What Are the Signs of High and Low Blood Sugar?

One of the challenges of managing diabetes is maintaining consistent blood sugar (glucose) levels. Even with diligence, some situations can cause high blood sugar, or hyperglycemia, while others can bring on low blood sugar, or hypoglycemia.

After all, it’s not just carbohydrate intake that influences the amount of glucose coursing through your bloodstream when you have type 2 diabetes. Emotional stress and certain medications can increase your blood sugar levels, and a boost in activity can cause it to drop, says Megan O’Neill, CDCES, a medical science liaison for diabetes care at Abbott healthcare company in Monterey, California. Sometimes people experience a spike in their blood sugar early in the morning due to the “dawn effect,” a temporary surge of hormones that occurs as the body prepares to wake, according to the Cleveland Clinic.

“For people with diabetes, managing blood glucose levels is especially important,” O’Neill says. “Levels that are too low or high can result in complications that affect your kidneys, heart, and vision, reduce your quality of life, require expensive interventions, or even be fatal.”

RELATED: 5 Strategies to Help Avoid Diabetes Complications

The more prepared you are to spot the signs of both high and low levels, the better able you’ll be to quickly and easily bring them back within a desired range and stay healthy.

What’s the right range for you? The answer is slightly different for everyone, and your doctor can help you pinpoint yours. The American Diabetes Association (ADA) generally recommends trying to stay within these blood sugar targets:

• Between 80 and 130 milligrams per deciliter (mg/dL) before meals
• Less than 180 mg/dL two hours after meals

The first step to staying in these ranges, and course-correcting high and low blood sugar levels along the way, is to monitor your blood sugar levels with a glucose meter.

Clinical guidelines published January 2017 in Diabetes Care, the journal of the ADA, recommend that anyone taking insulin test their glucose at least four times per day and as many as 12 times per day. Those who are pregnant or have difficulty maintaining healthy blood sugar levels also need to test their blood sugar more often. Factors that increase the ideal testing frequency include the type of insulin, past levels of glucose control, and symptoms, O’Neill says. Some people with diabetes can benefit from continuous glucose monitoring, a device that allows you to get readings without finger pricks every five minutes, she says.

RELATED: 9 Signs Your Blood Sugar Is Out of Control

About High Blood Sugar (Hyperglycemia)

High glucose levels occur when the body doesn’t have enough insulin or can’t properly use the insulin it has to shuttle glucose from the bloodstream to the body’s muscles, organs, and tissues for fuel, O’Neill says. As a result, the amount of sugar in the blood builds up.

Hyperglycemia typically happens when you consume more carbohydrates or bigger portions of food than usual; if you don’t take enough insulin or other diabetes medication as prescribed; and if you decrease your levels of physical activity, she says. Heightened stress levels can also increase blood sugar levels. Non-diabetes-related medications that are known to raise blood sugar levels include steroids, beta-blockers, birth control pills, and many mental health medications, she explains.

Signs of high blood sugar include frequent urination, fatigue, dry or itchy skin, feeling thirsty, more frequent infections, and eating more food but not gaining as much weight as usual, says Athena Philis-Tsimikas, MD, the corporate vice president for the Scripps Whittier Diabetes Institute in La Jolla, California.

High blood sugar levels can cause these symptoms through various mechanisms, according to the Mayo Clinic. For example, high blood sugar levels damage blood vessels and nerves throughout the body. They can also deprive organs of energy and can cause fluid to accumulate in the eyes. And in an attempt to get your blood sugar to a healthier level, your body will often increase urine output.

A blood sugar reading above 180 milligrams per deciliter (mg/dL) is considered above normal and can bring on these symptoms, although it’s possible to have high blood sugar without any symptoms, Dr. Philis-Tsimikas says.

A reading above 300 mg/dL can be dangerous, according to the University of Michigan, which recommends immediately informing your doctor if you have two or more readings of 300 mg/dL in a row. In severe cases, very high blood sugar levels (well above 300 mg/dL) can result in coma. If you experience mental confusion, nausea, or dizziness, proceed to the emergency room.

