I was diagnosed with type 2 with a random blood sugar of 128 mg/dl [7.1 mmol/L]. I am not overweight and had negative antibodies. What type of diabetes do I have?

Question from Sandy, Utah, USA:

I am a 43 year old Caucasian female, diagnosed with type 2 diabetes about a month ago. My blood glucose was 128 mg/dl [7.1 mmol/L] five hours after the last time I ate, so my doctor later ordered an A1c, which was 5.3 (with a glucose of 148 mg/dl [8.2 mmol/L] at that time). I’m now taking metformin and am scheduled for another A1c in a couple of months. I’m confused about my diagnosis because I am thin (BMI = 19.5), very active, have a good (low fat) diet, am asymptomatic, and have no family history of diabetes. My blood pressure, cholesterol, and triglycerides are normal. I wondered about LADA (have been hypothyroid for many years), but both GAD and ICA antibodies were negative, which my family practice doctor says means I have type 2. Could I still have type 1? Does it matter? Is it worth re-testing for autoantibodies and, if so, at what time interval? I’m trying to decide if I should just wait awhile and see how my response to metformin is, or try to see an endocrinologist.

I had a series of appointments with my family practitioner over the summer because of several symptoms, which have recently remitted, after troubling me for several months. The major issues were severe swelling and pain of several knuckles on my right hand, burning chest pain with decreased peak flow and consequent exercise intolerance. I was referred to a rheumatologist at the University of Utah who did a bunch of tests (many negative autoantibody tests, including ANA and double-stranded DNA. Normal pulmonary function testing except about 30% lower than expected peak flow and non-responsive to albuterol. Normal hand x-ray) and declared that he didn’t believe I currently had an autoimmune disease.”Come back if another joint blows up,” he said. In reviewing the rheumatologist’s report, my doctor noticed that a random laboratory glucose had been 128 mg/dl [7.1 mmol/L], so he repeated it with similar results (about 120 mg/dl [6.7 mmol/L]; I hadn’t eaten for at least four hours), so I got the A1c (5. 3) a few days later and was diagnosed based on that. None of my fasting values have been over 100 mg/dl [5.6 mmol/L].

My understanding is that it can take years for symptoms of lupus (or rheumatoid) to add up to enough factors to get diagnosed, but if it were an autoimmune syndrome causing my glycosemia (and/or hypothyroidism, and possibly joint pain), it seems like SOME autoantibody would be positive by now.

Maybe I should add that I have severe stress (I know, probably everybody says that). I am divorced, have five kids (ages eight to 16) — four with an undiagnosed, progressive neuropathy (peripheral, axonal, nondemyelinating) and one of those has very limited physical and cognitive function. Another one is bipolar and the “healthy” one was hospitalized a year ago after attempted suicide. I’m also recovering from a five year history of eating disorders and wondering if that had some destructive effect on my metabolism.

Fasting Blood Sugar: Normal, High, & Low + Ways to Improve

A fasting blood sugar test is one way to check for and monitor diabetes. Both high and low blood sugar levels can be dangerous. Read on to learn more about the test and causes of high or low blood sugar levels. We will also go over the best strategies to lower your blood sugar levels to successfully prevent or manage diabetes.

What is a Fasting Blood Sugar Test?

Procedure

A fasting blood sugar test is also called a fasting blood glucose test. It measures your sugar levels after fasting for at least 8 hours. Glucose is the main sugar found in your bloodstream and high levels after fasting may point to diabetes.

While fasting before the test, you can still drink water (unless otherwise directed by your doctor), but anything like coffee, tea, juice, and sodas should be avoided. A healthcare professional will draw blood for a vein in your arm, which will be sent to the lab for analysis [1].

After a meal, your blood glucose levels will normally increase over a few hours as you break down and absorb dietary carbohydrates. In healthy people, the pancreas will produce insulin to move glucose into tissues and out of the bloodstream. Thus, glucose levels will gradually drop after eating and stay low during fasting [2, 3].

People with diabetes either don’t have enough insulin to reduce blood glucose (type 1 diabetes) or their body cannot effectively use insulin (type 2 diabetes). In a fasting blood glucose test, diabetics will have much higher blood sugar levels than non-diabetics, which can lead to many health problems in the long run [4, 1].

A fasting blood sugar test measures your blood glucose levels after fasting for at least 8 hours. High levels may point to diabetes.

Why Doctors Order It

A fasting blood glucose test is done to screen for prediabetes and diabetes. It also helps doctors monitor diabetes and determine if medications and dietary changes are having an effect [1].

Your fasting blood glucose level is the lowest your blood sugar can be because the influence of recent meals is minimized [5, 6].

Fasting blood sugar is often checked alongside HbA1c (also known as glycated hemoglobin), which is a measure of your blood sugar levels over the past three months. The more sugar there is in the blood, the more it will attach to hemoglobin, raising HbA1c [7].

Taken together, the two offer more information than each test alone. For example, even if your blood sugar levels are very high at one random point, they may have been mostly low over the past couple of months (low HbA1c). On the other hand, HBA1c could be higher but your glucose levels at the moment lower.

Apart from diabetes, abnormal levels can point out issues such as insulin resistance, hormonal imbalances, and pancreatic, liver, or kidney disease.

Doctors order a fasting blood sugar test to screen for and monitor diabetes and prediabetes, usually alongside HbA1c.

Who Should Do the Test?

According to the American Diabetes Association, screening for diabetes is recommended in people over 45 (every 3 years), or at any age if you have certain risk factors, including [8]:

• Being overweight, obese, or physically inactive
• Having a close (first or second degree) relative with diabetes
• Belonging to a certain race/ethnic group (Native Americans, African-Americans, Hispanic Americans, Asians/South Pacific Islanders)
• Having signs of insulin resistance or conditions associated with insulin resistance, such as high blood pressure (hypertension), low good cholesterol and/or high triglycerides (dyslipidemia), and polycystic ovary syndrome
• Having had diabetes in pregnancy (gestational diabetes)

Blood Sugar Ranges

Normal Range

Normal fasting blood glucose levels in healthy people are 70 – 125 mg/dL or 3. 9 – 6.9 mmol/L.

Low blood sugar or hypoglycemia is when blood levels drop below 70 mg/dL in diabetics or around 55 mg/dL (3 mmol/L) in healthy people.

High blood sugar or hyperglycemia is when your blood glucose levels are too high, above 126 mg/dL or 7 mmol/L.

The normal fasting blood sugar range in healthy people is 70 – 125 mg/dL.

Prediabetes Range

Prediabetes (also known as impaired fasting glucose) refers to blood glucose levels that are consistently on the higher end of the normal range – between 100 – 125 mg/dL (5.6 – 7 mmol/L). Prediabetes is dangerous because it can easily develop into diabetes [9].

Prediabetes means that you almost have diabetes, but you shouldn’t despair. Prediabetes is reversible. By making lifestyle changes early on, you can prevent diabetes. If you don’t make any changes, however, studies suggest that there’s about a 40% chance that you will get diabetes four years down the line [10].

If your fasting blood sugar is 100 – 125 mg/dL, you may have prediabetes.

Prediabetes Range

Levels above >126 mg/dL or >7 mmol/L are in the range of diabetes. At least two values in this range on two separate tests are needed for your doctor to diagnose diabetes.

Glucose Meter

Being able to self-monitor your blood glucose levels is very important if you have diabetes. With a blood glucose meter, you can regularly check your sugar levels and modify your lifestyle and meals accordingly. Meters let you track fluctuations caused by exercise, food, medications, stress, and other factors [11].

You can choose from a broad range of blood glucose meters with varying accuracy. Meters that have very high accuracy tend to be more expensive. Some meters can now be integrated with a smartphone, and other newer models may not require finger pricking (some can be inserted under the skin) or use tiny and almost painless needles [11, 12].

Fasting blood glucose and HbA1c tests are more accurate, but blood glucose meters are easy to use, accessible, and indispensable for checking your sugar levels daily.

