What are the diagnostic criteria for prediabetes. How can prediabetes be effectively managed and treated. What lifestyle changes can help prevent progression to type 2 diabetes. When should children be tested for prediabetes.

Prediabetes Diagnosis: Key Tests and Criteria

Prediabetes is a condition that precedes type 2 diabetes, characterized by elevated blood sugar levels that are not yet high enough to be classified as diabetes. Early diagnosis is crucial for preventing progression to full-blown diabetes. Let’s explore the main diagnostic tests and criteria for prediabetes.

Glycated Hemoglobin (A1C) Test

The A1C test is a widely used method for diagnosing prediabetes. It measures the average blood sugar level over the past three months by analyzing the percentage of blood sugar attached to hemoglobin in red blood cells.

• Normal: A1C level below 5.7%
• Prediabetes: A1C level between 5.7% and 6.4%
• Type 2 diabetes: A1C level of 6.5% or higher on two separate tests

It’s important to note that certain conditions, such as pregnancy or uncommon forms of hemoglobin, can affect the accuracy of the A1C test.

Fasting Blood Sugar Test

This test requires fasting for at least eight hours before a blood sample is taken. The results are interpreted as follows:

• Normal: Below 100 mg/dL (5.6 mmol/L)
• Prediabetes: 100 to 125 mg/dL (5.6 to 7.0 mmol/L)
• Type 2 diabetes: 126 mg/dL (7.0 mmol/L) or higher

Oral Glucose Tolerance Test

While primarily used to diagnose diabetes during pregnancy, this test can also detect prediabetes. It involves fasting overnight, then drinking a sugary solution and measuring blood sugar levels after two hours.

• Normal: Less than 140 mg/dL (7.8 mmol/L)
• Prediabetes: 140 to 199 mg/dL (7.8 to 11.0 mmol/L)
• Type 2 diabetes: 200 mg/dL (11.1 mmol/L) or higher

Are you at risk for prediabetes? The American Diabetes Association recommends screening for most adults starting at age 45, or earlier if you’re overweight and have additional risk factors.

Prediabetes in Children: A Growing Concern

With the rise in childhood obesity, type 2 diabetes is becoming increasingly common in children and adolescents. Understanding the risk factors and testing recommendations for prediabetes in children is crucial for early intervention and prevention.

Risk Factors for Prediabetes in Children

The American Diabetes Association recommends prediabetes testing for children who are overweight or obese and have one or more of the following risk factors:

• Family history of type 2 diabetes
• African American, Hispanic, Native American, Asian American, or Pacific Islander ethnicity
• Low birth weight
• Born to a mother who had gestational diabetes

Testing Recommendations for Children

The blood sugar level ranges considered normal, prediabetic, and diabetic are the same for children and adults. Children with prediabetes should be tested annually for type 2 diabetes, or more frequently if they experience weight changes or develop symptoms such as increased thirst, increased urination, fatigue, or blurred vision.

Lifestyle Modifications: The Cornerstone of Prediabetes Treatment

Treating prediabetes primarily involves making healthy lifestyle choices to bring blood sugar levels back to normal or prevent them from rising further. Here are key strategies to manage prediabetes effectively:

Healthy Eating Habits

Adopting a nutritious diet is crucial in managing prediabetes. Focus on:

• Low-fat and low-calorie foods
• High-fiber options
• Fruits, vegetables, and whole grains
• A variety of foods to maintain taste and nutrition while meeting health goals

Increased Physical Activity

Regular exercise plays a vital role in improving insulin sensitivity and managing blood sugar levels. Aim for:

• At least 150 minutes of moderate aerobic activity per week
• Or 75 minutes of vigorous aerobic activity weekly

How can you incorporate more physical activity into your daily routine? Consider activities like brisk walking, cycling, swimming, or joining fitness classes that you enjoy.

Weight Management

Losing excess weight can significantly reduce the risk of developing type 2 diabetes. Even modest weight loss can make a difference:

• Aim to lose 5% to 7% of your body weight if you’re overweight
• For example, losing 14 pounds (6.4 kg) if you weigh 200 pounds (91 kg) can help reduce diabetes risk

Focus on sustainable changes to your eating and exercise habits to maintain a healthy weight long-term.

Additional Lifestyle Changes to Prevent Diabetes Progression

Beyond diet and exercise, there are other important lifestyle modifications that can help manage prediabetes and reduce the risk of developing type 2 diabetes:

Smoking Cessation

Quitting smoking is crucial for overall health and can help reduce the risk of developing type 2 diabetes. If you smoke, consider seeking support to quit through nicotine replacement therapy, counseling, or support groups.

Stress Management

Chronic stress can affect blood sugar levels and make it harder to maintain healthy habits. Incorporate stress-reduction techniques such as:

• Meditation or mindfulness practices
• Deep breathing exercises
• Regular physical activity
• Adequate sleep

Regular Health Check-ups

Maintain regular appointments with your healthcare provider to monitor your blood sugar levels and overall health. Your doctor may recommend:

• Annual blood sugar tests
• Regular blood pressure and cholesterol checks
• Screenings for diabetes-related complications

Medication Options for Prediabetes Management

While lifestyle changes are the primary approach to managing prediabetes, in some cases, medication may be recommended. Understanding the potential role of medications in prediabetes treatment is important.

Metformin

Metformin (Glumetza, others) is the most commonly prescribed medication for prediabetes:

• It works by reducing glucose production in the liver
• May be recommended for individuals at high risk of developing type 2 diabetes
• Generally well-tolerated, with potential side effects including gastrointestinal discomfort

Other Medications

In addition to metformin, your doctor might prescribe medications to address related health concerns:

• Cholesterol-lowering drugs
• Blood pressure medications

Is medication necessary for everyone with prediabetes? Not always. The decision to use medication depends on individual risk factors and should be made in consultation with a healthcare provider.

Prediabetes Management in Children: Special Considerations

Managing prediabetes in children requires a tailored approach that takes into account their unique needs and developmental stages. Here are key strategies for addressing prediabetes in pediatric populations:

Lifestyle Modifications for Children

Children with prediabetes should adopt similar lifestyle changes as adults, including:

• Weight management through healthy eating and increased physical activity
• Reducing intake of refined carbohydrates and unhealthy fats
• Increasing fiber consumption
• Limiting portion sizes and eating out less frequently
• Engaging in at least one hour of physical activity daily

Family-Based Approach

Successful management of prediabetes in children often requires a family-centered approach:

• Encourage the entire family to adopt healthier habits
• Create a supportive home environment that promotes healthy eating and regular physical activity
• Involve children in meal planning and preparation to teach them about nutrition

Medication Considerations for Children

Generally, medication is not recommended as the first-line treatment for prediabetes in children. However, in some cases, healthcare providers may consider medication if lifestyle changes alone are insufficient. Any decision to use medication in children should be made carefully, weighing potential benefits against risks.

Monitoring and Long-term Management of Prediabetes

Effective management of prediabetes requires ongoing monitoring and adjustment of treatment strategies. Understanding the importance of long-term management can help prevent progression to type 2 diabetes and maintain overall health.

Regular Blood Sugar Monitoring

Consistent monitoring of blood sugar levels is crucial for tracking progress and identifying any changes that may require intervention:

• Your doctor may recommend checking your blood sugar levels at least once a year
• More frequent testing may be necessary if you’re at higher risk or showing signs of progression
• Home blood glucose monitoring might be recommended in some cases

Adjusting Treatment Plans

As your health status changes, your prediabetes management plan may need to be adjusted:

• Regular consultations with your healthcare provider to review progress
• Modifications to diet, exercise routines, or medications as needed
• Addressing any new health concerns or risk factors that may arise

Education and Support

Ongoing education and support can play a crucial role in successful long-term management of prediabetes:

• Participate in diabetes prevention programs or support groups
• Stay informed about the latest research and recommendations for prediabetes management
• Seek support from family, friends, or mental health professionals if needed

How often should you reassess your prediabetes management plan? It’s generally recommended to review your plan with your healthcare provider at least annually, or more frequently if there are significant changes in your health or lifestyle.