Ways to treat high blood sugar include:

• Take your medications as directed. Missing doses or taking insulin or other diabetes-managing medications at incorrect times can lead to large fluctuations in blood sugar levels up or down, O’Neill says. Apps such as Medisafe, which is free to download on the App Store and on Google Play, can help you stay on top of your medication regimen. The top-rated app allows you to plug your meds into your calendar and set reminders so you never miss a dose.
• Eat carbohydrates in moderation. The ADA recommends an individualized carb count for everyone with diabetes. Higher intakes can result in hyperglycemia and lower intakes in hypoglycemia. Count carbs by using an app such as the Carb Manager keto diet app, which is top rated and free to download on the App Store and Google Play. It’s not just for those on the ketogenic diet; with the free version, you can record food, track your carb and calorie intake, monitor weight loss, and log workouts.
• Exercise regularly with your doctor’s guidance. Exercise can lower blood sugar in the short term by using glucose for fuel. It can also help you manage your blood sugar over the long term by increasing insulin health, O’Neill says. Plenty of exercise apps and free online resources exist; work with your CDCES to come up with an individualized exercise plan.

RELATED: 10 Surprising Causes of Blood Sugar Swings

About Low Blood Sugar (Hypoglycemia)

A1C Test and A1C Calculator

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

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

A1C calculator*

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

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

A1C Calculator

Average Blood Sugar
(100-300 mg/dL)

Please use a number
between 100 and 300.

Please use a number
between 100 and 300.

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

What is A1C?

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

Here’s how it works:

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

Self-monitoring blood glucose and A1C

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

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

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

How often do I need an A1C test?

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

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

Benefits of lowering your A1C test result

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

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

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

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

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

COVID-19 patients with high blood sugar at higher risk of death even if they don’t have diabetes, study suggests-Health News , Firstpost

Ever since the beginning of the COVID-19 pandemic, a number of underlying diseases have been associated with risks of severe disease, hospitalisation and even death. Diabetes is one of the key comorbidities associated with adverse COVID-19 outcomes, and many studies have thrown light on the various mechanisms involved in disease progression that make someone with diabetes more susceptible to severe symptoms and complications.

Diabetes, diabetic retinopathy and COVID-19

A study published in Diabetology in July 2020 revealed that COVID-19 patients with higher levels of fasting blood sugar are at risk of death within 28 days of getting infected, primarily due to older age and cerebrovascular diseases. The study data also showed that patients with fasting blood sugar levels less than 6.1 mmol/L (110 mg/dL) had a lower risk of severe outcomes due to COVID-19 .

A recent study published in Diabetes Research and Clinical Practice suggests that COVID-19 patients with both diabetes and diabetic retinopathy had a five-fold increased risk of intubation. Diabetic retinopathy is a complication of diabetes in which the small blood vessels of the eye are damaged, causing mild eye symptoms and blindness when left uncontrolled. Damage to the blood vessels is anyways linked to severe COVID-19 outcomes but this was the first study to link diabetic retinopathy with intubation during hospitalisation due to COVID-19 .

High blood sugar in non-diabetic patients

While the link between diabetes and severe COVID-19 outcomes is repeatedly highlighted by studies, it’s important to note that high blood sugar levels in non-diabetic patients can also lead to complications and even death. A new study published in the Annals of Medicine suggests that abnormally high blood sugar levels (hyperglycemia) at the time of admission are a strong predictor of worse outcomes and mortality in non-critical hospitalised COVID-19 patients regardless of any history of diabetes.

Previous research, including one published in the Journal of Clinical and Diagnostic Research in 2014, indicates that not all patients with hyperglycemia are diabetic and that this is a very important consideration people in medicine and surgery have to take during their regular practice. Underlying medical conditions like polycystic ovary syndrome (PCOS) and Cushing’s syndrome can cause hyperglycemia and so can stress, injury, trauma, infections like pneumonia and the use of certain medications like steroids and diuretics.

Hyperglycemia and severe COVID-19 outcomes

This type of hyperglycemia can also cause blood vessel damage and is just as likely to lead to severe complications. Add COVID-19 to the mix and the results are naturally likely to be graver if hyperglycemia is left untreated in non-diabetic patients. This is the reason why the researchers behind the new study strongly recommend that all patients hospitalised due to COVID-19 must be screened (and treated if necessary) for hyperglycemia to prevent COVID-19 complications.

