary, the endocrinologist will prescribe more frequent monitoring.

– Delivery with a diagnosis of GDM should take place in a specialized maternity hospital?

– Often yes, as the nursing staff must have experience in managing childbirth and nursing newborns. According to the International Diabetes Federation, every 6th child is born to a mother with gestational diabetes.

– What happens to pregnancy diabetes after childbirth?

– After childbirth, diet and insulin are canceled if the blood sugar in the venous plasma is below 6.0 mmol / L. After 6-8 weeks, OGTT-75 is performed to exclude diabetes and predisposition to it. GDM usually goes away after childbirth and no further blood sugar control is required.

– Is it possible to carry out prophylaxis at the stage of pregnancy planning?

– The main prevention is adherence to a healthy diet, physical activity for more than 150 minutes per week and weight loss if there is an excess of it.

IT IS NECESSARY TO KNOW

For gestational diabetes, your doctor will ask you to keep a food diary, in which you will need to record everything you eat during the day and sugar values ​​after meals.The goal is to keep fasting sugar below 5.1 by diet, and below 7.0 mmol / L an hour after eating.

Lean sugar is influenced not only by diet, but also by sleep, stress and physical activity.

90,000 Glucose convert to mmol / l, mg / dl, mg / 100 ml, mg%, mg / l, μg / ml. Online calculator / converter from traditional units to SI

Glucose is an important source of carbohydrates present in the peripheral blood. Oxidation of glucose is an important source of cellular energy in the body.Dietary glucose is converted into glycogen, which is stored in the liver, or fatty acids, which are stored in adipose tissue. The concentration of glucose in the blood is controlled within narrow limits by many hormones, the most important of which are the hormones of the pancreas.

The fast and accurate way to regulate fasting blood sugar is in stark contrast to the rapid increase in blood sugar during the digestion of carbohydrates. A decrease in blood glucose to a critical level (up to about 2.5 mmol) leads to dysfunction of the central nervous system.This manifests itself in the form of hypoglycemia and is characterized by muscle weakness, poor coordination of movements, and confusion of consciousness. A further decrease in blood glucose levels leads to hypoglycemic coma. Blood glucose values ​​are unstable and depend on muscle activity and the interval between meals. These fluctuations increase even more when the regulation of blood sugar levels is impaired, which is typical for some pathological conditions, when the blood glucose level can be increased (hyperglycemia) or decreased (hypoglycemia) .

The most common cause of hyperglycemia is diabetes mellitus resulting from insufficient insulin secretion or insulin activity. This disease is characterized by an increase in blood glucose to such an extent that it exceeds the renal threshold and sugar appears in the urine (glucosuria). Several secondary factors also contribute to high blood glucose levels. These factors include pancreatitis, thyroid dysfunction, kidney failure, and liver disease.

Less common hypoglycemia . A number of factors can cause a drop in blood glucose levels such as insulinoma, hypopituitarism, or insulin-induced hypoglycemia. Hypoglycemia occurs in several pathological conditions, including severe respiratory failure syndrome of newborns, toxicosis of pregnant women, congenital enzyme deficiency, Reye’s syndrome, liver dysfunction, insulin-producing pancreatic tumors (insulinomas), insulin antibodies, non-pancreatic tumors, septicemia, chronic renal failure and drinking alcohol.

Blood glucose measurement is used for screening diabetes mellitus, with suspected hypoglycemia, monitoring diabetes treatment, assessing carbohydrate metabolism, for example, in acute hepatitis in pregnant women with diabetes, acute pancreatitis and Addison’s disease.

Urine glucose measurement is used for the detection of diabetes, glycosuria, renal impairment, and for the treatment of patients with diabetes mellitus.

Cerebrospinal fluid glucose measurement is used to detect meningitis, tumors of the lining of the brain and other neurological disorders. Glucose in cerebrospinal fluid may be low or not detected at all in patients with acute bacterial, cryptococcal, tubular or carcinomatous meningitis, as well as with cerebral abscess. This may be due to high glucose uptake by leukocytes or other rapidly metabolizing cells.In viral infectious meningitis and encephalitis, glucose levels are usually normal.

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Method of determination
Hexokinase.

Study material
See description

Serum or blood plasma. If it is not possible to centrifuge the sample 30 minutes after collection to separate the serum / plasma from the cells, the sample is taken into a special tube containing a glycolysis inhibitor (sodium fluoride).

Synonyms: Blood glucose test; Plasma or serum glucose; Blood sugar; Blood glucose; Fasting blood glucose test; Blood sugar analysis. Glucose, Plasma or Serum; Fasting blood glucose; FBG; Fasting plasma glucose; Blood glucose; Blood sugar; Fasting blood sugar; FBS.

Brief characteristics of the analyte Glucose

Sources of glucose for the body are carbohydrates (fast and slow), supplied with food in the form of sucrose, fructose, maltose, lactose, starch, etc.In the body, glucose accumulates in the form of glycogen in the liver and, if necessary, can be synthesized from non-carbohydrate substrates (amino acids, glycerol, lactate).

