What are the target blood sugar levels for people with diabetes. How is hyperglycemia diagnosed and monitored. What are the home treatment options for managing high blood sugar. When is emergency treatment necessary for severe hyperglycemia.

Target Blood Sugar Ranges for Diabetes Management

Managing diabetes effectively requires maintaining blood glucose levels within specific target ranges. These ranges can vary based on factors such as age, overall health, and individual circumstances. Here are the general recommendations:

Mayo Clinic Recommendations

• For people under 59 with no other medical conditions: 80-120 mg/dL (4.4-6.7 mmol/L) before meals
• For people 60 and older or those with additional health conditions: 100-140 mg/dL (5.6-7.8 mmol/L) before meals

American Diabetes Association Guidelines

• Before meals: 80-130 mg/dL (4.4-7.2 mmol/L)
• Two hours after meals: Less than 180 mg/dL (10 mmol/L)

Are these target ranges universal for all individuals with diabetes? No, they serve as general guidelines. Your healthcare provider will set personalized target ranges based on your specific health profile, age, and other factors. It’s crucial to work closely with your medical team to determine the most appropriate goals for your diabetes management.

Diagnosing and Monitoring Hyperglycemia

Effective diabetes management relies on accurate diagnosis and consistent monitoring of blood glucose levels. Here are the primary methods used:

Home Blood Sugar Monitoring

Regular self-monitoring using a blood glucose meter is essential for day-to-day management. How often should you check your blood sugar? The frequency depends on your individual treatment plan, but it’s typically recommended to check:

• Before meals
• Before and after exercise
• Before bedtime
• When you suspect high or low blood sugar

If your blood sugar reading is 240 mg/dL (13.3 mmol/L) or higher, it’s important to check for ketones using an over-the-counter urine test kit. Why is this step crucial? Elevated ketone levels can indicate the risk of diabetic ketoacidosis, a serious complication that requires immediate medical attention.

Hemoglobin A1C Test

The A1C test provides a broader picture of your blood sugar control over the past 2-3 months. How does this test work? It measures the percentage of hemoglobin proteins in your red blood cells that are coated with sugar. A lower A1C percentage indicates better long-term blood sugar control.

What is considered a good A1C level for someone with diabetes?

• 7% or less: Indicates good blood sugar control
• Above 7%: May suggest the need for adjustments in your diabetes management plan
• 8% or higher: May be appropriate for some individuals, particularly older adults or those with certain medical conditions

How often should you have an A1C test? Most people with diabetes undergo this test 2 to 4 times a year, but your healthcare provider will recommend a schedule based on your individual needs.

Home Treatment Strategies for Managing Hyperglycemia

Effectively managing high blood sugar at home is a crucial aspect of diabetes care. Here are key strategies to help keep your glucose levels within your target range:

Physical Activity

Regular exercise can be a powerful tool for blood sugar control. How does physical activity help manage hyperglycemia? It increases insulin sensitivity, allowing your cells to use glucose more effectively. However, it’s important to note that you should not exercise if you have ketones in your urine, as this can potentially raise your blood sugar further.

Medication Adherence

Taking your diabetes medications as prescribed is crucial for maintaining stable blood glucose levels. If you experience frequent hyperglycemia, your healthcare provider may need to adjust your medication dosage or timing. Why is consistent medication use so important? It helps ensure that your body has the tools it needs to process glucose effectively throughout the day.

Dietary Management

Following a balanced diabetes meal plan is essential for blood sugar control. What are some key dietary strategies for managing hyperglycemia?

• Eat smaller, more frequent meals to avoid large spikes in blood sugar
• Limit sugary beverages and snacks
• Focus on complex carbohydrates, lean proteins, and healthy fats
• Monitor carbohydrate intake and balance it with your medication and activity levels

If you’re struggling to adhere to your meal plan, don’t hesitate to seek guidance from your healthcare provider or a registered dietitian specializing in diabetes care.