To prove this connection between hyperglycemia and adverse COVID-19 outcomes, the researchers studied 11,312 patients hospitalised in centres across Spain and analysed their risk of all-cause mortality. Only 18.9 percent of these patients (2,128) had diabetes at the time of admission. Around 20.4 percent patients (2,289) died during hospitalisation, and 15.7 percent of these patients had blood glucose levels less than 140 mg/dL, 33.7 percent had readings between 140-180 mg/dL and 41.1 percent had blood glucose above 180 mg/dL. Blood glucose levels below 140 mg/dL are considered to be within the normal range.

The researchers found that the cumulative probability of mortality was significantly higher in patients with hyperglycemia – whether they had diabetes or not – as compared to those with normal blood sugar levels. Hyperglycemia was also associated with a greater requirement of mechanical ventilation and admission to the intensive care unit. The findings of this study, therefore, indicate that screening all COVID-19 patients for hyperglycemia at the time of hospital admission can help doctors provide better care and treatment to minimise all-cause mortality as well as complication risks.

For more information, read our article on COVID-19 and diabetes. 

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

High Blood Glucose (Hyperglycemia) and Ketones

Hyperglycemia (said like: hi per glie SEE mee ah) is also called high blood glucose. It happens when blood glucose numbers are higher than 120 mg/dl.

What Causes High Blood Glucose?

• Eating more carbohydrates than you calculated for your insulin dose
• Not enough insulin is taken
• Stress
• Illness

How do I Prevent High Blood Glucose?

• Count your carbohydrate closely.
• Give the right insulin dose based on your meal and blood glucose number.
• Change the insulin doses when you see a pattern of high blood glucose levels.
• Give insulin for all the carbohydrate you eat.

How will I Feel when My Blood Glucose is High?

What Should I do if My Blood Glucose is High?

• Drink fluids that do not have carbohydrates. Try to drink 1 full glass (8 ounces) every 30 to 60 minutes.
• Use the high blood glucose correction dose.
• Check your urine or blood for ketones if blood glucose is higher than 300 mg/dl.

High blood glucose, by itself, is not an emergency. High blood glucose and small, moderate, or large ketones IS something you should take care of right away.

Why would I Have Ketones?

You need glucose in every cell in your body to use for energy. Your body needs glucose and insulin in your blood. When there is not enough glucose or not enough insulin, your cells will not have glucose to use for energy.

When Cells do not Have Glucose to Use for Energy:

• The body starts to use fat for energy.
• Ketones are made when fat is used for energy. 
• Ketones are in the blood and in the urine. 
• Ketones are acids. 

What 2 things does Your Body Need to Prevent Ketones?

1. _________________________________________________________
2. _________________________________________________________

How do I Check for Ketones?

1. Collect urine in a cup.
2. Dip the test strip into the cup (Picture 1).
3. Remove the test strip from the urine.
4. Wait 15 seconds.
5. Match the color on the strip to the colors on the bottle (Picture 2 and 3).

NOTE: There are some blood glucose meters that are able to measure ketones in a drop of blood if using a special test strip specific to check ketones.

    Picture 1                                   Picture 2                                Picture 3

Tips

• Check the expiration date on the bottle of test strips. Do not use them if it is past the date.
• Once the ketone bottle is opened, get new ketone test strips after 6 months.
• Keep the ketone test strips in the bottle that they come in with the lid on.

What do I do if I Have Ketones that are Small, Moderate, or Large?

You will need more rapid-acting insulin (Humalog®, Novolog®, or Apidra®).

This is called a ketone bolus.

A Ketone Bolus is:

Based on your daily Lantus® basal dose or your total daily basal insulin dose on your pump.

• If you have small ketones, give 5% (0.05) of your Lantus® dose.
• If you have moderate or large ketones, give 10% (0.1) of your Lantus® dose.

Dose is based on Lantus® dose, but use Humalog®/Novolog® for ketone bolus.

Example: Your daily Lantus dose is 20 units.