Preventing Complications and Reducing Risk of Type 2 Diabetes

While managing prediabetes, it’s crucial to focus on preventing potential complications and reducing the risk of progressing to type 2 diabetes. Understanding the long-term implications of prediabetes can motivate individuals to maintain healthy habits and adhere to their management plans.

Cardiovascular Health

Prediabetes is associated with an increased risk of cardiovascular disease. To protect heart health:

• Monitor and control blood pressure
• Manage cholesterol levels through diet, exercise, and medication if necessary
• Quit smoking and limit alcohol consumption
• Maintain a healthy weight

Kidney Function

Elevated blood sugar levels can impact kidney function over time. To protect your kidneys:

• Stay hydrated by drinking plenty of water
• Limit sodium intake
• Avoid excessive protein consumption
• Get regular kidney function tests as recommended by your healthcare provider

Eye Health

Prediabetes can affect eye health, potentially leading to vision problems. To maintain good eye health:

• Get regular eye exams
• Control blood sugar levels to prevent damage to blood vessels in the eyes
• Protect your eyes from UV radiation by wearing sunglasses outdoors

By focusing on these areas of health, individuals with prediabetes can significantly reduce their risk of developing type 2 diabetes and its associated complications. Remember, consistent management and regular check-ups are key to maintaining long-term health and preventing the progression of prediabetes.

Prediabetes – Diagnosis and treatment

Diagnosis

The American Diabetes Association (ADA) recommends that diabetes screening for most adults begin at age 45. The ADA advises diabetes screening before age 45 if you’re overweight and have additional risk factors for prediabetes or type 2 diabetes.

There are several blood tests for prediabetes.

Glycated hemoglobin (A1C) test

This test shows your average blood sugar level for the past three months. The test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells called hemoglobin. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached.

In general:

• An A1C level below 5.7% is considered normal
• An A1C level between 5.7% and 6.4% is considered prediabetes
• An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes

Certain conditions can make the A1C test inaccurate — such as if you’re pregnant or have an uncommon form of hemoglobin.

Fasting blood sugar test

A blood sample is taken after you fast for at least eight hours or overnight.

In general:

• A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal.
• A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose.
• A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes.

Oral glucose tolerance test

This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you’ll drink a sugary solution, and your blood sugar level will be measured again after two hours.

In general:

• A blood sugar level less than 140 mg/dL (7.8 mmol/L) is considered normal.
• A blood sugar level from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is considered prediabetes. This is sometimes referred to as impaired glucose tolerance.
• A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher indicates type 2 diabetes.

If you have prediabetes, your doctor will typically check your blood sugar levels at least once a year.

Children and prediabetes testing

Type 2 diabetes is becoming more common in children and adolescents, likely due to the rise in childhood obesity. The ADA recommends prediabetes testing for children who are overweight or obese and who have one or more other risk factors for type 2 diabetes.

These other risk factors include:

• Family history of type 2 diabetes.
• Race. Children who are African American, Hispanic, Native American, Asian American and Pacific Islander are at higher risk.
• Low birth weight.
• Being born to a mother who had gestational diabetes.

The ranges of blood sugar level considered normal, prediabetic and diabetic are the same for children and adults.

Children who have prediabetes should be tested annually for type 2 diabetes — or more often if the child experiences a change in weight or develops signs or symptoms of diabetes, such as increased thirst, increased urination, fatigue or blurred vision.

Treatment

Healthy lifestyle choices can help you bring your blood sugar level back to normal, or at least keep it from rising toward the levels seen in type 2 diabetes.

To prevent prediabetes from progressing to type 2 diabetes, try to:

• Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Eat a variety of foods to help you achieve your goals without compromising taste or nutrition.
• Be more active. Aim for at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity a week.
• Lose excess weight. If you’re overweight, losing just 5% to 7% of your body weight — about 14 pounds (6.4 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits.
• Stop smoking. Smoking may up your risk of developing type 2 diabetes.
• Take medications as needed. If you’re at high risk of diabetes, your doctor might recommend metformin (Glumetza, others). Medications to control cholesterol and high blood pressure might also be prescribed.

Children and prediabetes treatment

Children with prediabetes should undertake the lifestyle changes recommended for adults with type 2 diabetes, including:

• Losing weight
• Eating fewer refined carbohydrates and fats, and more fiber
• Reducing portion sizes
• Eating out less often
• Spending at least one hour every day in physical activity

Medication generally isn’t recommended for children with prediabetes unless lifestyle changes aren’t improving blood sugar levels. If medication is needed, metformin (Glumetza, others) is usually the recommended drug.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Many alternative therapies have been touted as possible ways to treat or prevent type 2 diabetes. But, there’s no definitive evidence that any alternative treatments are effective. Therapies that have been said to be helpful in type 2 diabetes and are also likely to be safe, include:

• Cassia cinnamon
• Flaxseed
• Ginseng
• Magnesium
• Oats
• Soy
• Xanthan gum

Talk to your doctor if you’re considering dietary supplements or other alternative therapies to treat or prevent prediabetes. Some supplements or alternative therapies might be harmful if combined with certain prescription medications. Your doctor can help you weigh the pros and cons of specific alternative therapies.

Preparing for your appointment

You’re likely to start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in diabetes treatment (endocrinologist), a dietitian or a certified diabetes educator.

Here’s some information to help you get ready for your appointment.

What you can do

Before your appointment, take these steps:

• Ask about any pre-appointment restrictions. You’ll probably need to fast for at least eight hours before your appointment so that your doctor can measure your fasting blood sugar level.
• List symptoms you’ve been having and for how long.
• List all medications, vitamins and supplements you take, including the doses.
• List key personal and medical information, including other conditions, recent life changes and stressors.
• Prepare questions to ask your doctor.

For prediabetes, some basic questions to ask your doctor include:

• How can I prevent prediabetes from turning into type 2 diabetes?
• Do I need to take medication? If so, what side effects can I expect?
• I have other health conditions. How can I best manage them together?
• How much do I need to exercise each week?
• Should I avoid any foods? Can I still eat sugar?
• Do I need to see a dietitian?
• Can you recommend any local programs for preventing diabetes?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Has your weight changed recently?
• Do you exercise regularly? If so, for how long and how often?
• Do you have a family history of diabetes?

Sept. 22, 2020

How Glucose Levels Affect Your Body

When you have diabetes, your blood sugar (aka blood glucose) levels may be consistently high. Over time, this can damage your body and lead to many other problems.

How much sugar in the blood is too much? And why is high glucose so bad for you? Here’s a look at how your levels affect your health.

What Are Normal Blood Sugar Levels?

They’re less than 100 mg/dL after not eating (fasting) for at least 8 hours. And they’re less than 140 mg/dL 2 hours after eating.

During the day, levels tend to be at their lowest just before meals. For most people without diabetes, blood sugar levels before meals hover around 70 to 80 mg/dL. For some people, 60 is normal; for others, 90.

What’s a low sugar level? It varies widely, too. Many people’s glucose won’t ever fall below 60, even with prolonged fasting. When you diet or fast, the liver keeps your levels normal by turning fat and muscle into sugar. A few people’s levels may fall somewhat lower.

Diagnosis

Doctors use these tests to find out if you have diabetes:

• Fasting plasma glucose test. The doctor tests your blood sugar levels after fasting for 8 hours and it’s higher than 126 mg/dL.
• Oral glucose tolerance test. After fasting for 8 hours, you get a special sugary drink. Two hours later your sugar level is higher than 200.
• Random check. The doctor tests your blood sugar and it’s higher than 200, plus you’re peeing more, always thirsty, and you’ve gained or lost a significant amount of weight. They’ll then do a fasting sugar level test or an oral glucose tolerance test to confirm the diagnosis.

Any sugar levels higher than normal are unhealthy. Levels that are higher than normal, but not reaching the point of full-blown diabetes, are called prediabetes.

According to the American Diabetes Association, 86 million people in the U.S. have this condition, which can lead to diabetes if you don’t make healthy lifestyle changes that your doctor recommends. It also raises the risk for heart disease, although not as much as diabetes does. It’s possible to keep prediabetes from becoming diabetes with diet and exercise.

Sugar and Your Body

Why are high blood sugar levels bad for you? Glucose is precious fuel for all the cells in your body when it’s present at normal levels. But it can behave like a slow-acting poison.