Regular Blood Sugar Monitoring

Consistent monitoring allows you to catch and address high blood sugar levels promptly. How can you use this information effectively? Keep a log of your readings, along with notes about your meals, activities, and any symptoms you experience. This data can help you and your healthcare team identify patterns and make informed adjustments to your management plan.

Insulin Adjustments

For those using insulin, making appropriate adjustments can help control hyperglycemia. What is an insulin supplement? It’s an extra dose of short-acting insulin used to temporarily correct high blood sugar levels. Always consult with your healthcare provider to determine when and how to use insulin supplements safely.

Recognizing and Responding to Severe Hyperglycemia

While home management is effective for most cases of high blood sugar, severe hyperglycemia can be a medical emergency requiring immediate attention. What are the signs of severe hyperglycemia that warrant urgent care?

• Extreme thirst and frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Shortness of breath
• Fruity-smelling breath
• Confusion or difficulty concentrating

If you experience these symptoms, especially if your blood sugar remains consistently high despite home treatment, seek medical attention immediately. Severe hyperglycemia can lead to serious complications such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).

Emergency Treatment for Severe Hyperglycemia

In cases of severe hyperglycemia, emergency medical intervention may be necessary. What does emergency treatment for hyperglycemia typically involve?

Fluid Replacement

Intravenous (IV) fluids are administered to rehydrate the body and dilute excess blood sugar. Why is fluid replacement crucial? Severe hyperglycemia can lead to significant fluid loss through increased urination, potentially causing dehydration and electrolyte imbalances.

Electrolyte Replacement

Along with fluids, electrolytes such as sodium, potassium, and chloride may need to be replenished. How do electrolyte imbalances occur in severe hyperglycemia? The loss of fluids through excessive urination can deplete these essential minerals, disrupting various bodily functions.

Insulin Therapy

Intravenous insulin may be administered to help lower blood glucose levels rapidly. Why is insulin given intravenously in these situations? This method allows for precise control and rapid action, helping to bring dangerously high blood sugar levels down to a safer range more quickly than oral or subcutaneous insulin.

Long-Term Management and Preventing Hyperglycemia

While treating acute hyperglycemia is important, the ultimate goal is to prevent high blood sugar episodes and maintain stable glucose levels over time. What strategies can help achieve this goal?

Continuous Glucose Monitoring (CGM)

CGM devices provide real-time data on blood glucose levels, allowing for more proactive management. How does CGM benefit diabetes care? It can alert you to rising blood sugar levels before they become problematic, enabling you to take corrective action quickly.

Diabetes Education and Self-Management Training

Ongoing education about diabetes management is crucial for long-term success. What topics should diabetes education cover?

• Proper use of diabetes medications and insulin
• Nutrition and meal planning
• Exercise and physical activity guidelines
• Blood sugar monitoring techniques
• Recognizing and treating high and low blood sugar
• Managing diabetes during illness or stress

By investing time in comprehensive diabetes education, you can gain the knowledge and skills needed to manage your condition effectively and reduce the risk of hyperglycemia.

Regular Medical Check-ups

Consistent follow-up with your healthcare team is essential for optimal diabetes management. How often should you see your diabetes care provider? Typically, visits are recommended every 3-6 months, but this may vary based on your individual needs and how well your diabetes is controlled.

During these appointments, your provider will review your blood sugar logs, A1C results, and overall health to make any necessary adjustments to your treatment plan. They may also perform important screenings to detect and prevent diabetes-related complications.

Lifestyle Factors Influencing Blood Sugar Control

Managing diabetes effectively goes beyond medication and monitoring. Various lifestyle factors play a significant role in maintaining stable blood glucose levels. What are some key areas to focus on?

Stress Management

Chronic stress can contribute to blood sugar fluctuations. How does stress affect glucose levels? It triggers the release of hormones that can cause blood sugar to rise. Implementing stress-reduction techniques such as meditation, deep breathing exercises, or regular physical activity can help mitigate this effect.