• 20 x 0.05 = 1, so:
  • Give 1 unit of Humalog® or Novolog® for small ketones.
• 20 x 0.1 = 2, so:
  • Give 2 units of Humalog® or Novolog® for moderate or large ketones.

Your rapid-acting insulin dose at that time will have three parts:

• Meal bolus
• Correction bolus
• Ketone bolus

All three bolus doses are added together to equal the rapid-acting insulin dose.

What is your Lantus® insulin dose?

________________________________________________________

What is 10% of your Lantus® insulin dose?

________________________________________________________

What is your ketone bolus dose for small ketones?

________________________________________________________

What is your ketone bolus dose for moderate or large ketones?

________________________________________________________

Refer to the Diabetes SOS: Sick Day Self-Management guidelines and ketone correction Bolus Worksheet.

Use one of the following flow sheets that most closely fits your symptoms:

• Sick day when you are able to drink.
• Sick day when you are vomiting and not able to drink.

Are Ketones a Problem?

Ketones can make you very sick. When there are ketones in the blood, the blood can become acidotic. This is called Diabetic Ketoacidosis (DKA).

Signs of Ketoacidosis:

• Fast breathing
• Fruity smell to the breath
• Hard to wake up
• Feeling sick to the stomach (nausea) or having belly pain

How do I Prevent Diabetic Ketoacidosis (DKA)?

• Check ketones if blood glucose is higher than 300 mg/dl and when you are sick.
• Give the right amount of ketone bolus if you have small, moderate, or large ketones.
• Call the Endocrinology office or doctor on call when:
  • You have used a ketone bolus for moderate or large ketones twice and your ketones are still moderate or large.
  • You have treated a low blood glucose twice and your blood glucose is still low.
  • You have thrown up (vomited) 3 times.

Important to Remember

• DKA is dangerous!!
• When you have signs of DKA, you need to act quick by:
  • Calling the endocrinology office or doctor on call,OR
  • Going to the local emergency department.

Back to the Managing Your Diabetes Resource Book Table of Contents »

DKA Information, Hyperglycemia Information | Ridgeland, MS

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) occurs when the body does not have enough insulin. When insulin is not present to break down sugars to use for energy, our body begins to break down fat insted. Fat breakdown produces ketones which spill into the urine and cause glucose build up in the blood, thus acidifying the body. Because sugar is not entering into our body’s cells for energy breakdown, the sugar is being processed by the kidneys and excreted through the urine; as a result, we become dehydrated and our blood becomes even more acidic. This leads to sickness and hospitalization if not treated.

Generally, if a person’s blood sugar is over 240, they should start checking their blood for ketones. If you have diabetes, or love someone who does, being aware of warning signs of diabetic ketoacidosis (DKA) can help save a life.

Early Symptoms of DKA:

• High blood glucose level, usually > 300
• High volume of ketones present in blood or urine
• Frequent urination or thirst which lasts for a day or more
• Dry skin and mouth
• Rapid shallow breathing
• Abdominal pain (especially in children)
• Muscle stiffness or aches
• Flushed face

As DKA Worsens:

• Decreases alertness, confusion – brain is dehydrating
• Deep, labored, and gasping breathing
• Headache
• Breath which smells fruity or like fingernail polish remover
• Nausea and/or vomiting
• Abdomen may be tender and hurt if touched
• Decreased consciousness, coma, death

If you think you might be in DKA, test for ketones. If ketones are present, call your health care provider right away.

To treat high blood sugar, hydrate with water or sugar-free, caffeine free drinks. Sugar free popsicles and snacks are also good alternatives. Always call the doctor if vomiting continues for more than two hours. Symptoms can go from mild to life-threatening within hours.

What Causes DKA?