• High sugar levels slowly erode the ability of cells in your pancreas to make insulin. The organ overcompensates and insulin levels stay too high. Over time, the pancreas is permanently damaged.
• High levels of blood sugar can cause changes that lead to a hardening of the blood vessels, what doctors call atherosclerosis.

Almost any part of your body can be harmed by too much sugar. Damaged blood vessels cause problems such as:

• Kidney disease or kidney failure, requiring dialysis
• Strokes
• Heart attacks
• Vision loss or blindness
• Weakened immune system, with a greater risk of infections
• Erectile dysfunction
• Nerve damage, also called neuropathy, that causes tingling, pain, or less sensation in your feet, legs, and hands
• Poor circulation to the legs and feet
• Slow wound-healing and the potential for amputation in rare cases

Keep your blood sugar levels close to normal to avoid many of these complications. The American Diabetes Association’s goals for blood sugar control in people with diabetes are 70 to 130 mg/dL before meals, and less than 180 mg/dL after meals.

Levels & What They Mean

Overview

What is a blood glucose test?

A blood glucose test is a blood test that screens for diabetes by measuring the level of glucose (sugar) in a person’s blood.

Who is most at risk for developing diabetes?

The following categories of people are considered “high-risk” candidates for developing diabetes:

• Individuals who are overweight or obese
• Individuals who are 45 years of age or older
• Individuals with first-degree relatives with diabetes (such as parents, children, or siblings)
• Individuals who are African-American, Alaska Native, American Indian, Asia American, Hispanic/Latino, Native Hawaiian, Pacific Islanders,
• Women who developed diabetes while they were pregnant or gave birth to large babies (9 pounds or more)
• Individuals with high blood pressure (140/90 or higher)
• Individuals with high-density lipoprotein (HDL, the “good cholesterol level”) below 25 mg/dl or triglyceride levels at or above 250 mg/dl
• Individuals who have impaired fasting glucose or impaired glucose tolerance
• Individuals who are physically inactive; engaging in exercise less than three times a week
• Individuals who have polycystic ovary syndrome, also called PCOS
• Individuals who have acanthosis nigricans — dark, thick and velvety skin around your neck or armpits

In addition to testing the above individuals at high risk, the American Diabetes Association also recommends screening all individuals age 45 and older.

Test Details

How can one tell if I have diabetes by examining my blood?

Your body converts sugar, also called glucose, into energy so your body can function. The sugar comes from the foods you eat and is released from storage from your body’s own tissues.

Insulin is a hormone made by the pancreas. Its job is to move glucose from the bloodstream into the cells of tissues. After you eat, the level of glucose in the blood rises sharply. The pancreas responds by releasing enough insulin to handle the increased level of glucose — moving the glucose out of the blood and into cells. This helps return the blood glucose level to its former, lower level.

If a person has diabetes, two situations may cause the blood sugar to increase:

• The pancreas does not make enough insulin
• The insulin does not work properly

As a result of either of these situations, the blood sugar level remains high, a condition called hyperglycemia or diabetes mellitus. If left undiagnosed and untreated, the eyes, kidneys, nerves, heart, blood vessels and other organs can be damaged. Measuring your blood glucose levels allows you and your doctor to know if you have, or are at risk for, developing diabetes.

Much less commonly, the opposite can happen too. Too low a level of blood sugar, a condition called hypoglycemia, can be caused by the presence of too much insulin or by other hormone disorders or liver disease.

How do I prepare for the plasma glucose level test and how are the results interpreted?

To get an accurate plasma glucose level, you must have fasted (not eaten or had anything to drink except water) for at least 8 hours prior to the test. When you report to the clinic or laboratory, a small sample of blood will be taken from a vein in your arm. According to the practice recommendations of the American Diabetes Association, the results of the blood test are interpreted as follows:

Fasting blood glucose level

• If your blood glucose level is 70 to 99* mg/dL (3.9 to 5.5 mmol/L). . .
  • What it means: Your glucose level is within the normal range
• If your blood glucose level is 100 to 125 mg/dL (5.6 to 6.9 mmol/L). . .
  • What it means: You have an impaired fasting glucose level (pre-diabetes**) . . .
• If your blood glucose level is 126 mg/dl (7.0 mmol/L ) or higher on more than one testing occasion
  • What it means: You have diabetes

*Values between 50 and 70 are often seen in healthy people

**The condition of “prediabetes” puts you at risk for developing Type 2 diabetes, high blood pressure, and blood lipid disorders

When Your “Normal” Blood Sugar Isn’t Normal (Part 1)

In the next two articles we’re going to discuss the concept of “normal” blood sugar. I say concept and put normal in quotation marks because what passes for normal in mainstream medicine turns out to be anything but normal if optimal health and function are what you’re interested in.

Here’s the thing. We’ve confused normal with common. Just because something is common, doesn’t mean it’s normal. It’s now becoming common for kids to be overweight and diabetic because they eat nothing but refined flour, high-fructose corn syrup and industrial seed oils. Yet I don’t think anyone (even the ADA) would argue that being fat and metabolically deranged is even remotely close to normal for kids. Or adults, for that matter.

In the same way, the guidelines the so-called authorities like the ADA have set for normal blood sugar may be common, but they’re certainly not normal. Unless you think it’s normal for people to develop diabetic complications like neuropathy, retinopathy and cardiovascular disease as they age, and spend the last several years of their lives in hospitals or assisted living facilities. Common, but not normal.

In this article I’m going to introduce the three markers we use to measure blood sugar, and tell you what the conventional model thinks is normal for those markers. In the next article, I’m going to show you what the research says is normal for healthy people. And I’m also going to show you that so-called normal blood sugar, as dictated by the ADA, can double your risk of heart disease and lead to all kinds of complications down the road.

The 3 Ways Blood Sugar Is Measured

Fasting blood glucose

This is still the most common marker used in clinical settings, and is often the only one that gets tested. The fasting blood glucose (FBG) test measures the concentration of glucose in the blood after an 8-12 hour fast.

It only tells us how blood sugar behaves in a fasting state. It tells us very little about how your blood sugar responds to the food you eat.

Up until 1998, the ADA defined FBG levels above 140 mg/dL as diabetic. In 1998, in a temporary moment of near-sanity, they lowered it to 126 mg/dL. (Forgive me for being skeptical about their motivations; normally when these targets are lowered, it’s to sell more drugs – not make people healthier.) They also set the upward limit of normal blood sugar at 99 mg/dL. Anything above that – but below 126 mg/dL – is considered “pre-diabetic”, or “impaired glucose tolerance” (IGT).

Oral glucose tolerance test (OGTT)

The OGTT measures first and second stage insulin response to glucose. Here’s how it works. You fast and then you’re given 75 grams of glucose dissolved in water. Then they test your blood sugar one and two hours after. If your blood sugar is >140 mg/dL two hours later, you have pre-diabetes. If it’s >199 mg/dL two hours later, you’ve got full-blown diabetes.

Keep in mind these are completely arbitrary numbers. If your result is 139 mg/dL – just one point below the pre-diabetic cut-off – you’ll be considered “normal”. Of course this is perfectly absurd. Diabetes isn’t like catching a cold. You don’t just wake up one day and say, “I’m not feeling so well. I think I got a bad case of diabetes yesterday.” Like all disease, diabetes—and diabesity—is a process. It goes something like this:

malfunction > disease process > symptoms

Before your blood sugar was 139, it was 135. Before it was 135, it was 130. Etcetera. Would you agree that it’s wise to intervene as early as possible in that progression toward diabetic blood sugar levels, in order to prevent it from happening in the first place? Well, the ADA does not agree. They prefer to wait until you’re almost beyond the point of no return to suggest there’s any problem whatsoever.

[End rant]

The other problem with the OGTT is that it’s completely artificial. I don’t know anyone who drinks a pure solution of 75 grams of glucose. A 32-oz Big Gulp from 7-11 has 96 grams of sugar, but 55% of that is fructose, which produces a different effect on blood sugar. The OGTT can be a brutal test for someone with impaired glucose tolerance, producing intense blood sugar swings far greater than what one would experience from eating carbohydrates.