Sleep Quality

Adequate, quality sleep is crucial for blood sugar regulation. How does poor sleep impact glucose control? Lack of sleep can affect insulin sensitivity and increase stress hormones, potentially leading to higher blood sugar levels. Aim for 7-9 hours of sleep per night and establish a consistent sleep schedule.

Alcohol Consumption

Alcohol can have complex effects on blood sugar levels. Why is it important to be cautious with alcohol if you have diabetes? Alcohol can cause both increases and decreases in blood sugar, depending on various factors. It’s essential to monitor your glucose levels closely when consuming alcohol and always drink in moderation, if at all.

Weight Management

Maintaining a healthy weight is beneficial for overall diabetes management. How does weight affect blood sugar control? Excess body fat, especially around the abdomen, can increase insulin resistance, making it more challenging to maintain stable glucose levels. Even modest weight loss can significantly improve blood sugar control in many individuals with type 2 diabetes.

Emerging Technologies and Treatments for Diabetes Management

The field of diabetes care is constantly evolving, with new technologies and treatments emerging to help individuals manage their condition more effectively. What are some promising innovations in diabetes care?

Artificial Pancreas Systems

These closed-loop systems combine continuous glucose monitoring with insulin pump technology to automatically adjust insulin delivery based on real-time glucose readings. How do artificial pancreas systems benefit diabetes management? They can help reduce the burden of constant decision-making and potentially improve overall glucose control, particularly overnight and during times of physical activity.

Smart Insulin

Researchers are developing glucose-responsive insulins that could revolutionize diabetes treatment. How would smart insulin work? These formulations are designed to activate only when blood glucose levels rise, potentially reducing the risk of hypoglycemia and simplifying insulin dosing.

Non-invasive Glucose Monitoring

Various technologies are being explored to measure blood glucose levels without the need for finger pricks or invasive sensors. What are some potential methods for non-invasive glucose monitoring?

• Optical sensors that measure glucose through the skin
• Breath analysis devices that detect acetone levels correlated with blood glucose
• Sweat or tear fluid analysis for glucose measurement

While many of these technologies are still in development, they hold promise for making diabetes management more convenient and less intrusive in the future.

Immunotherapy for Type 1 Diabetes

Researchers are exploring ways to prevent or reverse type 1 diabetes through immunotherapy. How might immunotherapy benefit individuals with type 1 diabetes? These treatments aim to modulate the immune system to prevent the destruction of insulin-producing beta cells or potentially regenerate these cells, potentially reducing or eliminating the need for external insulin.

As research in these areas continues, it’s important to stay informed about new developments in diabetes care. Always discuss any new treatments or technologies with your healthcare provider to determine if they might be appropriate for your individual situation.

Managing hyperglycemia in diabetes requires a comprehensive approach that combines medical treatment, lifestyle modifications, and ongoing education. By working closely with your healthcare team and staying proactive in your diabetes management, you can effectively control your blood sugar levels and reduce the risk of complications associated with chronic hyperglycemia. Remember that diabetes management is a journey, and with the right tools and support, you can lead a healthy, fulfilling life while effectively managing your condition.

Hyperglycemia in diabetes – Diagnosis & treatment

Diagnosis

Your health care provider sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals:

• Between 80 and 120 milligrams per deciliter (mg/dL) (4.4 and 6.7 millimoles per liter (mmol/L)) for people age 59 and younger who have no medical conditions other than diabetes
• Between 100 and 140 milligrams per deciliter (mg/dL) (5.6 and 7.8 millimoles per liter (mmol/L)) for:
  • People age 60 and older
  • Those who have other medical conditions, such as heart, lung or kidney disease
  • People who have a history of low blood sugar (hypoglycemia) or who have difficulty recognizing the symptoms of hypoglycemia

For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:

• Between 80 and 130 mg/dL (4. 4 and 7.2 mmol/L) before meals
• Less than 180 mg/dL (10 mmol/L) two hours after meals

Your target blood sugar range may differ, especially if you’re pregnant or you have other health problems that are caused by diabetes. Your target blood sugar range may change as you get older. Sometimes, reaching your target blood sugar range can be a challenge.