Common causes for DKA are:

• Underlying or associated infection
• Skipping or missing insulin dosages
• Undiagnosed diabetes
• Other factors include: medical, surgical or emotional stress, brittle diabetes, defective insulin pump infusion, catheter blockage, mechanical failure of the insulin infusion pump, medication, or even pregnancy

The Numbers:

• Diabetic ketoacidosis is typically characterized by hyperglycemia (high blood sugar) over 300 mg/dLm a bicarbonate level less than 15 mEq/L, and a pH less than 7.30m with ketones present in the blood and urine.
• While definitions vary, moderate DKA can be categorized by a pH less than 7.2 and a serum bicarbonate less than 10 mEq/L, whereas severe DKA has a pH less than 7.1 and bicarbonate less than 5 mEq/L.
• Numbers from MEdscape

How Does COVID-19 Affect Diabetics? – Healthcare Services in New York

Infectious diseases such as COVID-19 are more serious in people with diabetes, according to the CDC. Why is this? 1) the immune system of diabetics does not function as well, which makes it harder for their bodies to fight the virus; and 2) the coronavirus appears to thrive in an environment of elevated blood glucose levels which makes the healing response to any infection slower. High blood sugar levels combined with a persistent state of inflammation make it much more difficult for people with diabetes to recover from illnesses such as COVID-19.

Anyone with diabetes who notices symptoms of COVID-19 (fever of 100.4 degrees Fahrenheit or higher, cough, shortness of breath or trouble breathing) should speak to his/her provider as soon as possible. At CareMount Medical, we are seeing patients in the office and using virtual visits so patients can see their own personal, trusted providers online. After a virtual visit, your provider can decide if you need to come in for an appointment based on your symptoms, medical history and needs. If you are scheduled for any in-office medical testing, it is necessary to continue with your appointment without delay.

Your risk of getting very ill from COVID-19 is likely to be lower if your diabetes is well-controlled. Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19 since your body’s ability to fight off an infection is compromised.

Preventative Actions:
• Avoid people who are sick or who have been exposed to the virus.
• Clean your hands often using soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer.
• Clean and disinfect frequently touched surfaces daily.
• Avoid touching your face, especially your eyes, mouth, and nose.
• Wear a face mask when you leave your home.
• Avoid touching high-touch surfaces in public – use a tissue, glove or sleeve to touch them if necessary

Be Prepared:
If you have type 1 or type 2 diabetes, take the following action steps to prepare and reduce your risk of infection:
• Have up-to-date supplies and prescriptions of your diabetes devices and medications. Stock up on insulin supplies, glucose testing supplies, ketone test strips, glucose tablets, and up-to-date prescriptions.
• Ask your doctor how often to check blood glucose levels.
• Continue taking ACE inhibitors and ARBs as directed. If you take ACE inhibitors or ARBs for high blood pressure, heart disease, or diabetes, keep taking them unless your physician recommends otherwise. There was a controversial report saying that these drugs might make people more susceptible to COVID-19, but there is no evidence that this is true. In fact, the American Heart Association and other major associations recommend their use.
• Be prepared if you do get sick. Keep a supply of fever-reducing medications, like acetaminophen, and cough syrup in your home.

Diabetes and a COVID-19 Diagnosis
If you have been diagnosed with COVID-19 and you are diabetic, follow your provider’s advice diligently. Ask your doctor for instructions on how to watch your blood sugar and adjust for changes.

In addition, check your blood sugar more frequently and contact your doctor if it stays above 240 mg/dL. If you have type 1 diabetes and your blood sugar rises above 240, you could be at risk for ketoacidosis, which occurs when the body burns fat for energy and creates high levels of blood acids, known as ketones. Eventually these ketones can poison the body. During the coronavirus outbreak, it’s especially important to keep your ketone levels down and avoid trips to the emergency room, when possible.

Overall, having diabetes does put you at risk for COVID-19 complications so do your best to avoid getting sick and needing care at the hospital.

For all of us, routines have been disrupted, therefore it’s so important to get enough sleep, eat nutritious meals, and exercise within your ability. Keep in mind that your mental health can also have an impact on your blood sugar levels. Make time to do the things you love, and stay connected to friends and family. This is a unique period in our lives. We’ll get through it together.

To schedule an in-person visit with your CareMount provider, click here.

Sources: American Diabetes Association, Centers for Disease Control and Prevention

Glucose Curves for Cats | Vetsulin

Managing Feline Glucose Curves

The blood glucose curve is an ideal tool to determine the effectiveness of the insulin and identify the appropriate dose and frequency of administration. In general, maintaining blood glucose levels in a cat with diabetes between 120–300 mg/dL for the majority of the day will minimize the symptoms of diabetes and complications.