Be sure to get an accurate glucose meter to monitor your sugar levels regularly if you have diabetes.

High Fasting Blood Sugar

For the purposes of this article, we will treat blood sugar in the range of prediabetes and above (>100 mg/dL or >5.6 mmol/L) as high.

Causes

Causes shown below are commonly associated with high glucose levels. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret this test, taking into account your medical history and other tests results.

Chronic conditions that can increase fasting glucose levels include:

• Insulin resistance [13, 14]
• Obesity [15, 16, 17, 18]
• Type 1 and 2 diabetes [19, 4]
• Pregnancy and gestational diabetes [19, 20]
• Fatty liver and other liver disease [21, 22, 23]
• Kidney disease [24]
• Overactive thyroid (hyperthyroidism) [25]
• Stress due to illness, injury, or surgery [26, 27, 19]
• Endocrine disorders, such as Cushing’s syndrome (too much cortisol), pheochromocytoma (benign tumors of the adrenal gland), acromegaly (excess growth hormone) [19, 28]
• Pancreatic inflammation (pancreatitis) or cancer [19]

The following factors also increase blood sugar levels:

• Overeating [29]
• Acute and chronic stress [30, 31, 32]
• Poor sleep quality or not enough sleep [33, 34, 35]
• Smoking [36, 37, 38]
• Air pollution [39]
• Chronic exposure to toxins such as polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) [40]

Many drugs can increase glucose levels, including:

• Antidepressants [41]
• Drugs that treat high blood pressure, such as thiazide diuretics and beta blockers [42, 42]
• Epinephrine/adrenalin [43]
• Estrogen and oral contraceptives [19, 44]
• Lithium [45]
• Anti-seizure medication Phenytoin (Dilantin) [19]
• Glucocorticoids [19, 46]
• Niacin (vitamin B3) [47, 48]

Symptoms

When your blood sugar is high, you may experience the following symptoms [19]:

• Feeling very thirsty
• Urinating often
• Fatigue
• Blurred vision
• Slow-healing infections

Ways to Decrease Blood Sugar

The most important thing is to work with your doctor to find out what’s causing your high glucose levels and to treat any underlying conditions!

Discuss the additional lifestyle changes listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

Lifestyle Changes

If you are overweight, losing some weight will improve the ability of your body to use and respond to glucose more efficiently and reduce your risk of diabetes. Being obese is the number one risk factor for developing diabetes [15, 16, 18]! Losing even a small amount of your body weight can be very beneficial.

Physical activity is a great way to manage your blood glucose levels. Muscle activity burns glucose for energy and makes cells more sensitive to insulin. Find something fun that you will enjoy doing regularly (over 3 times a week for over 30 minutes) [49, 50, 51, 52, 53].

Get adequate rest. Sleep deprivation and poor sleep quality decrease the ability of cells to react to insulin, and over time causes increases in blood sugar levels [33, 35].

Manage stress. Stress can increase blood sugar levels, by increasing hormones such as cortisol and inflammatory molecules in your body [30, 54, 32, 55].

Diet

A healthy diet will help control your blood sugar levels!

Beneficial foods include vegetables, fruits, nuts, whole grains, fish, and olive oil [56, 57, 58]

Foods to avoid include red and processed meat, refined carbs and sweets, sugar-sweetened beverages, and high-fat foods. Most importantly, avoid overeating in general [59, 29].

Eat regularly, and especially take care not to skip breakfast. Starting your day without breakfast can lead to increased blood glucose [60].

On the other hand, you may want to refrain from nighttime snacks. A study shows that these are associated with obesity and higher blood sugar levels [61].

Drink plenty of water [62, 63]. It’s especially beneficial if you replace sugary drinks with water.

Studies show that moderate alcohol consumption (1 drink per day) can lower blood glucose levels and prevent diabetes and heart disease [64, 65, 66, 67]. However, heavier consumption has a negative effect and increases the risk of type 2 diabetes. Discuss your alcohol intake with your doctor.

Supplements

Talk to your doctor about the following foods and supplements. Initial studies suggest they may help decrease blood sugar levels or may be otherwise beneficial in prediabetes and diabetes:

• Aloe [68, 69, 70, 71]
• Alpha-lipoic acid [72, 73]
• Berberine [74, 75, 76, 77]
• Caffeine/Coffee [78, 79, 80, 81, 82, 83]
• Chromium [84, 85]
• Cinnamon [86, 87]
• Fenugreek [88, 89, 90]
• Fiber, such as glucomannan or beta-glucans [91, 92, 93, 94, 95, 96, 97, 98, 99]
• Flaxseed [100, 101, 102, 103]
• Garlic [104, 105]
• Green tea [106, 107, 108]
• Magnesium [109, 110]
• Milk thistle [111, 112]

Look out for deficiencies in the following nutrients and work with your doctor on correcting them if present:

Low Fasting Blood Sugar

Low blood sugar is called hypoglycemia (hypo = low, glycemia = blood sugar). It’s blood sugar below 70 mg/dL (3. 9 mmol/L) in diabetics or around 55 mg/dL (3 mmol/L) in healthy people.

Causes

Causes shown here are commonly associated with lower blood sugar. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret this test, taking into account your medical history, signs and symptoms, and other test results.

Hypoglycemia or low blood sugar can be caused by:

• Type 1 or 2 diabetes [120, 121]
• Intense exercise or overtraining [122]
• Malnutrition/starvation [123]
• Too much alcohol [124, 125]
• Weight loss surgery (bariatric surgery) [125]
• Underactive thyroid (hypothyroidism) [126]
• Severe infections or illness, including liver, kidney, or heart failure [127, 125, 128, 24]
• Adrenal insufficiency (low adrenaline and cortisol) [129, 123]
• Pituitary insufficiency (hypopituitarism) [130]
• Pancreatic tumors [123, 131]
• Some rare genetic disorders or autoimmune conditions affecting insulin [132, 133, 125]

Hypoglycemia is often caused by medications. Many drugs can decrease blood sugar levels, including:

• Insulin and antidiabetics, including metformin [134, 125]
• Aspirin [125]
• Drugs used to treat high blood pressure, such as beta-blockers [135]

Symptoms

Symptoms of low blood sugar include [136, 137]:

• Sweating
• Hunger
• Trembling
• Headaches
• Anxiety
• Blurred vision

Ways To Increase Blood Sugar

The most important thing is to work with your doctor to find out what’s causing your low blood sugar and to treat any underlying conditions!

Discuss the additional lifestyle changes with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

Lifestyle

When we exercise, our muscles burn glucose fast. Make sure you are eating well beforehand, to prevent drops in blood sugar levels.

Diet

Make sure you eat regularly, ideally frequent smaller meals throughout the day, and that your diet is well-balanced. Go for quality carbs and foods rich in dietary fiber, vitamins, and minerals and low in added sugars, fats, and sodium [138].

Refrain from drinking alcohol, especially on an empty stomach. It can decrease your blood sugar [124].

Supplements

If you are susceptible to low blood sugar due to diabetes, carry a glucose supplement with you and take it when you start to feel symptoms of low blood sugar.

Genetics

Additional to food and lifestyle, genetics also plays a role in fasting blood glucose and HbA1c levels [139, 140]

A genome-wide association study in seven Mexican cohorts found a relationship between fasting blood glucose levels and the MTNR1B gene. Interestingly, this gene codes for the melatonin receptor and helps you fall asleep, but its over-activation may block insulin release and increase the risk of diabetes [141].

There are two associated versions of the MTNR1B gene, one of which is expressed more. Studies suggest that having the overexpressed version of this gene may be a risk factor for diabetes and high blood sugar [141].

An additional study found nine SNPs that were associated with glucose levels. More genes that impact fasting blood glucose levels are G6PC2 and GCK [142, 143, 144].

One variant (rs1050828) in the G6PD gene artificially lowers HbA1c levels, which makes this test less sensitive to detecting diabetes [145].

Remember, although genes and gene variants may have some effect on your glucose levels, the biggest effect is still due to your lifestyle and your dietary choices. Choose wisely!