Hemoglobin A1c

Hemoglobin A1c, or A1c for short, has become more popular amongst practitioners in the past decade. It’s used to measure blood glucose in large population-based studies because it’s significantly cheaper than the OGTT test.

A1c measures how much glucose becomes permanently bonded (glycated) to hemoglobin in red blood cells. In layperson’s terms, this test is a rough measure of average blood sugar over the previous three months.

The higher your blood sugar has been over the past three months, the more likely it is that glucose (sugar) is permanently bonded to hemoglobin.

The problem with the A1c test is that any condition that changes hemoglobin levels will skew the results. Anemia is one such condition, and sub-clinical anemia is incredibly common. I’d say 30-40% of my patients have borderline low hemoglobin levels. If hemoglobin is low, then there’s less of it around to become bonded to glucose. This will cause an artificially low A1c level and won’t be an accurate representation of your average blood sugar over the past three months.

Likewise, dehydration can increase hemoglobin levels and create falsely high A1c results.

The “normal” range for A1c for most labs is between 4% and 6%. (A1c is expressed in percentage terms because it’s measuring the percentage of hemoglobin that is bonded to sugar.) Most often I see 5.7% as the cutoff used.

In the next article we’ll put these “normal” levels under the microscope and see how they hold up.

A1C Test and A1C Calculator

Your A1C test result (also known as HbA1c or glycated hemoglobin) can be a good general gauge of your diabetes control, because it provides an average blood glucose level over the past few months.

Unlike daily blood glucose test results, which are reported as mg/dL, A1C is reported as a percentage. This can make it difficult to understand the relationship between the two. For example, if you check blood glucose 100 times in a month, and your average result is 190 mg/dL this would lead to an A1C of approximately 8.2%, which is above the target of 7% or lower recommended by the American Diabetes Association (ADA) for many adults who are not pregnant. For some people, a tighter goal of 6.5% may be appropriate, and for others, a less stringent goal such as 8% may be better.¹ Talk to your doctor about the right goal for you.

A1C calculator*

The calculation below is provided to illustrate the relationship between A1C and average blood glucose levels. This calculation is not meant to replace an actual lab A1C result, but to help you better understand the relationship between your test results and your A1C. Use this information to become more familiar with the relationship between average blood glucose levels and A1C—never as a basis for changing your disease management.

See how average daily blood sugar may correlate to A1C levels.² Enter your average blood sugar reading and click Calculate.

A1C Calculator

Average Blood Sugar
(100-300 mg/dL)

Please use a number
between 100 and 300.

Please use a number
between 100 and 300.

*Please discuss this additional information with your healthcare provider to gain a better understanding of your overall diabetes management plan. The calculation should not be used to make therapy decisions or changes.

What is A1C?

Performed by your doctor during your regular visits, your A1C test measures your average blood sugar levels by taking a sample of hemoglobin A1C cells—a component of your red blood cells.

Here’s how it works:

• Some blood sugar (or glucose) naturally attaches itself to A1C cells as they move through your bloodstream. When this happens, the cell is considered “glycated.”
• Once a cell has been glycated, it stays that way. And since each A1C cell has a lifespan of about 4 months, your A1C sample will include cells that are a few days, a few weeks and a few months old. As a result, the test covers a span of about 2 to 3 months.
• The more sugar in your blood, the higher the percentage of glycated A1C cells you’ll have—that percentage is your A1C test result.³

Self-monitoring blood glucose and A1C

A1C is important, but it’s not a substitute for frequent self-monitoring. Only regular blood sugar checks show you how meals, activity, medications and stress affect your blood sugar at a single moment in time, as well as over the course of a day or week.

Without regular self-testing to provide day-to-day insights, an A1C result can be confusing. Because it gives a long-term view, a person with frequent highs and lows could have an in-range A1C result that looks quite healthy.⁴

The only way to get a complete picture of your blood sugar control is by reviewing your day-to-day self-checks along with your regular A1C tests, and working closely with your healthcare team to interpret the results.

How often do I need an A1C test?

This calculator only estimates how the A1C of someone who self-monitors quite frequently might correlate with their average meter readings. But many factors can affect blood glucose, so it’s critical to have your A1C checked by your doctor regularly.

The ADA recommends an A1C test at least 2 times a year for those who are in good control. For those who have changed their therapy or who are not in good control and not meeting glycemic goals, an A1C test is recommended quarterly. Your doctor will help you decide what’s right for you.¹

Benefits of lowering your A1C test result

Keeping your A1C test results low can significantly reduce the risk of long-term diabetes complications such as nerve problems, damage to your eyes, kidney disease and heart problems.³

¹American Diabetes Association. Standards of medical care in diabetes—2017 [position statement]. Diabetes Care. 2017;40(1): S1-S135. Available at: http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Sup…. Accessed July 28, 2017.

²Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8): 1473-1478. Available at http://care.diabetesjournals.org/content/31/8/1473.full.pdf. Accessed July 28, 2017.

³American Diabetes Association. A1C and eAG. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-gl…. Accessed July 28, 2017.

⁴Tylee TS, Trence DL. Glycemic variability: looking beyond the A1C. Diabetes Spectrum. 2012;24(3): 149-153. Available at http://spectrum.diabetesjournals.org/content/25/3/149.full. Accessed July 28, 2017.

Diagnosing Diabetes: glucose tolerance test and blood glucose levels.

In diagnosing diabetes, physicians primarily depend upon the results of specific glucose tests.  However, test results are just part of the information that goes into the diagnosis of type 1 or type 2 diabetes. Doctors also take into account your physical exam, presence or absence of symptoms, and medical history.

Some people who are significantly ill will have transient problems with elevated blood sugars, which will then return to normal after the illness has resolved. Also, some medications may alter your blood glucose levels (most commonly steroids and certain diuretics, such as water pills).

The 2 main tests used to measure the presence of blood sugar problems are the direct measurement of glucose levels in the blood during an overnight fast and measurement of the body’s ability to appropriately handle the excess sugar presented after drinking a high glucose drink.

Fasting Blood Glucose (Blood Sugar) Level
A value above 126 mg/dL on at least 2 occasions typically means a person has diabetes.

The Oral Glucose Tolerance Test
An oral glucose tolerance test is one that can be performed in a doctor’s office or a lab. The person being tested starts the test in a fasting state (having no food or drink except water for at least 10 hours but not greater than 16 hours).

An initial blood sugar is drawn and then the person is given a “glucola” bottle with a high amount of sugar in it (75 grams of glucose or 100 grams for pregnant women). The person then has their blood tested again 30 minutes, 1 hour, 2 hours, and 3 hours after drinking the high glucose drink.

For the test to give reliable results, you must be in good health (not have any other illnesses, not even a cold). Also, you should be normally active (for example, not lying down or confined to a bed like a patient in a hospital), and you should not be taking any medicines that could affect your blood glucose. The morning of the test, you should not smoke or drink coffee. During the test, you need to lie or sit quietly.

The oral glucose tolerance test is conducted by measuring blood glucose levels 5 times over a period of 3 hours. In a person without diabetes, the glucose levels in the blood rise following drinking the glucose drink, but then they fall quickly back to normal (because insulin is produced in response to the glucose, and the insulin has a normal effect of lowing blood glucose). 

In a diabetic, glucose levels rise higher than normal after drinking the glucose drink and come down to normal levels much slower (insulin is either not produced, or it is produced but the cells of the body do not respond to it).

As with fasting or random blood glucose tests, a markedly abnormal oral glucose tolerance test is diagnostic of diabetes.   However, blood glucose measurements during the oral glucose tolerance test can vary somewhat. For this reason, if the test shows that you have mildly elevated blood glucose levels, the doctor may run the test again to make sure the diagnosis is correct.

Glucose tolerance tests may lead to one of the following diagnoses:

• Normal Response: A person is said to have a normal response when the 2-hour glucose level is less than or equal to 110 mg/dL.
• Impaired Fasting Glucose: When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dL, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes.
• Impaired Glucose Tolerance: A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dL. This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dL to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.
• Diabetes: A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dL. This must be confirmed by a second test (either one) on another day. There has recently been discussion about lowering the upper value to 180 mg/dL to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.
•  Gestational Diabetes: A woman has gestational diabetes when she is pregnant and has any 2 of the following: a fasting plasma glucose of more than 105 mg/dL, a 1-hour glucose level of more than 190 mg/dL, a 2-hour glucose level of more than 165 mg/dL, or a 3-hour glucose level of more than 145 mg/dL.