Veterinarians commonly adjust the insulin dose based on a blood glucose curve. When creating a glucose curve, remember that stress can affect the reliability of results, and the glucose curve is only one tool among others that can help diagnose and monitor diabetes mellitus. Your veterinarian will take clinical signs (or lack thereof) into account when contemplating any change in insulin therapy. The ultimate goal in regulating a cat with diabetes is to control the clinical signs adequately so your pet can enjoy a good quality of life.

How to complete a glucose curve

The procedure is as follows: shortly after your cat has been given its first meal (preferably at home), the first blood sample is taken just before the morning insulin is given. Blood samples are then collected every 2 hours throughout the day, for 12 hours if possible. This data is then plotted on a graph to generate a curve. Veterinarians will use the blood glucose curve to determine if any adjustments need to be made to the insulin dosage and feeding regimens.

How to interpret a glucose curve

The aim of treatment is to alleviate clinical signs of diabetes. To achieve this goal, veterinarians aim to keep blood glucose concentrations below the renal threshold and avoid hypoglycemia. They do this by maintaining blood glucose concentrations roughly between 120 to 300 mg/dL in cats for the majority of the day.³

The duration of insulin action is measured from the time of Vetsulin^® (porcine insulin zinc suspension) injection, followed by a fall in blood glucose concentration, to the time that blood glucose exceeds the renal threshold concentration of 200 to 280 mg/dL in cats. Because stress can falsely increase the blood glucose values in cats, sometimes other blood tests are utilized to help manage the diabetic cat.

Measuring blood glucose

Two different options:

Blood samples can be taken to measure blood glucose or blood insulin concentrations. Two methods of taking blood samples to produce glucose curves include:

1. Collection by your veterinarian of a venous blood sample from a peripheral vein. Plasma glucose concentrations are measured in a laboratory or by an in-clinic analyzer.
2. At home, or in clinic collection of a drop of capillary blood from the pinna, analyzed using a handheld glucometer.

• Glucometers should be calibrated specifically for dogs and cats because of the difference in the ratios of glucose in plasma and red blood cells from humans.
• Readings may vary as much as 15% from samples submitted to the laboratory.
• Handheld meters are reasonably accurate. If a reading seems unusual or does not match the clinical signs, a second reading should be taken or another method used to confirm the blood glucose measurement.

Management goals

Treatment is successful when the clinical signs of diabetes mellitus improve without inducing hypoglycemia.

Routine rechecks

After your cat stabilizes successfully, your veterinarian may perform routine rechecks every 2 to 4 months. Careful monitoring and control will help to limit long-term complications.

Blood glucose concentrations

The aim of therapy is to produce a blood glucose curve that approaches the average range and avoids potentially fatal hypoglycemia. A stable cat with diabetes exhibits a blood glucose range of around 120 to 300 mg/dL for most of a 24-hour period.

Ideal blood glucose curve

The graph below demonstrates an ideal blood glucose curve for a cat receiving Vetsulin^&reg twice daily. Not all blood glucose curves will be ideal at first.

If you feel your cat is at risk for developing diabetes, consider having your pet tested during a regular veterinary examination at least once a year.

Tracking Tools & Resources

1. Pet Diabetes Tracker app
   
   Review and keep important information to manage care.
2. Blood Glucose Curve Tool
   
   Easily record blood glucose readings to generate a blood glucose curve.
3. Helpful Downloads
   
   Additional resources to understand and manage feline diabetes.