Takeaway

A fasting blood sugar test is also called a fasting glucose test. It measures your sugar levels after fasting for at least 8 hours. Glucose is the main sugar found in your bloodstream and high levels after fasting may point to diabetes. The normal range in healthy people is 70 – 125 mg/dL. Levels on the higher end of the normal range (above 100 mg/dL) signal prediabetes, which often leads to diabetes if you ignore it and delay making healthy lifestyle and dietary changes. Doctors typically order the fasting blood sugar test alongside HbA1c, which can reveal your sugar levels over the past couple of months. Both low and high levels of blood sugar can be dangerous. If you have diabetes, monitor your sugar levels regularly (with both lab tests and glucose monitors) to make sure they’re stable.

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

Prediabetes Definition | What Is Prediabetes?

What is prediabetes?

Prediabetes is a condition in which blood glucose levels are elevated, but not yet within the diabetic range. Prediabetes is also known as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The new term was inaugurated by the U.S. Department of Health and Human Services (HHS) and the American Diabetes Association (ADA) in March 2002 to promote public understanding of this increasingly widespread problem. According to the Centers for Disease Control and Prevention (CDC), roughly 84.1 million Americans have prediabetes. Studies have shown that most people with blood glucose levels in the prediabetes range go on to develop type 2 diabetes within 10 years; the condition also raises the risk of having a heart attack or stroke by 50 percent. Prediabetes can be controlled, and in many cases even reversed, through lifestyle changes.

Detection & Screening: What Is the Prediabetic Range?

Prediabetes can be detected by a number of standard tests currently used to diagnose diabetes. In the fasting plasma glucose test (FPG), a person fasts overnight and then has blood drawn for testing first thing in the morning, before he eats. Until 2003, a fasting blood glucose level under 110 mg/dl was considered to be normal and fasting blood glucose in the range of 110 to 125 mg/dl indicated impaired fasting glucose (IFG), or prediabetes. In late 2003, an international expert panel recommended that the cutoff be lowered to 100 mg/dl, so now people with a fasting blood glucose level of 100 to 125 mg/dl are considered to have prediabetes. A fasting blood glucose level over 125 mg/dl indicates diabetes. (A second test must be done on a subsequent day to confirm a diagnosis of diabetes.)

In the oral glucose tolerance test (OGTT), a person’s blood glucose is tested once after an overnight fast and again two hours after he has consumed a special, glucose-rich drink. A normal blood glucose level two hours after the drink would be below 140 mg/dl; an elevated blood glucose level in the range of 140 to 199 mg/dl indicates impaired glucose tolerance, or prediabetes. A blood glucose level 200 mg/dl or higher two hours after the drink indicates diabetes. (Again, a second test must be done on a subsequent day to confirm diabetes.)

Additionally, an HbA1c result (a test indicating blood glucose control over the previous 2–3 months) 5. 7 percent to 6.4 percent is considered to be prediabetes, while a result of 6.5 percent or higher indicates diabetes. (Again, a second test is required to confirm the diagnosis.)

Risk factors for prediabes: Who’s at risk?

Who is at risk for prediabetes? An expert panel convened by HHS and the ADA recommends that physicians begin screening all people age 45 and up for the condition. All overweight adults should also be screened if they have one or more of the following risk factors for diabetes: high blood pressure, a family history of diabetes, low high-density lipoprotein (HDL, or “good”) cholesterol and high triglycerides, a history of gestational diabetes or giving birth to a baby over 9 pounds, or belonging to one of the racial or ethnic groups that is at increased risk for type 2 diabetes (African-Americans, Native Americans, Asian Americans/Pacific Islanders, and Hispanic Americans/Latinos). If a person is tested for prediabetes and his results are within the normal range, the ADA recommends that he be retested every three years (unless his doctor recommends testing more frequently). If a person is diagnosed with prediabetes, he should be screened for type 2 diabetes every one to two years.

Prediabetes in children & adolescents

Prediabetes can also affect children and adolescents. A research letter published in JAMA (the Journal of the American Medical Association) in July 2016 found that nearly 18 percent of adolescents (age 12–19) tested had blood glucose levels within the prediabetes range. Currently, not much is known about how to prevent or delay the onset of type 2 diabetes in children. The widespread screening of younger people for prediabetes, therefore, is not currently called for by major health organizations. However, in 2000, the American Academy of Pediatrics recommended diabetes testing for obese children who also have two or more of the additional risk factors for diabetes mentioned above.

In adults who have been diagnosed with prediabetes, lifestyle changes can delay or prevent the development of full-blown type 2 diabetes. Results from the Diabetes Prevention Program, a study conducted by HHS and involving more than 3,000 participants, showed that a 5 percent to 7 percent weight loss lowered the incidence of type 2 diabetes by 58 percent. The weight loss was achieved through dieting (cutting fat and calories) as well as exercising moderately (most participants chose walking) for at least 150 minutes a week. Use of the oral diabetes drug metformin (brand name Glucophage and others) also helped to delay the onset of diabetes in some study participants; however, it was not as effective as diet and exercise.

Want to learn more about prediabetes? Read “Prediabetes: What to Know” and “Stopping Prediabetes In Its Tracks.”

En Español: Definición de Prediabetes: ¿Qué es la Prediabetes?

Originally Published May 17, 2006

Want to know if your diet is healthy? Track your blood sugar!

Are you confused about whether your diet is healthy?

Are whole grains good for us?

Do we need to be gluten-free?

Should we be eating dairy regularly?

What about fruit?

Nuts?

Beans?

With all the conflicting diet information out there, it’s enough to drive you crazy trying to figure out the right approach! Where do you even start?

Fortunately, it actually doesn’t have to be complicated.

The impact particular foods have on your health can be quickly identified by one very basic measurement: your blood sugar. 

Having a normal functioning blood sugar is the key to optimal health and the prevention of chronic disease in your life. Virtually all chronic diseases are either caused by poor blood sugar control or are improved by better blood sugar management.

But first, let’s look at the very basics.

Blood sugar, or glucose, is the sugar found in your blood that comes mainly from the food you eat. Whenever you eat something, your digestive system breaks it down into smaller components, and one of the major components is glucose. 

Glucose is our bodies’ preferred energy source. It’s a necessary ingredient for maintaining the optimal function of your organs, muscles, and nervous system.

If you just ate a meal high in carbohydrates, starch, and/or sugar, your blood sugar will rise high over a normal fasting level. If you just had a meal of healthy fats and proteins, your blood sugar will not rise as high.

Blood sugar after meals that is continuously outside of the normal range can lead to major blood vessel and body tissue damage.

This damage creates toxic compounds called advanced glycation end products (AGEs). 

AGEs are proteins or lipids that are tagged with glucose molecules as a result of continuous exposure to high sugar levels. AGEs accelerate the aging process by depleting your body’s antioxidant stores. 

They also wreak havoc in the body by damaging DNA and lead to the development, or worsening, of many diseases including diabetes, atherosclerosis, high blood pressure, kidney disease, and Alzheimer’s disease. 

Fortunately, it’s very simple to measure the direct effect on your blood sugar of any kind of food, whether it’s a bowl of greens or a big juicy burger. 

That means you can always make an informed decision about your dietary choices and ensure that you have the data you really need to optimize your health over the long term.

To test your blood sugar at home, all you need is a very inexpensive piece of equipment you can find at any drug store or pharmacy called a glucose meter or glucometer.

Glucose testing from home using a glucometer is typically done by a finger stick test. This involves pricking the tip of your finger and collecting a small drop of blood onto the testing strip.

Here is a glucometer that I recommend, which includes 100 testing strips and 100 lancets. 

Click here for a video tutorial on how to test your blood sugar.

The test itself is very mildly painful but if you are feeling squeamish, I recommend having someone else help you with the finger stick because it may be harder to do on yourself.