 

 

Updated on: 04/26/16

Skipping Breakfast: Bad Idea for People With Type 2 Diabetes

Non-Fasting Glucose: What Are Normal Blood Sugar Levels?

People with diabetes should test their non-fasting glucose levels regularly.

Image Credit: PeopleImages/E+/GettyImages

Non-fasting glucose levels can be a key measurement of any person’s health, and regular blood sugar testing is an especially critical part of any diabetes care plan.

Here’s what you should know about non-fasting blood work, including normal blood glucose levels.

Glucose 101

Blood sugar, or glucose, is one of the body’s primary sources of fuel, which it mainly gets by metabolizing the carbohydrates in food. The hormone insulin helps move glucose out of the blood and into the cells.

But people with diabetes either don’t make enough insulin or can’t use the insulin their bodies do make effectively, according to the American Diabetes Association (ADA). This results in high blood sugar, or hyperglycemia. People with diabetes can also experience low blood sugar (hypoglycemia), especially if they are taking blood sugar-lowering medications like insulin.

A blood sugar level is simply a measurement of how much glucose is in the bloodstream at the moment you check. If you have diabetes, your doctor will help you determine how frequently you need to check your sugar level. According to the Mayo Clinic, people with diabetes may need to monitor their blood sugar anywhere from two to 10 times per day.

What Is Normal Non-Fasting Glucose?

Normal non-fasting blood sugar levels should be less than 180 milligrams per deciliter (mg/dL) for those with diabetes, according to the ADA. For those without diabetes, it’s less than 140 mg/dL, according to Virginia Mason Diabetes Care.

Blood Sugar Before and After Meals

There are many different times of day when you can check your blood sugar, but the most important times are typically before and after a meal. Checking your blood sugar before a meal can help you decide which foods to eat and how much insulin to take. According to the ADA’s Standards of Medical Care in Diabetes — 2019, a healthy blood sugar level before a meal should fall somewhere between 80 and 130 mg/dL.

Checking your blood sugar after you eat tells you how your body is processing your meal and whether or not you currently have enough insulin in your system. But don’t check your blood sugar immediately after you finish your food. “If a patient wants to see their body’s response to a meal, they need to wait two hours before checking blood glucose,” says Samar Hafida, MD, an endocrinologist at Boston’s Joslin Diabetes Center. “That’s how long it takes for the body to fully digest carbs.”

To see the effect of a meal on your blood glucose, measure your blood sugar two hours after starting your meal; that’s when your blood sugar will peak. According to the ADA, the goal is that this peak, non-fasting glucose level will be less than 180 mg/dL.

Read more: How Long Does It Take for Blood Sugar Levels to Peak After Eating?

Your blood sugar levels will measure differently before and after meals.

Image Credit: Marco_Piunti/iStock/GettyImages

Blood Sugar Levels at Night

It’s also important to check your blood sugar before bedtime. According to the Joslin Diabetes Center, your before-bed blood sugar should be between 90 and 150 mg/dL. If your level is lower than this, you may need to have a small snack to prevent your blood sugar from falling too low overnight.

If you notice that your morning blood sugar levels are high, it may be due to something called the Somogyi effect, according to the Cleveland Clinic. This phenomenon occurs when blood sugar levels drop too low overnight, prompting the liver to release stored glucose to “rescue” you. If your doctor suspects that you are experiencing the Somogyi effect, he or she may ask you to check your blood sugar between 2 and 3 a.m. for several nights in a row. If your overnight sugars are indeed too low, your doctor will help you come up with a plan to manage the situation.

Read more: How to Quickly Reverse a Sugar Crash

When Should You Check Your Non-Fasting Glucose Levels?

Talk with your doctor about how often you need to check your blood sugar. Testing will depend on the type of diabetes medicine you take, as well as your overall glucose level (aka A1C level). If you’re new to insulin, you’ll likely have to check your blood sugar several times a day. Other people with diabetes may only need to check their levels a few times a week.

You might occasionally need to check your blood sugar at times unrelated to a meal or bedtime. For example, if your doctor has recently made a change to your diabetes medication, he or she may ask you to monitor your blood glucose more frequently throughout the day in order to gauge how well your new medications are working.

You may also experience elevated blood sugars when you’re sick, as this can be part of the body’s natural response to fighting an infection, according to the National Institutes of Health. If you have a cold, therefore, you might need to check your blood sugar levels more frequently. Blood glucose can also be elevated during pregnancy or times of stress.

If you experience the symptoms of hypoglycemia, check your blood sugar ASAP. This is the only way to actually confirm that it’s low, according to the ADA.

It’s not a good idea to check your blood sugar without a clear reason, however. “The meaningful data points provided by blood sugar readings are usually tied to a meal,” Dr. Hafida explains. Checking blood sugar randomly — especially directly after a meal — can be misleading, and might cause you to adjust your medicine or carb intake incorrectly.

Blood glucose level | Medtronic Diabetes Russia

Norms of blood glucose

Blood glucose is measured in millimoles (mmol / L) per liter. The measurement is carried out using a blood glucose meter and a test strip. The recommended range for blood sugar levels for patients with diabetes is shown in Table ¹ below.

	Fasting blood sugar	Blood sugar after meals (after 90 minutes)
Diabetes free	4.0-5.9 mmol / L (72-106 mg / dL)	Up to 7.8 mmol / L (140 mg / dl)
Type 1 diabetes	5-7 mmol / L (90-126 mg / dL)	About 5-9 mmol / L (90-162 mg / dL)
Type 2 diabetes	4-7 mmol / L (90-126 mg / dL)	About 5-8.5 mmol / L (90-153 mg / dL)

Blood sugar levels generally fluctuate throughout the day.However, if a healthy body can handle the excess sugar on its own, diabetes requires outside help. To take the right and timely measures, you need to constantly monitor your blood sugar levels.

What factors influence blood sugar levels?

Blood sugar levels change under the influence of various factors. Among them:

• Food consumption
• Skipped meals
• Physical activity
• Stress
• Disease
• Alcohol consumption
• Taking medicines
• Changes in the usual way of life
• Pregnancy

As you can see, many different elements of daily life can affect blood sugar levels.This is why blood sugar control should be done on a regular basis.

When should you measure your blood sugar?

• Before meals
• 2 hours after eating
• Bedtime
• Before exercise
• Before drinking alcohol
• In case of feeling unwell

Hypoglycemia and hyperglycemia: what to do?

The two most common short-term complications of diabetes are a drop in blood sugar below the recommended target range, or, conversely, an increase in it.If your blood sugar is too high, the condition is called hyperglycemia. The condition of low blood sugar is called hypoglycemia (or simply “hypo”).

Both hyper- and hypoglycemia can ultimately lead to the development of short-term and long-term complications. For example, persistently high blood sugar can lead to serious complications in the long term. This is why it is critical to monitor blood sugar levels and take timely measures necessary to keep blood sugar levels within the recommended range.The system of continuous glucose monitoring can become a faithful assistant in this, the main purpose of which is to make everyday life with diabetes easier.

Glucose – OVUM – medical laboratory in Kemerovo

Description

Glucose – is the main indicator of carbohydrate metabolism in the body. Glucose is found in most organs and tissues and is the main source of energy for cells.

During the day, glucose levels change significantly and depend on food intake, on the degree of physical activity, on the emotional state, on the time of day.

Mechanisms of glucose concentration regulation depend on various factors of the external and internal environment, the central nervous system, many hormones, liver function.

The main hormone that reduces the concentration of glucose in the blood – insulin, is produced in the pancreas. Hormones that increase blood glucose levels: adrenaline, cortisol (adrenal hormones), thyroid hormones (thyroid hormones), growth hormone and adrenocorticotropic hormone (pituitary hormones), glucagon (pancreatic hormone).

Physiological increase in glucose concentration is observed during exercise, stress, smoking. A decrease in glucose concentration is observed during fasting.