90,000 November 14 – World Diabetes Day – News

World Diabetes Day, founded by the International Diabetes Federation, is celebrated on November 14, the birthday of Frederick Bunting, who, together with Charles Best, played a pivotal role in the 1922 discovery of insulin, a drug that saved millions of lives of people with diabetes.
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, a hormone that regulates blood glucose, or the body is unable to effectively use the produced insulin, which leads to an increased level of blood glucose – hyperglycemia.
More than 220 million people worldwide have diabetes. The world is undergoing a global epidemic of diabetes, characterized by a rapidly increasing prevalence of overweight, obesity and physical inactivity.
By 2030, diabetes is projected to be the seventh leading cause of death in the world.
There are two main types of disease. Type I diabetes mellitus develops due to the complete absence of the pancreatic hormone insulin, which is responsible for carbohydrate metabolism.Diabetes mellitus type II – with insufficient production of insulin or in violation of its interaction with the cells of the body.
More than 3 thousand new cases of diabetes mellitus are registered annually in Yekaterinburg. About 40 thousand people are registered with the disease, including more than 300 children under the age of 14.
The most dangerous consequence of diabetes mellitus is its systemic vascular complications – kidney damage, eye damage, damage to the main vessels of the heart, brain, peripheral vessels of the lower extremities.Complications are becoming the main cause of disability and mortality in patients with diabetes mellitus, and a decrease in average life expectancy.
Age over 45, overweight, cardiovascular diseases, heredity, childbirth over 4 kg, sedentary lifestyle, unhealthy diet are the main risk factors for the onset and development of the disease.
Prevention of type 1 diabetes mellitus is considered to be breastfeeding and the prevention of infectious diseases.
In order to prevent type 2 diabetes mellitus, it is necessary to lead an active lifestyle, because any physical activity lowers blood sugar and increases insulin sensitivity.
In the diet, it is important to eat foods with a high content of dietary fiber, which include almost all fruits and vegetables, legumes, and various types of nuts.
Such food normalizes bowel function, lowers cholesterol levels, promotes weight loss, improves blood sugar levels.
Whole grains, which are very healthy, should make up half of the diet.
In addition, you need to learn how to resist stress, maintain a normal weight, constantly monitor blood sugar levels using modern means of express diagnostics, give up bad habits and, if necessary, attend “Schools of Diabetes Mellitus” at polyclinics, which teach how to fight diabetes.
Photo: www.yandex.ru

90,000 Scientists: daytime sleep may be a sign of type 2 diabetes

September 15, 2016

Photo author, Thinkstock

Photo caption,

Is there a connection between prolonged daytime sleep and diabetes?

Japanese doctors believe that prolonged naps may be one of the symptoms of type 2 diabetes.

They found this connection by analyzing the results of observations of more than 300 thousand.patients.

British experts confirm that people suffering from chronic diseases, including diabetes, often get very tired by the middle of the day.

However, the British disagree that sleeping in the middle of the day can cause or contribute to the development of diabetes.

Japanese doctors presented their work at the meeting of the European Association for the Study of Diabetes, which was held in Munich.

The main factor, in their opinion, is the duration of sleep.People who sleep more than 60 minutes during the day are 45% more likely to develop type 2 diabetes. However, there is no link between diabetes and a daytime sleep of less than 40 minutes.

Sleep structure

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Sleep disorders can be signs of a variety of diseases

Researchers say that prolonged sleep during the day is often the result of poor sleep at night, which can be caused by a condition called sleep apnea.It is about stopping breathing for more than 10 seconds. With a longer breath hold, the body goes from deep sleep to a more superficial one, sometimes with awakening.

Sleep apnea increases the risk of heart attacks, strokes, and other cardiovascular and metabolic problems, including type 2 diabetes.

Lack of sleep caused by overwork or overly active entertainment can lead to increased appetite, which also increases the risk of type 2 diabetes.

But it is also possible that less healthy people, as well as those who already have diabetes, are more tired and therefore more likely to sleep longer in the middle of the day.

Naps, on the other hand, increase concentration and motor skills, according to the study authors.

Early signs

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High blood sugar can also lead to drowsiness

University of Glasgow professor, metabolism specialist Navid Sattar told the BBC that there is a lot of evidence the fact that there is a definite connection between sleep disorders and diabetes.

“It is likely that the risk factors that can lead to diabetes also trigger the urge to sleep during the day.Slightly elevated blood sugar levels, causing drowsiness, may be the first sign of diabetes, “he said.

” However, in order to determine exactly how different sleep patterns affect human health, more detailed research is required, “he said. Sattar.

At the same time, Dr. Benjamin Cairns from the University of Oxford believes that the results of the study of Japanese scientists should be approached with caution.

clinical observations.These results do not rule out alternative explanations, “he said.