Maintaining blood glucose at a certain level is an example of one of the most perfect mechanisms for regulating homeostasis, in the functioning of which the liver, extrahepatic tissues and some hormones are involved. Insulin transports glucose into cells and is the only hormone that lowers blood glucose levels.Other hormones such as glucagon, cortisol, adrenaline, thyroid hormones, growth hormone cause an increase in its level in the blood, exhibiting a counterinsular effect. As a result of the action of regulatory mechanisms, the blood glucose level normally fluctuates within a narrow range of values.

The main laboratory test for assessing carbohydrate metabolism is the determination of fasting blood glucose. Its increased content is called hyperglycemia and can be a symptom of diabetes mellitus.

Diagnostic criteria for diabetes mellitus

Laboratory criteria in the diagnosis of diabetes mellitus based on blood glucose levels are currently considered:

  1. fasting glucose level 7.0 mmol / l and above;
  2. combination of clinical symptoms of diabetes mellitus and an accidental (independent of the time of the previous meal) increase in blood plasma glucose to 11.1 mmol / L and higher;
  3. glucose level two hours after taking glucose (75 g) when performing an oral glucose tolerance test of 11.1 mmol / l and higher.

Since changes in blood glucose concentration can be detected much earlier than clinical manifestations of diabetes mellitus, it is recommended that all people over 45 years of age (even without symptoms of diabetes mellitus) have an annual fasting blood glucose monitoring test. At an earlier age, screening is done in people at increased risk of diabetes (including children over ten years of age). Also, the determination of fasting blood glucose is included in the mandatory examination of pregnant women.Hormonal changes during pregnancy cause a physiological increase in insulin resistance in a woman’s body. The relative lack of insulin during this period in some women can lead to an increase in blood glucose and the development of diabetes during pregnancy (gestational diabetes).

What is the purpose of determining the level of glucose in serum or plasma

Determination of the level of glucose in plasma or serum is used for the diagnosis and control of diabetes mellitus and other diseases associated with impaired carbohydrate metabolism.

What can affect the test result Glucose

In vitro, glucose can be determined in whole blood, serum or plasma (the latter is preferred). When interpreting the results of glucose studies, it is useful to take into account the following data: glucose freely penetrates into erythrocytes, but its concentration in blood plasma is about 11-14% higher than in whole blood due to different water content in plasma and blood cells. So, the glucose content in the plasma of venous blood taken on an empty stomach may be higher than in the whole blood sample taken from the finger at the same time.Heparinized plasma glucose is 5% lower than serum glucose. Whole venous blood contains less glucose than finger capillary blood due to the utilization of glucose in tissues. This difference is insignificant when taking blood on an empty stomach (the difference is about 0.1 mmol / L), but it increases markedly after eating (the difference is about 15%) or when an oral glucose tolerance test is performed (the difference is 20-25%) – the effect of insulin release.

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Glucose is a carbohydrate, the main function of which is energy.

Glucose enters the body with food unchanged or as part of complex carbohydrates by splitting them; also after the breakdown of glycogen – the main substrate for glucose stores in the cell. Another mechanism for producing glucose is gluconeogenesis – its synthesis from non-carbohydrate products (amino acids, keto acids).

When and to whom should blood glucose be measured?

Given the disappointing statistics on the number of patients with carbohydrate metabolism disorders (in November 2017, the director of the National Medical Research Center of Endocrinology of the Russian Ministry of Health announced 4.3 million diabetes patients registered in the Russian Federation, while in fact there are about 8 million of them.Another 30 million Russians are in a state of prediabetes, most of whom are unaware of the problem. Such data were obtained by examining people on the street), everyone should know their glucose level.

It is especially important to determine the glucose level if you often experience thirst, dry mouth, frequent and profuse urination, in addition, severe weakness, dizziness. If people around you notice the smell of acetone from you (not always perceptible on your own). Alertness to the amount of glucose should be shown to persons with obesity (waist 80 cm and more for women, 94 and more for men), burdened by heredity for diabetes.

You can monitor glucose whenever you want and an unlimited number of times. However, for screening for pre-diabetes and diabetes, it is more convenient to use a glycosylated hemoglobin test (blood glucose test), which characterizes the level of glucose in the human body over the past 3 months.

You can find out the level of glucose in the blood in two ways: by analyzing venous (less often capillary) blood in the laboratory, or by an express method using a glucometer. The result of the first will be ready the next day, and an express blood glucose test is performed with the patient and takes no more than a minute.

What are the requirements for performing the analysis?

Blood sampling for glucose determination is performed in the morning on an empty stomach (fasting for at least 8 and no more than 14 hours). It is recommended to exclude the use of sweets, flour, alcohol the evening before. No other preparation is required. The express method is applicable at any time of the day.

Norms of glucose in blood (according to WHO data)

The normal fasting blood glucose level is considered to be less than 5.6 mmol / L in capillary blood and less than 6.1 in venous blood.If these indicators are exceeded, we recommend that you contact an endocrinologist or therapist as soon as possible.

We carry out the analysis on the most modern equipment using foreign reagents, so we can guarantee the quality and high speed of the study, and professional nurses will ensure comfort when taking blood.

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