An increase in glucose concentration (hyperglycemia) occurs with diabetes mellitus, with pathology of the endocrine glands (thyrotoxicosis, acromegaly, Cushing’s syndrome, etc.), diseases of the pancreas, diseases of the liver and kidneys, taking certain medications (estrogens, glucocorticoids, thiazides, etc.).), with trauma, stress, acute infections.

A decrease in glucose concentration (hypoglycemia) is observed with malnutrition, starvation, in premature babies, with severe chronic liver diseases, endocrine diseases (adrenal insufficiency, hypothyroidism, etc.), taking certain medications (anabolic steroids, anaprilin, etc.).

Why is the glucose test performed

Determination of the concentration of glucose in the blood is mainly carried out for the diagnosis and control of the treatment of diabetes mellitus.Diabetes mellitus is characterized by high blood glucose levels, which develop due to absolute or relative insulin deficiency.

Signs of diabetes mellitus can be thirst, frequent, profuse urination, weight loss, itching, furunculosis, infections often join, wounds heal poorly. Diabetes mellitus is dangerous for its complications, acute – the development of coma and chronic, when a prolonged increase in blood glucose levels leads to vascular damage, pathological changes and dysfunctions of many organs, for example, kidneys, eyes, heart, nervous system.

The level of glucose in the blood reflects its momentary concentration, depends on many factors, therefore, the diagnosis of diabetes mellitus in patients without pronounced signs of the disease must be confirmed by repeated glucose studies on other days.

How is diabetes mellitus diagnosed

The World Health Organization (WHO) recommends testing for diabetes for all people over 45 years old, every 3 years with normal test results.

The main tests for the diagnosis of diabetes mellitus are:

• Glucose.
• Glycosylated hemoglobin.
• Test with a glucose load (performed as prescribed by an endocrinologist).

Additional tests that the doctor prescribes to clarify the type of diabetes and control the development of the disease are:

• Insulin.
• C-peptide.
• Autoantibodies to islet cells.
• Leptin.

Who needs a glucose test

• Patients with signs of diabetes mellitus.
• People with suspected diabetes mellitus based on laboratory test results.
• Overweight and obese people.
• People with diseases of the pancreas, liver, diseases of the endocrine glands (thyroid gland, adrenal glands, pituitary gland).
• Relatives of patients with diabetes.
• Pregnant women for gestational diabetes screening (pregnancy diabetes).
• Women diagnosed with gestational diabetes during pregnancy.
• For women, at the birth of a child weighing more than 4.5 kg.

Coca material is used for blood glucose testing

Optimally, the study of glucose levels should be carried out from venous blood plasma. The venous blood collection technique is standardized, blood is drawn into special disposable vacuum systems containing a coagulation activator for serum production or an anticoagulant for plasma production.Determination of glucose in plasma or serum of venous blood does not depend on the volume of red blood cells in the blood (hematocrit).

Capillary blood glucose may be prescribed for glucose screening in children. The result of the analysis is influenced by erythrocytes; when taking an analysis, trauma to cells and an admixture of intercellular fluid is possible. Finger puncture for research is carried out with a special automatic disposable lancet, for less trauma and safety.

For glucose studies, depending on the material for analysis, there are standards.The concentration of glucose in plasma and serum is 10-15% higher than in whole blood, since there are no blood cells there. If abnormalities are detected in the study of glucose from capillary blood, it is recommended to conduct a study of glucose from plasma or venous blood serum.

Capillary blood glucose is used by patients with diabetes mellitus for self-monitoring of home treatment with glucometers.

Analysis result

Normal fasting venous blood plasma or serum glucose: less than 6.1 mmol / L.

Normal fasting capillary blood glucose: less than 5.6 mmol / L.

The interpretation of the research result is carried out by an endocrinologist, taking into account all data on the patient’s health status, medicinal substances taken by him, and the results of laboratory tests performed.

Preparation rules

• It is necessary to exclude factors influencing the research results: physical activity (running, climbing stairs, lifting heavy weights), thermal procedures (baths, saunas), emotional arousal.
• Before taking blood, you should rest for 10-15 minutes in the waiting room, calm down.
• Avoid alcohol intake 1-2 days before the study.
• Avoid smoking 1 hour before the study.
• The analysis is taken strictly on an empty stomach. “On an empty stomach” is when at least 8 hours pass between the last meal and blood sampling (preferably at least 12 hours). You can only drink water. On the eve of the study, food overloads should be avoided.

Take a blood glucose test in the laboratory Blood sugar test, prices in the laboratory KDL

Glucose – is the main source of energy for the cells of the body and the only source of energy for the brain and cells of the nervous system.A healthy body maintains a certain level of glucose in the blood. The balance of glucose in the blood depends on the hormones of the pancreas: insulin and glucagon. Insulin promotes the absorption of glucose by the cells of the body and the formation of its reserves in the liver in the form of glycogen. In contrast, glucagon mobilizes glucose from the store in order to increase blood glucose levels when needed.

When is a glucose test usually prescribed?

Usually the glucose level is determined when a carbohydrate metabolism disorder is suspected.The most common cause of chronic elevated blood glucose (hyperglycemia) is diabetes mellitus. It is important to check fasting glucose during clinical examination for healthy people, since diabetes can be asymptomatic for several years and is diagnosed already at the stage of complications.

Glucose test (otherwise called “blood sugar”) is used to screen healthy individuals, to identify patients with prediabetes and diabetes, when examining pregnant women.

Low glucose levels (hypoglycemia) can be life-threatening; acute hypoglycemia can lead to coma and brain cell death.

Several consecutive blood glucose measurements are taken during the glucose tolerance test. In this case, the patient is first measured fasting glucose, and then given the so-called “sugar load”, after which the glucose level is measured after 1 and 2 hours. The glucose tolerance test (GTT) is not performed in the medical offices of the laboratory, as the patient must be under the supervision of a physician during the test. OGTT (oral glucose tolerance test) can only be done in patients whose fasting glucose level does not exceed 7 mmol / L.

What exactly is determined in the analysis process?

Determined the level of glucose in the venous blood. In order to avoid the absorption of glucose by red blood cells, a special tube with sodium fluoride is used. This filler helps stabilize the glucose level in the test tube for up to 48 hours.

What do the test results mean?

An elevated fasting blood glucose level can be a sign of various disorders of carbohydrate metabolism. Such test results are possible with diabetes mellitus, impaired glucose tolerance and taking the test not on an empty stomach.The degree of glucose increase should be assessed by the doctor. Fasting glucose of more than 7.0 mmol / L or more than 11.1 mmol / L when taken at any time, regardless of food intake is considered a sign of diabetes mellitus.

Decreased blood glucose levels may result from inadequate use of antihyperglycemic drugs. Hypoglycemic conditions may be associated with the presence of a pancreatic tumor that produces glucagon – glucagonoma.

Typical test lead time

Typically, a blood sugar (glucose) result can be obtained within 1 day.

Do I need special preparation for the analysis?

Usually, a glucose test is taken strictly on an empty stomach. You need 8-12 hours of fasting before taking the test. You can and should drink water.