Home blood sugar monitoring

Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your target range. Check your blood sugar as often as your health care provider recommends.

If you have any symptoms of severe hyperglycemia — even if they seem minor — check your blood sugar level right away.

If your blood sugar level is 240 mg/dL (13. 3 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. Talk to your health care provider about how to lower your blood sugar level safely.

Hemoglobin A1C test

During an appointment, your health care provider may conduct an A1C test. This blood test shows your average blood sugar level for the past 2 to 3 months. It works by measuring the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells, called hemoglobin.

An A1C level of 7% or less means that your treatment plan is working and that your blood sugar was consistently within a healthy range. If your A1C level is higher than 7%, your blood sugar, on average, was above a healthy range. In this case, your health care provider may recommend a change in your diabetes treatment plan.

For some people, especially older adults and those with certain medical conditions, a higher A1C level of 8% or more may be appropriate.

How often you need the A1C test depends on the type of diabetes you have and how well you’re managing your blood sugar. Most people with diabetes receive this test 2 to 4 times a year.

More Information

Treatment

Home treatment

Talk to your health care provider about managing your blood sugar. Understand how different treatments can help keep your glucose levels within your target range. Your health care provider may suggest the following:

• Get physical. Regular exercise is often an effective way to control blood sugar. But don’t exercise if you have ketones in your urine. This can drive your blood sugar even higher.
• Take your medication as directed. If you develop hyperglycemia often, your health care provider may adjust the dosage or timing of your medication.
• Follow your diabetes eating plan. It helps to eat smaller portions and avoid sugary beverages and frequent snacking. If you’re having trouble sticking to your meal plan, ask your health care provider or dietitian for help.
• Check your blood sugar. Monitor your blood glucose as directed by your health care provider. Check more often if you’re sick or if you’re concerned about severe hyperglycemia or hypoglycemia.
• Adjust your insulin doses. Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. A supplement is an extra dose of insulin used to help temporarily correct a high blood sugar level. Ask your health care provider how often you need an insulin supplement if you have high blood sugar.

Emergency treatment for severe hyperglycemia

If you have signs and symptoms of diabetic ketoacidosis or hyperosmolar hyperglycemic state, you may be treated in the emergency room or admitted to the hospital. (4p4) Emergency treatment can lower your blood sugar to a normal range. Treatment usually includes:

• Fluid replacement. You’ll receive fluids — usually through a vein (intravenously) — until your body has the fluids it needs. This replaces fluids you’ve lost through urination. It also helps dilute the extra sugar in your blood.
• Electrolyte replacement. Electrolytes are minerals in your blood that are necessary for your tissues to work properly. A lack of insulin can lower the level of electrolytes in your blood. You’ll receive electrolytes through your veins to help keep your heart, muscles and nerve cells working the way they should.
• Insulin therapy. Insulin reverses the processes that cause ketones to build up in your blood. Along with fluids and electrolytes, you’ll receive insulin therapy — usually through a vein.

As your body returns to normal, your health care provider will consider what may have triggered the severe hyperglycemia. Depending on the circumstances, you may need additional tests and treatment.

Preparing for your appointment

If you have trouble keeping your blood sugar within your target range, schedule an appointment to see your health care provider. Your provider can help you make changes to better manage your diabetes.

Here’s information to help you get ready for your appointment and know what to expect from your health care provider.

What you can do

• Be aware of any pre-appointment restrictions. If your health care provider is going to test your blood sugar, you may need to stop eating or drinking anything but water for up to eight hours before your appointment. When you’re making an appointment, ask if there are any restrictions on eating or drinking.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you take.
• Create a record of metered glucose values. Give your health care provider a written or printed record of your blood glucose values, times and medication. Using the record, your health care provider can recognize trends and offer advice on how to prevent hyperglycemia or adjust your medication to treat hyperglycemia.
• Write down questions to ask your health care provider. If you need more information about your diabetes management, be sure to ask.
• Check if you need prescription refills. Your health care provider can renew your prescriptions while you’re at the appointment.