Here are the data points that you will want to track when assessing your body’s response to meals: :

• fasting blood sugar levels
• blood sugar 1 hour after eating
• blood sugar 2 hours after eating
• blood sugar 3 hours after eating
• how long it takes for blood sugar to return to fasting levels after eating 
• a diary of foods eaten before the tests

Let’s work through the best way to test your blood sugar and get all these data points.

First: Test your blood sugar first thing in the morning before you have eaten anything.

This is called your “fasting” blood sugar level. Optimally this level should be between 82-88 mg/dL (4.55-4.88 mmol/L). Conventional medicine considers anything <100 mg/dL (5.55 mmol/L) as normal. 

Second: Test your 1-hour post-meal blood sugar. 

Your blood sugar will reach its highest point around 1-hour after eating the meal. This reading tells you how high your meal has made your blood sugar. It is important that you are not eating food that consistently raises your blood sugar over 120 mg/dL (6.66 mmol/L).

Third: Test your 2-hour post-meal blood sugar. 

This reading tells you how efficient your body is at balancing your blood sugar. Optimally this level should be less than 120 mg/dL (6.66 mmol/L). The closer to 100, the better. 

Fourth: Test your 3-hour post-meal blood sugar.

Your glucose level should be back to your fasting level or under 100 mg/dL (5.55 mmol/L). This is a normal healthy response to eating a meal.

Fifth: If your blood sugar has not returned to your fasting level by hour three, continue to test it hourly until you see how long this process takes for your body. A normal response is 3 hours post-meal.

In the beginning, it is a good idea to pick some meals that you eat on a regular basis and take a day to test those. 

Record your findings. And as time goes on, you will have a diary of what foods your body responds to best.

Ready to get to work on improving your own blood sugar levels? Interested in working with a doctor to finally nail down the best diet for your body and health? Click here to complete a short application to start working with Dr. Alexis Shields.  

I’ve written extensively about the difference between normal and optimal blood markers here, and the same applies to your blood sugar ranges. 

From the perspective of conventional medicine, a fasting blood sugar level of 100-125 mg/dL (5.6-6.9 mmol/L) indicates prediabetes.

Two consecutive fasting glucose levels of ≥ 126 mg/dL (7.0 mmol/L) indicates diabetes, as well as a random glucose reading of ≥ 200 mg/dL (11.1 mmol/L), and a 2-hour post-meal reading of ≥ 200 mg/dL (11.1 mmol/L).

But much of the data in conventional medicine comes from populations who are not enjoying optimal health.

So what does a healthy daily glucose response look like from the perspective of preventative medicine?

On waking: Research indicates that your optimal glucose after waking in the morning should be between 82-88 mg/dL (4.55-4.88 mmol/L). This level is associated with optimal aging, the lowest risk of chronic disease, and the lowest mortality risk.

(Of course, there are always exceptions. Some people experience something called the “dawn phenomenon” in the morning and their fasting glucose level is slightly elevated above 88 mg/dL. This can be a normal response to cortisol raising in the morning. If this occurs, avoid eating for an hour and then observe your 1-hour post waking glucose level.)

After meals: Blood sugar peaks between 1 and 2 hours after the meal and should be back down to fasting levels by 3 hours post-meal. From the perspective of optimal health, you should avoid regularly eating foods that raise your blood sugar over 100 mg/dl (5.55 mg/dL).

One strategy to test the impact of your diet on your long-term health is to measure your blood sugar before and after meals. 

Identifying the foods or meals that regularly spike your blood sugar too high, too fast, or too long can help you to individualize your diet for longevity.

After a few weeks of testing your blood sugar levels after eating various types of food, you should have a clear record of how your body responds. 

By familiarizing yourself with the effect that food has on your blood sugar, you will start to learn what foods your body loves and which ones to eat only on special occasions or not at all. 

A balanced blood sugar results in a greater sense of wellbeing, having more energy, preventing the afternoon crash and feeling “hangry” (hungry + angry), and getting a better night’s rest. 

Here’s what It feels like to have normal blood sugar:

• No extreme hunger between meals
• No sleepiness after meals or mid-day
• Balanced mood
• Stable energy
• Restful and refreshing sleep
• Mentally sharp

• Feeling fatigued and sleepy, especially after meals
• Poor brain function and focus
• Increased thirst
• Frequent urination
• Dry mouth
• Weight fluctuations

But what does it mean if you eat something clearly unhealthy, like a candy bar or burger, and your blood sugar does not elevate over the 120 mg/dL (6.66 mmol/L) mark? 

This means your body is adapting to the rise in blood sugar very well!

This is a good thing. You have a very healthy body. However, if you continue to eat processed foods high in starch and sugars, over time your body will slowly lose this ability to adapt. This is not a good practice. 

Want to know some foods that commonly convert quickly to sugar and cause a rapid high spike in blood sugar?

• White foods: white rice, white potato, all forms of sugar
• Refined grains: bread, pasta, crackers, baked goods, cereals, chips
• Candy and sweets
• Soda, juice, sweetened drinks

Consumption of processed sugar increases your risk for many chronic diseases including obesity, cardiovascular disease, diabetes, and non-alcoholic fatty liver disease (NAFLD).

If your blood sugar is too high, or if you’re simply experiencing some of the symptoms of high blood sugar after eating, the best thing you can do is to exercise. Exercise clears sugar from the blood so that it can be used as a fuel source for your muscles.

Different types of exercise work to a different extent for different people. To determine your individual effect from exercise, test your glucose levels before and immediately after different types of exercise. Going for a walk after meals or a quick high-intensity interval training (HIIT) session is a good place to start.

If your test results are consistently outside the healthy range, here’s what you do:

• Test and record your levels
• Get a blood test to further investigate other blood sugar related biomarkers: hemoglobin A1c, fasting insulin, triglycerides
• Experiment with reducing foods high in carbohydrates and starches, especially low-fiber processed foods (ie. white bread) and those with added sugar (ie. salad dressings with sugar as an added ingredient, check your labels!)

Need a blood test to check your blood sugar related biomarkers? Click here, if you are in the US, to order your own blood test. 

And if you want help with these steps, click here to explore a Mini Health Review. After a simple blood test, I’ll review your data and come back to you with an action plan tailored to your specific needs. 

• Hunger
• Feeling shaky or trembling
• Mood changes — irritable or moody (“hangry”), anxious
• Sweating
• Tired
• Heart rate fast or pounding
• Dizziness
• Sleepiness
• Weight fluctuations

If your blood sugar is too low, the best thing to do is to eat a balanced meal based on the data you’ve collected since you started tracking your blood sugar after eating. 

If you don’t have enough data (or any) just yet, start with something that’s moderate in carbohydrate and also contains some protein and healthy fats. An apple with some nut butter is a good option, as is meat or seafood with some vegetables cooked in olive oil. 

Clearly, there’s a huge range in the effects different types of food have on your blood sugar.

That’s why tracking your blood sugar 1 hour after eating and your blood sugar 3 hours after eating over a few weeks can be such a valuable tool. 

When you’re learning how to improve your blood test results and optimize your long term health and longevity, you must have data as the foundation.

Your blood sugar is one of the fundamental indicators of your current and future health, and if you focus on this one metric alone, all the other biomarkers in your annual labs are likely to improve as well. 

Ready to get to work on improving your own blood sugar levels? Interested with working with an online functional medicine doctor? The Mini Health Review as an easy first step to getting started: click here to learn more.

Measuring blood sugar on a low-carb diet — Diet Doctor

By , medical review by – Updated September 19, 2021

Maybe you bought a blood sugar meter because you’ve been given a concerning diagnosis of pre-diabetes or diabetes. Or maybe one of these conditions runs in your family. Perhaps you’re just curious to know what food does to your blood sugar — and willing to sacrifice a few drops of blood to find out.

If you’re new to testing your blood sugar, rest assured that it’s simple to do.

If you’ve had diabetes for a while, you may have already been tracking your blood sugar for years. Yet it may take some time to understand changes that occur after switching to a low-carb or keto diet.