Clinical Study Impaired Glucose Tolerance (IGT): AO-128 – Clinical Trials Registry

Sponsors	Lead Sponsor: Takeda
Source	Takeda
Summary	The aim of this open-label study is to evaluate the efficacy and safety of AO-128 (voglibose).0.6 mg / day in patients with impaired glucose tolerance (IGT) who did not respond to diet and exercise therapy, as well as monitoring progress after treatment in patients with normoglycemia.
Detailed description	Voglibose α-glucosidase inhibitor was developed by Takeda Pharmaceutical Co. Ltd. one of the most commonly used oral antidiabetic agents in Japan. Voglibose is used as a first-line treatment for the improvement of postprandial hyperglycemia in diabetic patients with an inadequate response to diet and exercise therapy and as an adjunctive treatment to other oral antidiabetic drugs and insulin.In 2009, voglibose was approved for administration in Japan. prediabetes (IGT). This study was an open-label, multicenter, single group study. The training period consisted of a screening period of 1 week or less, a treatment period of 96 weeks or more, and a follow-up period of 48 weeks. However, if the patient had type 2 diabetes mellitus or normoglycemia, the treatment period had to be completed, and only those judged to be normoglycemic had to proceed.Follow-up also had to be discontinued if patients were examined. as having IGT or type 2 diabetes at the time of follow-up.
General status	Completed
Start date	March 2010
Completion date	November 2012
Initial completion date	November 2012
Phase	Stage 4
Study type	Interventional
Primary Result	Measure Time limit Assessment of diabetic status during treatment (type 2 diabetes mellitus, normoglycemia or impaired glucose tolerance (IGT)) Treatment period: up to 122 weeks.Treatment was to be discontinued when patients were judged to have type 2 diabetes or normoglycemia. Diabetic status assessment at follow-up (type 2 diabetes, normoglycemia, or IGT) Observation at 12, 24, 36 and 48 weeks.
Secondary result	Measure Time limit Time to progression of type 2 diabetes during treatment, calculated using the Kaplan-Meier method Day 168, 336, 504 and 672 Time to progression of type 2 diabetes during treatment, calculated using the cumulative incidence function Day 168, 336, 504 and 672 Time to improvement of normoglycemia during treatment, calculated using the Kaplan-Meier method Day 168, 336, 504 and 672 Time to improvement to normoglycemia during treatment, as measured by the cumulative morbidity function Day 168, 336, 504 and 672 2-hour plasma glucose analysis during oral glucose tolerance test (OGTT) 75 g Week 0, 24, 48, 72, 96, 120 and end of treatment period 2-hour plasma glucose intake for 75 g OGTT at follow-up Observation at 0, 12, 24, 36 and 48 weeks. Hemoglobin A1c (HbA1c) Week 0, 12, 24, 48, 72, 96, 120 and end of treatment period. HbA1c follow-up Follow-up at week 0, 12, 24, 36 and 48 Body weight Week 0, 12, 24, 48, 72, 96, 120 and end of treatment period Follow-up weight Follow-up at week 0, 12, 24, 36 and 48
Registration	197
Status
Intervention	Intervention type: Drug, remedy, medication Intervention name: AO-128 Description: Tablet AO-128 Arm Group label: AO-128 0.6 mg
Eligibility	Criteria: Inclusion criteria: 1.Patients undergoing diet and exercise therapy within 3-6 months prior to screening, with baseline plasma glucose (fasting) 2. Patients meeting any of the following items 1 to 4: – 1) Comorbid hypertension or high normal blood pressure – 2) Comorbid dyslipidemia – 3) Comorbid obesity – 4) Patients with a family history of up to second degree type 2 diabetes mellitus. 3. Patients with HbA1c 4.Male or female patients are at least 20 years old at the time of obtaining informed consent. received 5. Treatment category: outpatient. Exclusion criterion: 1. Patients with previously diagnosed diabetes mellitus. 2. Patients with an overt impairment of glucose metabolism or with a disease or condition. potentially with impaired glucose metabolism. 3. Patients with severe hepatic impairment. 4. Patients with severe renal failure. 5. Patients with serious cardiac, cerebrovascular, pancreatic, hematological or other diseases. disease. 6. Patients with a history of intestinal obstruction or laparotomy for 6 years. months (24 weeks) before screening. Floor: Everything Minimum age: 20 years Maximum age: There is no data Healthy volunteers: Not
General Official	Last Name Role Join Medical Director Clinical Science Study Director Takeda
Inspection date	April 2015
Responsible party	A type: Sponsor
Extended Access	Not
Status View
Number of arms	one
Armament group	Label: AO-128 0.6 mg A type: Experimental Description: One tablet of AO-128 0.2 mg was taken orally 3 times a day before meals.
Study Design Information	Distribution: There is no data Intervention model: Assigning one group Primary purpose: treatment Disguise: No (open label)

Promotion! “-25% for an extended biochemical blood test.” From 03/10/2020 to 05/31/2020

A biochemical blood test is needed to identify various diseases, as well as to evaluate treatment.

To indications for biochemical blood test
include:

• diagnostics of diseases of internal organs;
• determination of indicators of metabolism of proteins, carbohydrates, fats,
• the state of water-salt balance;
• monitoring of treatment in a hospital or in
  outpatient clinic, evaluation of effectiveness,
• the need to change the dosage of drugs,
• for the operation;
• to prevent disease for all people is not
  less than once a year, especially after 40 years,
• hereditary tendency to disease,
• smoking,
• low physical activity,
• overweight or underweight;
• registration for pregnancy;
• transferred infections,
• poisoning,
• injuries,
• acute circulatory disorders;
• long-term use of medicines,
  contraceptives.

A biochemical blood test will help determine
kidney function (urea, creatinine), liver (enzymes, bilirubin), condition
metabolic processes (total protein, glucose, cholesterol), the need for minerals
(potassium, sodium, calcium).

Deciphering of indicators is carried out by a doctor, he
analyzes the data obtained in combination with complaints, examination, other
patient examinations.

Basic indicators of biochemical analysis

1.Glucose

The most important blood component responsible for carbohydrate metabolism.
Its content in arterial blood is higher than in venous blood.

Norm:
3.30-6.00 mmol / L.

High glucose levels may indicate a threat of diabetes
1 or 2 types, or impaired glucose tolerance.

2. Total protein

The total concentration of proteins consisting of amino acids.
Is directly involved in supporting Ph blood,
in the clotting and transportation of various substances to organs
and fabrics.

Norm: 64-84 g / l.

If normal values ​​are exceeded, this may indicate
about an infectious disease, arthritis, rheumatism or cancer
disease.

For low protein: diseases of the liver, intestines, kidneys or
cancer.

3.
Urea

Main protein breakdown product.

Norm: 2.5-8.3 mmol / l.

Increase in the level of urea in the biochemical blood test
speaks of poor kidney function, heart failure, tumors,
bleeding, intestinal obstruction or urinary tract obstruction.A short-term increase in urea may occur after
intense training or physical activity.

4. Creatinine

Like urea, creatinine is an indicator of kidney function,
participates in the energy metabolism of tissues.

Norm (depends on muscle mass): husband –
62-115 μmol / L, women – 53-97 μmol / L.

An increase in level usually indicates renal
insufficiency or hyperthyroidism.

5.Cholesterol (cholesterol)

Component of fat metabolism, participates in the construction of membranes
cells, the synthesis of sex hormones and vitamin D. There is total cholesterol,
low-density lipoprotein (LDL) and high-density cholesterol
(HDL).

Norm (total cholesterol): 3.5-5.2 mmol / l.

An elevated level indicates a risk of atherosclerosis,
diseases of the cardiovascular system or liver

6.
ALT (ALT) Alanine aminotransferase

Liver enzyme, used to evaluate liver function.Contained in the cells of the liver, kidneys and heart. Gets into the blood
when the cells of these organs are destroyed.

Norm: husband – up to 41 units / l, wives –
up to 31 units / l.

A high content of ALT in the blood indicates a lesion
heart or liver and related serious diseases:
viral hepatitis, cirrhosis, liver cancer, heart attack, heart failure, or
myocarditis.

7.
ASAT (AST)
Aspartate aminotransferase

Cellular enzyme, like ALT, is contained in cells
heart, liver and kidney.Participates in the exchange of amino acids.

Norm: husband – up to 41 units / l, wives –
up to 31 units / l.

Elevated AST in the blood can cause a heart attack,
hepatitis, pancreatitis, liver cancer, or heart failure.

8.
Bilirubin

Yellow-red blood segment formed during decay
hemoglobin. There are direct and indirect bilirubin, together they make up
total bilirubin.

Norm (total bilirubin): 5-20 μmol / l.

With an increase above 27 μmol / l, jaundice begins.High
content may cause cancer or liver disease, hepatitis,
poisoning or symptoms of liver cirrhosis, cholelithiasis, or deficiency
vitamin B12.

9. Amylase

Breaks down carbohydrates from food,
ensures their digestion. Contained in the salivary glands
and the pancreas. There is alpha-amylase (diastase)
and pancreatic amylase.

High amylase content
in a biochemical blood test indicates: peritonitis, pancreatitis,
diabetes mellitus, pancreatic cyst, stone, cholecystitis, or renal
failure.

Preparation for
analysis

For the reliability of the blood test completely
preparation and conduct may be affected. Therefore, it is worth noting the main
preparation points for normal test results to come without
false rejections.