For hyperglycemia, questions you may want to ask include:

• How often do I need to monitor my blood sugar?
• What is my target range?
• How do diet and exercise affect my blood sugar?
• When do I test for ketones?
• How can I prevent high blood sugar?
• Do I need to worry about low blood sugar? What are the symptoms I need to watch for?
• Will I need follow-up care?

Sick-day planning

Illness or infections can cause your blood sugar to rise, so it’s important to plan for these situations. Talk to your health care provider about creating a sick-day plan. Questions to ask include:

• How often should I monitor my blood sugar when I’m sick?
• Does my insulin injection or oral diabetes pill dose change when I’m sick?
• When should I test for ketones?
• What if I can’t eat or drink?
• When should I seek medical help?

High blood sugar – self-care: MedlinePlus Medical Encyclopedia

High blood sugar is also called high blood glucose, or hyperglycemia.

High blood sugar almost always happens in people who have diabetes. High blood sugar occurs when:

• Your body makes too little insulin.
• Your body does not respond to the signal insulin is sending.

Insulin is a hormone that helps the body move glucose (sugar) from the blood into muscle or fat, where it is stored for later use when energy is needed.

Sometimes high blood sugar occurs due to stress from surgery, infection, trauma, or medicines. After the stress is over, blood sugar returns to normal.

Symptoms of high blood sugar can include:

• Being very thirsty or having a dry mouth
• Having blurry vision
• Having dry skin
• Feeling weak or tired
• Needing to urinate a lot, or needing to get up more often than usual at night to urinate

You may have other, more serious symptoms if your blood sugar becomes very high or remains high for a long time. Over time, high blood sugar weakens your immune system and makes it more likely for you to get infections.

High blood sugar can harm you. If your blood sugar is high, you need to know how to bring it down. If you have diabetes, here are some questions to ask yourself when your blood sugar is high:

• Are you eating right?
• Are you eating too much?
• Have you been following your diabetes meal plan?
• Did you have a meal or a snack with a lot of carbohydrates, starches, or simple sugars?

Are you taking your diabetes medicines correctly?

• Has your doctor changed your medicines?
• If you take insulin, have you been taking the correct dose? Is the insulin expired? Or has it been stored in a hot or cold place?
• Are you afraid of having low blood sugar? Is that causing you to eat too much or take too little insulin or other diabetes medicine?
• Have you injected insulin into a scar or overused area? Have you been rotating sites? Was the injection into a lump or numb spot under the skin?

What else has changed?

• Have you been less active than usual?
• Do you have a fever, cold, flu, or another illness?
• Are you dehydrated?
• Have you had some stress?
• Have you been checking your blood sugar regularly?
• Have you gained weight?
• Have you started taking any new medicines such as for high blood pressure or other medical problems?
• Have you had an injection into a joint or other area with a glucocorticoid medicine?

To prevent high blood sugar, you will need to:

• Follow your meal plan
• Stay physically active
• Take your diabetes medicines as instructed

You and your doctor will:

• Set a target goal for your blood sugar levels for different times during the day. This helps you manage your blood sugar.
• Decide how often you need to check your blood sugar at home.

If your blood sugar is higher than your goals over 3 days and you don’t know why, check your urine for ketones. Then call your health care provider.

Hyperglycemia – self care; High blood glucose – self care; Diabetes – high blood sugar

• Food and insulin release

American Diabetes Association Professional Practice Committee. 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S60-S82. PMID: 34964866 pubmed.ncbi.nlm.nih.gov/34964866/.

American Diabetes Association Professional Practice Committee. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S83-S96. PMID: 34964868 pubmed.ncbi.nlm.nih.gov/34964868/.

Atkinson MA, Mcgill DE, Dassau E, Laffel L. Type 1 diabetes. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 36.

Riddle MC, Ahmann AJ. Therapeutics of type 2 diabetes. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 35.

Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Browse the Encyclopedia

Glucose

Glucose

Glucose

Glucose

Glucose is the simplest of carbohydrates, which belongs to the mono saccharides. Along with lipids, glucose is one of the body’s preferred sources of energy in the form of carbohydrates. Glucose is found in the blood, lymph, brain, heart and skeletal muscles.