Whether you’re experienced at it or not, testing your blood sugar can help you better identify which dietary changes lower your blood sugar over time. It can also help you identify specific foods that raise blood sugar.

Disclaimer: This guide is meant to help you understand the basics of checking blood glucose. It is not meant as medical advice. Low blood sugar can potentially be a life threatening condition. If you have low blood sugar and have symptoms as described in this guide, the quickest solution is to eat or drink sugar or carbs, and then consult with your physician regarding the next step

1. Getting started

Many different blood sugar meters (also known as glucose meters or glucometers) are available, and most of them are fairly inexpensive.

However, make sure that the test strips for your meter are affordable and available. The real cost of blood-sugar testing lies in the cost of the strips, which can only be used once and expire after a certain date.

In addition to a meter and strips, you’ll need a lancet, which contains a short, small needle that will prick your finger quickly and (almost) painlessly. Lancets are very inexpensive and are discarded after each use. Most blood sugar meters come with a lancet and about a dozen replacement needles.

How to measure blood sugar

You should read the directions that come with your blood sugar meter and follow those carefully. For most meters, the general procedure goes like this:

• With clean hands, place a test strip in your blood sugar meter.
• Prick the side of a finger with the lancet to draw a drop of blood.
• Place the tip of the test strip on the drop of blood.
• After a few seconds, the blood sugar meter will give you a reading.

Many blood sugar meters will keep track of your blood sugar readings for a number of days or weeks. Even if your meter stores these readings, it may be a good idea to record the date, time, and other information to share with your healthcare provider or for your own purposes. Use a notebook, computer spreadsheet program, or app like this one to keep track of your readings.

When to measure blood sugar

If your healthcare provider has given you specific instructions about when to test your blood sugar, you should follow those instructions.

Many people check their blood sugar first thing in the morning, before eating. Because no food has been consumed for at least 8-10 hours, a blood sugar measurement at this time of day is called a “fasting blood sugar.” It’s best to check this at the same time every day.

You can also check your blood sugar right before eating (a pre-meal or preprandial level) or after a meal (a post-meal or postprandial level). If you’ve been instructed to check your blood sugars at a specific time interval after a meal, you should begin timing once you start eating.

2. What is a normal blood sugar?

Ideas about “normal” blood sugar levels are based on individuals eating a standard American diet. This type of diet usually contains about 50% of calories from carbohydrate, the nutrient that tends to raise blood sugar the most.

If your own carbohydrate intake is much lower than this, you may have a different “normal.” You can jump to How a low-carb diet affects blood sugar measurements for more information.

Fasting blood sugar levels

A normal fasting blood sugar level in someone who does not have diabetes is generally between 70 and 100 mg/dL (3.9 to 5.6 mmol/L).

Fasting blood sugar that consistently falls in the range of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes, which is also referred to as impaired fasting glucose.

If your fasting blood sugar is above 126 mg/dL (7.0 mmol/l) on two separate occasions, then you may have diabetes.

If you are concerned about the measurements you’re getting, especially if you are already on a low-carbohydrate diet, see How a low-carb diet affects blood sugar measurements. A few blood sugar measurements may not always provide an accurate picture of your health.

Post-meal blood sugar levels

If your healthcare provider has not given you specific instructions regarding when to test post-meal blood sugar, you may want to try measuring it one to two hours after you begin eating. Whichever reading is the highest is the one that you should pay attention to, because blood sugar levels may peak at different times.

How much and how quickly your blood sugar level increases after eating is mainly determined by your body’s ability to handle carbohydrates.

In people who don’t have diabetes, blood sugar levels typically peak about an hour after starting a meal. However, in people with type 2 diabetes, blood sugar typically peaks about two hours after starting a meal. For this reason, people with diabetes are usually advised to measure their blood sugar two hours after eating.

According to the American Diabetes Association, a normal post-meal blood sugar reading one or two hours after a meal is below 140 mg/dL (7.8 mmol/L). Some clinicians and individuals who are more cautious about high blood sugar may prefer using a carb-restricted approach targeting a post-meal blood sugar level of 120 mg/dl (6.7 mmol/L) or lower.

If your blood sugar is consistently 140 mg/dL (7.8 mmol/L) or higher but less than 200 mg/dL (11.1 mmol/L) when measured two hours after beginning a meal, you may have prediabetes or impaired glucose tolerance.

If your blood sugar measurements are consistently 200 mg/dL (11.1 mmol/L) or higher two hours after beginning a meal, you likely have diabetes.

If your fasting or post-meal blood sugar levels are consistently higher or lower than normal, you may have a medical condition that requires a visit to a healthcare provider.

However, if your blood sugar levels suddenly go from “normal” to “not normal” when you get a new meter or a new container of test strips, check your meter and strips to ensure they’re taking accurate measurements. When a result is very different than expected, take three measurements and use the average of the three.

Blood glucose chart

Each measure should be done on at least two separate occasions before you suspect that your blood sugars are too high or too low. See your healthcare provider about any concerns you may have about your blood sugar readings

3. What to do if your blood sugar levels are lower than normal

Blood sugar levels that are below 70 mg/dL (3.9 mmol/L) are known as hypoglycemia. Symptoms of hypoglycemia include heart palpitations and feeling lightheaded, jittery, irritable, fatigued, or sweaty.

Low fasting blood sugar levels can occur if you have diabetes and your medication does not match your carbohydrate intake. So it’s very important to let your healthcare provider know you’re following a low-carb diet so they can adjust your medication to match your carb intake.

In people who do not have diabetes, low fasting blood sugar levels may be the result of a serious underlying medical condition such as an eating disorder or a tumor. If your fasting blood sugar is low and you do not take diabetes medications, see your healthcare provider.

Low blood sugar levels after eating are often called reactive hypoglycemia. This can occur in people with diabetes, as well as those with normal fasting blood sugars. How it should be treated depends on what the underlying cause is. But if you have low blood sugar and experience symptoms, you can remedy this in the short term by eating something with carbs or sugar.

High-carb intake may cause reactive hypoglycemia in people who are very insulin sensitive or have experienced massive weight loss. A low-carb, high-protein diet has been found to improve reactive hypoglycemia in adults who have undergone weight-loss surgery.

Reactive hypoglycemia can also be a symptom of polycystic ovary syndrome (PCOS), a condition which in some cases can be successfully treated with a low-carb diet.

4. What to do if your blood sugar levels are higher than normal

If your fasting or post-meal blood sugar readings are consistently higher than normal, you may have prediabetes or diabetes. If you suspect you have diabetes or prediabetes, you should see your healthcare provider as soon as possible.

Symptoms of diabetes, beyond elevated blood sugars, may include increased thirst and urination, severe fatigue and excessive hunger. For more details, see our guide to common signs and symptoms of diabetes.

5. Personalizing your diet based on blood sugar response

In addition to seeing your healthcare provider, there are steps you can take to reduce your blood sugar levels. If you check your blood sugar after meals and keep track of those measurements, along with the types and amounts of food you ate, you may be able to see which foods are problematic.

Although an increase in blood sugar is usually due to eating high-carb foods, all carbs are not the same when it comes to raising blood sugar. Because starchy foods digest down to glucose (sugar) very quickly, some starchy foods may end up having a much greater impact on blood sugar than you might expect.

For instance, even though a banana tastes sweeter than a baked potato, the potato may actually have a bigger impact on blood sugar.

Because high-carb foods have the biggest impact on blood sugar levels, it makes sense to reduce them, no matter what type of diet you follow. The American Diabetes Association made this point in a 2019 paper on nutrition for people with diabetes.

Sometimes making gradual changes can work best. Our guide, Eating better: six steps down carb mountain, can help you lower your carb intake, one step at a time.

If you’ve been diagnosed with type 1 or type 2 diabetes, our guide to the best foods for people with diabetes can help you make choices that may reduce your need for blood sugar control medications.

Although carbohydrates are the main contributor to high post-meal blood sugar, sometimes eating very large amounts of protein can cause blood sugar levels to rise. Our protein guide can help you find the right amount to eat, while keeping your blood sugar levels in check.