1. Eliminate heavy food from the diet
   (fried, fatty and spicy dishes) at least a day before blood sampling – better
   just follow a balanced diet a few days before the study.
2. Reduce coffee consumption to a minimum,
   strong tea, psychostimulants – 12 hours before donating blood is generally prohibited
   take substances that affect the central nervous system (caffeine, alcohol).
3. Provide a comfortable environment for
   emotional state, avoid stress and physical exertion.
4. On the day of blood collection before the procedure
   you can not eat.

According to the analysis, the doctor compares
results from a laboratory with generally accepted, and determines the presence of a possible
diseases.

There are 2 sets of biochemical analyzes in the price list of our laboratory. There is a 25% discount on the detailed biochemical blood test, from 03/10/2020 to 05/31/2020:

Code	Item	Cost
14004	Basic biochemical blood test: glucose, total protein, urea, creatinine, AST, ALT, total cholesterol, total bilirubin, iron	900.00
14005	Extended biochemical blood test: glucose, total protein, urea, creatinine, total cholesterol, triglycerides, total bilirubin, AST, ALT, iron, alkaline phosphatase, alpha-amylase, GGT, uric acid, total calcium	1400.00

If you have any questions, we will be happy to answer by phone +7 (4852) 20-65-50

What sugar level is considered normal? | Eternal Questions | Question-Answer

When it comes to measuring blood sugar, we really mean determining the amount of glucose, which is the main source of energy and ensures the functioning of all organs and tissues.Hormones affect blood glucose levels. Insulin is the main hormone that lowers blood sugar levels; it is produced in the pancreas, in its beta cells. Many hormones increase the glucose content: glucagon, adrenaline, norepinephrine, glucocorticoids (cortisol, corticosterone) and others.

Both high and low glucose levels are possible.

The norm of glucose in the blood from a finger on an empty stomach is from 3.3 to 5.5 millimoles per liter of blood.

The indicator 5.6-6.6 mmol / l is the norm after meals, and on an empty stomach may indicate impaired glucose tolerance.This is not diabetes, but a violation of insulin sensitivity, which must be detected and treated in time before the condition turns into diabetes.

A fasting sugar level above 6.7 mmol / l almost always indicates the presence of diabetes mellitus.

In turn, a decrease in the sugar index below 3.3 mmol / l indicates the development of hypoglycemia, that is, a lowered sugar level.

What are the symptoms of high sugar?

When blood glucose levels are more than 6.7 mmol / l, experts talk about hyperglycemia, i.e.e. high sugar levels.

With a mild degree of hyperglycemia (up to 8.2 mmol / l), the main symptom is increased thirst. However, with the further development of hyperglycemia, the symptoms will certainly increase: blood pressure drops, ketone bodies in the blood rise, which leads to severe dehydration.

Further increases in blood sugar levels lead to hyperglycemic coma. It occurs if the sugar content is more than 33 mmol / l.

With the progression of hyperglycemia, the patient develops ketoacidosis.This is a medical emergency requiring the patient to be hospitalized. With an increase in the reading of the glucometer above 55 mmol / l, the patient develops a hyperosmolar coma. Complications of hyperosmolar coma are deep vein thrombosis, acute renal failure, and pancreatitis. Mortality in such a coma often reaches 50 percent.

What are the symptoms of low sugar?

An indicator below 3.3 mmol / l indicates hypoglycemia, that is, a low blood sugar content. In this case, the person has the following symptoms:

• increased irritability;
• excessive sweating;
• weakness;
• hand shake;
• dizziness and muscle weakness;
• blurred and impaired vision;
• nausea;
• strong feeling of hunger;
• numbness of the limbs.

Symptoms of hypoglycemia worsen if the meter reading falls below 2.2 mmol / L. With the progression of the condition, hypoglycemic coma inevitably develops.

Does the blood glucose level depend on the patient’s age?

Yes, it does. The norm of blood sugar in children is different from the norm in adults. So, in children under one year old, the glucose level is 2.8-4.4 mmol / liter, up to five years – 3.3-5.0 mmol / l, in older children – the same as in adults. If the child has a sugar level of 6.1 mmol / L or higher, this requires contacting a specialist and taking a blood test.

Under what conditions should the sugar level be measured?

A blood test for sugar is carried out on an empty stomach, that is, before donating, you can not eat or drink anything for 8-10 hours. If the patient ate food before measuring blood for sugar, the numbers change dramatically. In addition, you need to get a good night’s sleep before testing. The accuracy of the result can be affected by an acute infectious disease, therefore, during the period of illness, blood sugar is usually not checked.

See also:

Index NOMA: glucose, insulin, index NOMA-IR

Preslidzhuvaniy material
Blood syrovatka

The most common method for assessing insulin resistance is the basal (fasting) glucose to insulin ratio.

The study is carried out strictly on an empty stomach, after an 8-12 hour period of overnight fast. The profile includes indicators:

1. glucose
2. insulin
3. calculated index of insulin resistance HOMA-IR.

Insulin resistance is associated with an increased risk of diabetes and cardiovascular disease and appears to be a component of the pathophysiological mechanisms underlying the association of obesity with these types of diseases (including metabolic syndrome).The simplest method for assessing insulin resistance is the HOMA-IR Insulin Resistance Index, an indicator derived from the work of Matthews D.R. et al, 1985, related to the development of a mathematical homeostatic model for assessing insulin resistance (HOMA-IR – Homeostasis Model Assessment of Insulin Resistance). It has been demonstrated that the ratio of basal (fasting) levels of insulin and glucose, reflecting their interaction in a feedback loop, largely correlates with the assessment of insulin resistance in the classical direct method for assessing the effects of insulin on glucose metabolism – the hyperinsulinemic euglycemic clamp method.

The HOMA-IR index is calculated using the formula: HOMA-IR = fasting glucose (mmol / L) x fasting insulin (μU / ml) / 22.5.

With an increase in fasting glucose or insulin levels, the HOMA-IR index, respectively, increases. For example, if fasting glucose is 4.5 mmol / L and insulin is 5.0 μU / mL, HOMA-IR = 1.0; if fasting glucose is 6.0 mmol and insulin is 15 μU / ml, HOMA-IR = 4.0.

The threshold value of insulin resistance, expressed in HOMA-IR, is usually defined as the 75th percentile of its cumulative population distribution.The HOMA-IR threshold is method dependent and difficult to standardize. The choice of the threshold value, in addition, may depend on the objectives of the study and the selected reference group.

The HOMA-IR index is not included in the main diagnostic criteria for metabolic syndrome, but it is used as additional laboratory studies of this profile. In assessing the risk of developing diabetes mellitus in a group of people with glucose levels below 7 mmol / L, HOMA-IR is more informative than glucose or fasting insulin themselves.The use in clinical practice for diagnostic purposes of mathematical models for assessing insulin resistance based on the determination of fasting plasma insulin and glucose levels has a number of limitations and is not always acceptable for deciding on the appointment of antihyperglycemic therapy, but can be used for dynamic observation. Impaired insulin resistance with an increased frequency is noted in chronic hepatitis C (genotype 1). An increase in HOMA-IR among these patients is associated with a poorer response to therapy than in patients with normal insulin resistance, and therefore correction of insulin resistance is seen as one of the new targets in the treatment of hepatitis C.An increase in insulin resistance (HOMA-IR) is observed in non-alcoholic hepatic steatosis.

Literature

1. Matthews DR et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985,28 (7) 412-419.

2. Dolgov V.V. et al. Laboratory diagnostics of carbohydrate metabolism disorders. Metabolic syndrome, diabetes mellitus.M. 2006.

3. Romero-Gomez M. et al. Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology, 2006, 128 (3), 636-641.

4. Mayorov Alexander Yurievich The state of insulin resistance in the evolution of type 2 diabetes mellitus. Abstract of thesis. diss. etc. m. n, M, 2009

5. O.O. Khafisova, T.S. Polikarpova, N.V. Mazurchik, P.P. Ogurtsov Influence of metformin on the formation of a stable virological response during combined antiviral therapy of chronic hepatitis with Peg-IFNa2b and ribavirin in patients with initial insulin resistance.