Free glucose is used by the body for the biosynthesis of other sugars. It is a structural component of many other important substances – cellulose, starch, glycosides and others. In the human body, due to oxidation, an average of 60-70% of chemical energy is released, which is necessary for the energy supply of various life processes. Glucose is involved in many metabolic reactions in the body and is central to carbohydrate metabolism. The main storage carbohydrate of the body is glycogen, the molecule of which is built from interconnected glucose residues. If there is an excess of glucose in the cell, then it joins the ends of the glycogen chain, but if the body needs glucose, it is split off from glycogen. These reactions are related to the mechanisms of storage and use of energy necessary for the life of the organism.

At the same time, although glucose is very important for the body, it is best to consume it in moderation. A blood glucose level that is above or below the physiological norm can have serious consequences for a person’s health. The concentration of glucose in the body is regulated by hormones and the central nervous system.

The pancreas, which produces hormones including insulin, is an integral part of glucose metabolism. When we eat, the pancreas releases insulin to deal with the rise in blood sugar.

Keeping glucose levels within normal limits is an important part of our body’s efficient functioning. By regularly measuring blood glucose levels, you can find out when blood sugar levels are much higher than the physiological norm or, on the contrary, too low, which can subsequently cause certain symptoms and serious problems in the human body. Determination of glucose levels is carried out during a preventive examination of patients without an established diagnosis of diabetes, since this disease can begin with imperceptible symptoms for the patient. Overweight and obese people, as well as those over the age of 45, are recommended to do a blood glucose test annually.

Glucose testing is especially important for people with type 1 and type 2 diabetes. Regular glucose testing is one way people with diabetes can learn more about their condition, understand how different foods and medications affect diabetes, and make important decisions about medication dosage, exercise, and diet. Diabetes can also develop during pregnancy, which usually goes away after the baby is born.

In certain cases, high blood glucose can be a sign of kidney failure, a hormonal disorder, or Cushing’s syndrome, which occurs when a person’s body produces too much cortisol.

If possible, it is necessary to maintain the glucose level within the physiological norm. High blood glucose levels for a long time can lead to long-term complications such as heart disease, vision problems, effects on blood vessels, joint problems, kidney disease, if not treated in time.

Regular monitoring and control of blood glucose levels can help improve a person’s health.

Preparation of patients according to the general rules

Restrictions :

It is necessary to stop taking drugs in advance (in consultation with the attending physician) that may distort the result of the study. False increase results cause: caffeine, glucocorticoids, estrogens. False reduction: salicylates, hypoglycemic drugs, insulin, amphetamines, antihistamines, anabolic steroids.

Material : blood serum

Transport medium: sodium fluoride vacutainer with/without gel phase, 2 or 4 ml

Sample stability: 90 006

• 24 hours at +2 – + 8 ⁰ C
• It is recommended to conduct research on freshly collected biological material

Method : Colorimetric

Analyzer : Bio Chem FC-200

Test – system : Glucose, Bio Systems S. A., (Spain)

900 02 Reference values ​​(norm):

The main indications for the appointment of the test:

• Diagnosis of high and low blood sugar
• Obesity (including in children)
• diabetes monitoring
• pathologies of the liver, adrenal glands, thyroid gland
• preventive examinations

Interpretation of results:

Increased concentration:

• diabetes mellitus type 1 and 2
• myocardial infarction
• cystic fibrosis
• hyperthyroidism
• chronic diseases of the liver and kidneys
• pancreatitis or inflammation of the pancreas, tumors of the pancreas
• stress, smoking, malnutrition

Reduced concentration:

• diseases of the pancreas (hyperplasia, adenoma)
• hypothyroidism
• liver diseases (hepatitis, cancer)
• alcohol abuse
• arsenic poisoning or overdose of certain medications
• gastrointestinal surgery
• fasting, excessive exercise

Blood glucose testing

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