Other foods that are low in carbs may also increase blood sugar response. For example, in one study when caffeinated coffee was consumed with meals containing either rapidly digested or slowly digested carbs, blood sugar levels were higher than they were after the same meals without caffeine.

If a food or beverage seems to be causing your blood sugar to rise too much, try leaving it out of your diet for a few days to see if you notice a difference.

6. Other ways to measure blood sugar

Checking your blood sugar levels with a glucometer is not the only way to measure blood sugar. Other tests that your healthcare provider might use to check your blood sugar levels are hemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT). If you’re really lucky, you may have access to a continuous glucose monitor (CGM).

HbA1c provides an estimate of your average blood sugar levels over time, giving you a sense of your blood sugar control over the last two or three months. An HbA1c test is the most common measurement used for diagnosing type 2 diabetes.

However, HbA1c tests and blood sugar tests don’t always agree. Using HbA1c levels to diagnose diabetes often fails to identify individuals who would otherwise be diagnosed with diabetes using blood sugar levels.

Your HbA1c is normal if it is below 5.7%. You may have prediabetes if your HbA1c is above 5.7% but less than 6.5%. You may have diabetes is your HbA1c is 6.5% or over.

To learn more about HbA1c measurements and how they relate to blood sugar levels you record with your glucometer, see our full guide to understanding HbA1c.

An oral glucose tolerance test (sometimes referred to as an OGTT) can be more accurate in terms of diagnosing prediabetes or diabetes. It measures your blood sugar two hours after you drink 75 grams of glucose. Because it requires drinking a large sugar solution, an OGTT may not be a useful test for someone on a long-term low-carb or ketogenic diet (more on this in the next section).

A continuous glucose monitor (CGM) is a wearable device that, as the name says, continuously measures blood glucose levels. Although they’re expensive and usually only approved by insurance for type 1 diabetes, they’re a very accurate way to measure blood sugar throughout the day. This allows you to easily see post-meal variations and get an average blood sugar level for the day.

7. How a low-carb diet affects blood sugar measurements

If you are on a low-carb diet, you may find that some ways of measuring blood sugar will not provide you with “normal” levels.

For example, fasting blood sugar levels may be slightly above normal. This may be due to “adaptive glucose sparing” and “the dawn phenomenon.”Your fasting blood sugar levels may be elevated because your liver is making extra glucose to prepare your body for the day.

If you are concerned about these levels, ask your healthcare provider to check your HbA1c, which reflects your average blood sugar control over 2-3 months (more on this below).

If you’re on a low-carb diet, your HbA1c will likely be lower than your fasting blood sugar levels would predict, since your blood sugar probably doesn’t increase much after meals.

For people who have been on a low-carb diet for a long time, an OGTT may mistakenly diagnose you as having diabetes. Because your body is fat adapted and no longer using sugar as its main fuel, you may have an exaggerated blood sugar response to the glucose drink. If that occurs, you may fail the test and be given a diabetes diagnosis when you actually do not have the condition.

If your doctor orders an OGTT test and you want to take it, start consuming carbs and sugar about three days before the test.

Conversely, if you are on a ketogenic diet and have elevated ketones, your blood sugar may naturally be 70 mg/dL (3.9 mmol/L)or slightly below. In this case, because ketones are fueling your body, you likely won’t have typical symptoms of hypoglycemia, such as shakiness or lightheadedness.

Checking blood sugar can be a simple way to learn the effects various foods have on your body. However, it’s important to remember that your blood sugar level, like your weight, is just a number. Panicking when your fasting blood sugar is 102 mg/dL (5.7 mmol/L) one morning adds extra stress to your day, which isn’t beneficial to your health!

Use your glucometer wisely, as another tool in your toolbox on your health journey.

/ Adele Hite, PhD MPH RD

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90,000 What is the normal sugar level? | Eternal Questions | Question-Answer

When we talk about measuring blood sugar levels, we really mean determining the amount of glucose, which is the main source of energy and ensures the work 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.

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, that is, an increased sugar level.

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 rise in the blood, 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 hospitalization of the patient. 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?

Indicator below 3.3 mmol / l indicates hypoglycemia, i.e. low blood sugar. In this case, the person has the following symptoms:

• increased irritability;
• excessive sweating;
• weakness;

90,025 hand tremors;

90,025 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 an appointment with a specialist and a blood test.

Under what conditions should the sugar level be measured?

A blood sugar test is carried out on an empty stomach, that is, before taking it, 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:

90,000 Zinc supplementation (zinc supplementation) for the prevention of type 2 diabetes

Review Question

What are the effects of zinc supplementation versus placebo or no treatment for preventing type 2 diabetes in adults with insulin resistance?

Relevance

Several studies show that zinc improves glucose levels (glycemic control) in diabetic patients.Delayed complications of diabetes, such as damage to the kidneys, nerves, and eyes, can develop in diabetes. Also, the risk of cardiovascular complications, such as angina attacks and strokes, increases. Type 1 diabetes is a form of diabetes in which the body can no longer produce insulin. The risk of developing type 2 diabetes increases with age, obesity, and physical inactivity. It is characterized by an increasing inability of the body to make good use of insulin (insulin resistance).Zinc (a mineral) plays a key role in the action of insulin and, in theory, supplementing zinc to patients with insulin resistance could prevent diabetes.

Characteristics of research

We included three randomized controlled trials with a total of 128 participants in this review. The zinc supplementation period ranged from four to 12 weeks.

Key Findings

None of the studies reported key patient outcomes (new detection of type 2 diabetes mellitus, side effects, health-related quality of life, all-cause mortality, diabetes complications, socioeconomic effects.The effect of zinc supplementation on insulin resistance and blood lipid levels (mainly cholesterol and triglycerides) has not been determined.

Quality of evidence

The quality of the majority of the studies included in the review was unclear as the study authors did not provide important information that would enable us to assess how the studies were conducted (the risk of bias is unclear / not excluded in most cases).In addition, the number of studies and participants was low, and the study authors did not investigate important outcomes such as re-occurrence of type 2 diabetes or the side effects of zinc supplementation.

Relevance of evidence

This evidence is current up to March 2015.

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: 90 100

• 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
  clinic, assessment 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 the 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 90 100

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 90 100

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 90 100

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 90 100

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) 90 100

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 90 100

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 90 100

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 90 100

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 content of amylase
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 foods) 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 comfortable conditions 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:

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

2.3 Laboratory diagnostic tests / ConsultantPlus

Currently, there is no “gold standard” for laboratory diagnostics of HA, which is associated with too low concentration of biochemical markers in the blood and urine, as well as the layering of parallel current pathological processes in other joints of the patient [28, 29].

Recommended for patients with OA, with clinically significant concomitant pathology (cardiovascular, endocrine), in order to identify possible contraindications for prescribing drugs to perform before starting treatment:

– general (clinical) blood test [122], – blood biochemical general therapeutic (study of the level of high-density lipoprotein cholesterol in the blood, study of the level of creatinine in the blood, study of the level of total bilirubin in the blood, study of the level of glucose in the blood, study of the level of cholesterol in the blood, study of the level of cholesterol of low-density lipoprotein, determination of the activity of aspartate aminotransferase in the blood, determination of activity alanine aminotransferase in blood) [123, 124].The level of persuasiveness of the recommendations C (the level of evidence is 4)

It is recommended that patients with OA with concomitant lesions of the small joints of the hand and foot, for the differential diagnosis of OA with rheumatic diseases, perform:

– determination of the content of rheumatoid factor (RF) in the blood [152], – antibodies to cyclic citrulline peptide (ACCP) [125], – study of the level of uric acid in the blood [126]. The level of persuasiveness of recommendations B (level of evidence confidence – 3)

Comment: in OA there are no pronounced inflammatory changes in the clinical blood test, RF – mostly do not detect, antibodies to ACCP, the concentration of uric acid in the blood serum is often normal or slightly increased.

It is recommended that patients with OA and synovitis of the knee joint to exclude inflammation perform:

– study of erythrocyte sedimentation rate (ESR),

– study of the level of C-reactive protein in blood serum (CRP) [122]. The level of persuasiveness of recommendations C (level of evidence confidence – 4)

Comment: a moderate increase in these indicators can be observed with synovitis, a pronounced increase indicates another disease.

Recommended only in the presence of synovitis for the purpose of differential diagnosis (suspicion of inflammatory joint disease or infectious arthritis, or microcrystalline arthritis) study of the chemical properties of synovial fluid, study of protein levels in synovial fluid, study of the physical properties of synovial fluid [127, 128, 129, 130 ].The level of persuasiveness of the recommendations is C (the level of evidence is 4). Comments: Laboratory tests are prescribed mainly to assess the state of the patient’s internal organs and systems [28, 29]. Laboratory tests of blood, urine, or synovial fluid are not required to diagnose knee OA, but can be used to confirm or rule out other inflammatory diseases (pyrophosphate arthropathy, gout, rheumatoid arthritis, etc.). In the presence of synovitis of the knee joint, it is necessary to perform a puncture of the joint with the evacuation of synovial fluid with its subsequent examination.OA is characterized by a non-inflammatory nature of the synovial fluid: sterile, transparent or slightly cloudy, viscous, with a leukocyte concentration of less than 2000 / mm3. Higher rates are characteristic of inflammatory joint diseases. Detection of crystals in synovial fluid is not typical for OA. It is recommended to perform a general (clinical) blood test, blood test, biochemical general therapeutic, general (clinical) urine analysis at discharge from the hospital [1]. The level of persuasiveness of recommendations C (level of evidence confidence – 5)

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Urine glucose test

Diagnostic direction

Assessment of the state of carbohydrate metabolism

General characteristics

Normally, glucose is absent in urine or is found in minimal amounts, i.e.because glucose, after filtration through the membrane of the glomeruli of the kidneys, is completely absorbed back into the proximal tubules. When the concentration of glucose in the blood is more than 8.8-9.9 mmol / L, exceeding the maximum ability of the kidneys to reabsorb glucose (renal threshold) or when this ability decreases due to changes in the functions of the renal tubules, glucose appears in the urine (glucosuria). With age, the renal threshold for glucose decreases. It decreases in chronic kidney disease, in hypertension, in diabetic nephropathy, while glucosuria may appear when the concentration of glucose in the blood is below the threshold (

Indications for prescribing

1.Diabetes (sugar, kidney, steroid) 2. Kidney pathology. 3. Sharp abdomen 4. Some poisoning. 5. Hyperthyroidism.

Marker

Marker of disorders of carbohydrate metabolism and renal function.

Clinical significance

An increase in the concentration of glucose in urine reflects either the presence of hyperglycemia or a defect of function in the proximal tubule. As a screening test for diabetes mellitus, the test has low sensitivity but reasonably good specificity.

Composition of indicators:

Glucose in urine (quantitative)

Method :
Spectrophotometric

Measuring range :
0-45.0

Unit of measure :
Millimole in 24 hours

Reference values:

Age

Comments

Method :
Spectrophotometric

Measuring range :
0-45.0

Unit of measure :
Millimole per liter

Reference values:

Age

Comments

Execution possible on biomaterials:

Biological material

Delivery terms

Container

Volume

Random urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Sterile container with lid

Volume:

50 Milliliters

Random urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Cone test tube, graduated

Daily urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Sterile container with lid

Volume:

50 Milliliters

Daily urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Cone test tube, graduated

Morning urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Sterile container with lid

Volume:

50 Milliliters

Morning urine

Delivery terms:

7 hours.at a temperature from 2 to 8 degrees Celsius

Container:

Cone test tube, graduated

Rules for the preparation of the patient

Daily urine. Standard conditions: Biological material is accepted during the working day of the department of ML “DILA”. The morning urine portion goes down the toilet. Collect urine in a clean container for collecting urine for a day, including the morning portion of the next day. Important: the volume of the container must be sufficient for the expected amount of urine per day. After the last collection of urine, mix all collected urine, determine its volume and record it. Pour 100 ml and deliver to the nearest department of ML “DILA” within 2 hours. Keep the container with urine in a cool, dark place during collection.To collect daily urine, the patient is offered to purchase a 2.0 liter container at the price list (the cost of the container is not included in the cost of the study). Random urine sample: Any urine sample regardless of the time of day. The urine is collected after using the external genital area. First morning urine: In the morning until 10-00. Before collecting urine, it is imperative to conduct a toilet of the external genital organs.

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Interference:

• Cortisol preparations, morphine, strychnine, phosphorus
• Sugar-lowering drugs

Interpretation:

• Diabetes mellitus; acute pancreatitis; hyperthyroidism; renal diabetes; poisoning with morphine, strychnine, phosphorus; dumping syndrome; Cushing’s syndrome, myocardial infarction; pheochromocytoma; big trauma; burns, tubulointerstitial kidney damage.

90,000 Private medical center for adults and children. Attentive Medicine Clinic

Anyone who plans to make an appointment with a cardiologist, endocrinologist or nutritionist for overweight and type 2 diabetes, Scandinavia will conduct free glucose and lipid analysis before consulting a specialist.

A lipidogram shows the level and composition of cholesterol in the body, which accumulate in the blood vessels, form plaques in them and prevent blood from moving freely throughout the body.People with diabetes and overweight need to pay special attention to the level of lipids and glucose in order to avoid cardiovascular diseases in the future.

With the test results on hand, the doctor can conduct a detailed consultation: assess the individual risks of heart attacks and strokes, choose a diet, exercise, treatment plan and answer all your questions about the diagnosis.

The offer is valid until December 31, 2021 in two departments of the clinic:

• at the clinic on Liteiny prospect, 55a, a cardiologist, an endocrinologist and a nutritionist lead an appointment;

• at the clinic on Ilyushin Street, 4/1, a consultation is carried out by a cardiologist and an endocrinologist.

The test results will be ready in 20 minutes, so you do not have to come to the clinic several times – the doctor will consult immediately after the examination.

How to prepare for the test

Your fingertip will be taken for analysis. It can be taken at any time, but it is better 3 hours after a meal.

We use the Cholestech LDX apparatus, the quality of which is confirmed by research in the USA, Great Britain and other countries.The equipment is recommended in clinical practice and allows you to get an accurate result in less than half an hour.

You can sign up for the procedure by calling +7 (812) 600-77-77.

Consult a specialist for possible contraindications and side effects.

Diet Amino Acids and Insulin Resistance (Part 1)

Poor nutrition contributes to the development of obesity.The modern approach to the treatment of overweight is based not only on optimizing the energy balance, but also on reducing the manifestations of hyperinsulinemia and insulin resistance. Carbohydrates are not the only stimulant of insulin secretion and are responsible for only 47% of its response. Protein foods cause a more powerful insulin response, even more than high-carb foods. Physiological insulin secretion is a multifaceted process and a better understanding of metabolic interactions between nutrients is needed, which has clinical and practical relevance in the treatment of obesity.

The basis for the treatment of overweight and obesity is a rational diet therapy based on reducing the caloric intake of the diet. But the main role in diet therapy of obesity is attributed to fats and easily digestible carbohydrates, therefore, many authors traditionally recommend, in order to reduce the caloric intake of overweight patients, first of all, to reduce the amount of fat-containing foods and carbohydrates with a high glycemic index (GI), which are rapidly absorbed into the gastrointestinal tract. – the intestinal tract (GIT), contributing to a sharp increase in the release of insulin and with a simultaneous increase in the proportion of protein in the diet, giving preference among various types of animal proteins, dairy products that consistently show a beneficial effect on glucose regulation, body weight and a decrease in the risk of developing type 2 diabetes mellitus (SD-2).[47, 74, 75] Consideration of the effect of products on insulin secretion is mandatory, because It is now known that one of the causes of the onset and development of obesity and its complications is insulin resistance (IR) and compensatory hyperinsulism, aimed at maintaining normal glucose metabolism. [1] Insulin resistance and hyperinsulinemia often occur simultaneously, and elevated insulin concentrations cause insulin resistance. [43] At the same time, milk protein causes a more significant insulin response than expected based on the low GI.Considering this, the reduction of the load on the insular apparatus achieved by diet therapy is extremely important in the treatment of obesity.

Insulin resistance is a decrease in tissue sensitivity to endogenous or exogenous insulin. Insulin-dependent tissues include muscle, adipose and liver. Glucose enters the cells of these tissues only after the interaction of insulin with its receptor, activation of the receptor tyrosine kinase and phosphorylation of the insulin receptor substrate (IRS-1) and other proteins that ensure the movement of vesicles with the glucose transporter protein (GLUT-4) from the intracellular space to the plasma membrane.It has been proven that IR is directly dependent on the degree of obesity and is diagnosed in overweight people long before the onset of diabetes mellitus. Reduced insulin-dependent glucose transport leads to the fact that the pancreas increases insulin production to overcome insulin resistance and hyperinsulism develops. In most cases, high insulin levels are the primary factor and lead to insulin resistance and obesity. [35] For example, tight control of blood sugar levels in diabetes treatment requires significant doses of insulin, which leads to hyperinsulinemia with progressive weight gain, even with reduced caloric intake.[23] DelPrato et al. [13] showed that indexing hyperinsulinemia at physiological concentrations for 48-72 hours under conditions of normoglycemia leads to a decrease in insulin sensitivity by 20-40% in healthy people.

Insulin is the main hormone that regulates lipogenesis in adipose tissue, firstly, through the influx of acetyl-CoA and energy in the form of HADPH, which is formed in the pentose phosphate pathway, which are necessary for the synthesis of fatty acids. Second, insulin activates the enzymes acetyl Coa carboxylase, which catalyzes the conversion of acetyl CoA to malonyl Coa, which provides bicarbon building blocks for making larger fatty acids, and the synthesis of fatty acids.Thirdly, due to the influx of glycerol formed from 3-phosphoglycerate for the formation of triglycerides. Fourth, it activates the lipoprotein lipase enzyme. In addition, insulin is a potent inhibitor of lipolysis in the liver and adipose tissue, due to its ability to inhibit the activity of hormone-sensitive lipase, and as a result, insulin reduces the content of fatty acids in the blood. [ten]

Insulin secretion is influenced by many more factors than the glycemic response to carbohydrate intake.For food products, the more important indicator is the insulin index (II). This value, which characterizes a food product in terms of insulin response to it. Protein-rich foods [9, 24], especially milk proteins, have a disproportionately higher insulin index, on the order of 90-98, than would be expected based on the glycemic response (15-30). [17, 42, 43, 77] A randomized crossover study compared the effects of four types of protein: whey, tuna, turkey, and egg albumin on postprandial glucose, insulin concentration, and appetite.All protein types elicited an insulin response despite negligible carbohydrates, and whey protein elicited the most potent insulin response (all p <0.001). [32]

Dietary proteins, like glucose, can directly stimulate insulin secretion. But not only the interaction of these nutrients with the beta cell of the islets of Langerhans, but also intestinal hormones are involved in stimulating insulin secretion. The insulin response to dairy products is correlated with the content of essential BCAAs (BCAAs).BCAAs), such as leucine, valine and isoleucine, with a particular emphasis on leucine [37, 42, 43, 46, 73], which initiate the synthesis of two peptides directly related to the endocrine effect and called glucagon-like peptide-1 (GLP- 1) and glucose-dependent insulinotropic polypeptide (GIP). The role of these incretins is to lower circulating blood glucose levels by stimulating insulin secretion while suppressing glucagon release, which reduces postprandial glucose increases.Incretins are synthesized from a common precursor called proglucagon. Proglucagon is metabolized in two ways. With the help of the enzyme prohormone convertase-2, glucagon is formed in the alpha cells of the pancreas. At the same time, GLP-1 and GLP-2 are formed in the gastrointestinal tract with the help of prohormone convertase-1. GLP-1 and GLP-2 are produced by L-cells of the endocrine part, predominantly of the distal part (jejunum and ileum). HIP is secreted as one biologically active form by K-cells located in the upper parts of the small intestine (duodenum and jejunum).It turns out that proglucagon simultaneously produces two opposite substances: glucagon, which is an insulin antagonist and increases the level of glycemia, and incretins, which stimulate insulin secretion. Approximately 60% of the insulin secreted in response to a mixed meal is due to the incretin effect. Both hormones have similar insulinotropic effects at glucose concentrations of 5.5 mmol / L. [12, 39]

The average value of insulin and incretins is significantly higher with the combined intake of carbohydrate and protein foods than for carbohydrates or protein separately.[44] In experiments, a pre-meal load of whey followed by a standard high-carb breakfast increased insulin and GLP-1 by 105% and 141%, respectively, compared with controls (250 ml of plain water before breakfast). [28] Accordingly, different protein sources have different effects on postprandial blood glucose. If protein intake alone does not affect glucose levels and remains stable [44], then a mixture of leucine, isoleucine, and valine dramatically increases glucose clearance after a dietary carbohydrate load due to increased insulin.[42, 73] Whey protein rich in these amino acids is most effective in lowering blood glucose. [7, 21, 28] This effect is undoubtedly a plus in the control of hyperglycemia for patients with diabetes, but what happens to blood glucose and whether its excess can serve as a source of de novo triglycerides in the liver remains unanswered.

More than 30 years ago, the association of BCAA branched amino acids with insulin resistance was discovered [14, 15, 20] and was repeatedly confirmed later.Surprisingly, BCAA amino acids, rather than lipid metabolism, are the main markers most closely associated with insulin sensitivity, which has been confirmed in studies with subjects with metabolic syndrome [25] and in groups of Chinese and Asian men with “relatively low body weight “. [62] Elevated baseline BCAA concentrations have been associated with progressive deterioration in glucose tolerance and an index of glucose distribution over time in adolescents after 2.3 ± 0.6 years of follow-up. [65] The Fiehn study [16] showed that leucine and valine from more than 350 metabolites were increased in African American women with T2DM. After 12 years of follow-up, when comparing 189 people who developed diabetes and 189 people who did not develop it, of the same weight, lipid profile and other clinical parameters, five metabolites had the highest significant association with the development of diabetes in the future – leucine, isoleucine , valine, phenylalanine and tyrosine. These and other results [56, 57, 58, 34, 72] highlight the potential key role of amino acid metabolism in the pathogenesis of insulin resistance.[70]

The question of whether the BCAA amino acids are simply markers of insulin resistance, or whether they are direct participants in the development of insulin resistance, is attracting increased research interest. Interventional studies have shown that short-term amino acid infusion induces peripheral insulin resistance in healthy individuals by inhibiting glucose transport / phosphorylation and thus decreasing glycogen synthesis.Intramuscular glycogen and glucose-6-phosphate concentrations were monitored using 13C and 31P NMR spectroscopy. A 2.1-fold increase in plasma amino acids decreased glucose utilization by 25% (p <0.01). The level of muscle glycogen synthesis decreased by 64% (p <0.01), which was accompanied by a decrease in glucose-6-phosphate. [eleven]

While in rodents the amino acid leucine increases glucose tolerance [6, 7, 76], in animals and humans, leucine decreases it. [4, 32, 41, 50, 63, 64, 66]
Replacing 1% of the dietary energy value from carbohydrates with an equivalent amount of energy from protein was associated with a 5% increased risk of developing T2DM.And replacing 1% of the energy value from animal protein with plant protein was associated with an 18% reduction in the risk of T2DM. This association persisted after adjusting for BMI [69].

Prescribing 15g of BCAA amino acids for women and 20g for men per day for 3 months in the vegan and omnivorous groups reduced insulin sensitivity in vegans. In omnivores, such changes were not observed, but at the same time it led to an increase in the expression of lipogenic enzyme genes in adipose tissue [19].

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