Glucose tolerance test

The glucose tolerance test determines the ability of the human body to absorb glucose

The test passes in stages

assesses the level of glucose (sugar) on an empty stomach and after taking a certain amount of glucose

This analysis is especially relevant for pregnant women, therefore, an extended version of the test is allocated for them.

The decision on the need for a glucose tolerance test is made by the attending physician

Preparing for the

glucose tolerance test

• last meal 8-14 hours before the test, but in no case more than 16 hours

• smoking must be excluded before the test

• blood is donated in the morning before taking medications for the reliability of the result

• if X-ray, endoscopic, rectal examinations or physiotherapy procedures are planned on this day, then the sample is done before them

• before donating blood, physical activity is excluded (running, fast climbing stairs)

• try to eliminate emotional stress

• just before the procedure, you need a rest of 10-15 minutes to calm down

• You must bring a bottle of still water 0.5 l with you

Compliance with these recommendations directly affects the research outcome.

Conducting glucose tolerance test in Medgard-Ulyanovsk

1) from 8:00 to 10:00, contact the receptionist with a referral, you will be directed to the blood collection office.Time is limited so that the patient can properly maintain the fasting interval in the evening

2) after the first blood sampling (on an empty stomach) within 5 minutes, the patient drinks a glucose solution – 75 g of glucose + 300 ml of water. Glucose will be provided at the clinic

3) after that, the patient calmly waits for the allotted time. At this time, it is forbidden to eat, drink, smoke, actively move, be nervous. Better to take your favorite book or magazine with you and read

4) the second blood sample is taken

• in pregnant women exactly 1 hour after drinking water with glucose

• in non-pregnant women – exactly in 2 hours

5) the third blood sampling is performed only from pregnant women exactly 2 hours after drinking the glucose solution

Glucose tolerance test is carried out in our own laboratory Medgard-Ulyanovsk

For the sample, venous blood is taken.One take is paid

What is diabetes mellitus?

“Life is not sugar,” we say, complaining about some difficulties and sorrows and believing that sugar and sweets are always good. Doctors will not agree with us. They have long sounded the alarm: the disease caused by excess sugar – diabetes mellitus – has become a kind of scourge of our time. Meanwhile, this disease is very insidious and can lead to serious consequences. What are the first signs of diabetes? Why do you need to be able to count calories on time? And what if the tests showed an excess of sugar in the blood?

If the “key” does not fit the “lock”

What is diabetes mellitus?

Constant thirst is a sign that diabetes is developing

– Diabetes mellitus is a condition in which the level of glucose in the blood rises – or, as they usually say: sugar.And the word “diabetes” is Greek, meaning “flowing, passing through”; it indicates that the disease causes fatigue – dehydration of the body as a result of exhausting urination. The first symptom of diabetes: a person loses fluid. And to make up for the loss of fluid, he begins to drink a lot. This constant urge to drink is a sign that diabetes is developing.

Diabetes is of two types, and these are diseases that are somewhat different in their causes. They are called type 1 diabetes mellitus and type 2 diabetes mellitus.

– How does one differ from the other?

– Diabetes mellitus type 1 develops mainly in young people, it is also called juvenile, although this disease can affect people of any age. Sometimes this type of diabetes is congenital. A disease occurs when, for some reason, the production of insulin in the pancreas decreases, and this decrease is very significant. If we conventionally designate the level of insulin in a healthy person as 100%, then in type 1 diabetes insulin drops to only 10%.If a person is not helped, then after three to four days he will fall into a coma.

– For what reasons does the pancreas stop producing insulin?

– Now medical science believes that the reason for the decrease in the production of insulin is attacks of special proteins – antibodies – on the cells in which insulin is produced – the so-called beta cells of the islets of Langerhans. And these antibodies can form in the body against the background, as a rule, of viral infections – very different, including acute respiratory infections, measles, rubella … As a result, insulin, a hormone that regulates the concentration of glucose in the blood, falls catastrophically.

– What happens with type 2 diabetes?

– The opposite process is going on: insulin is produced not 100%, but much more. At the same time, the sensitivity of body tissues to the action of insulin decreases. Typically, this type of diabetes develops in older people.

– Who is at risk?

Overweight people at risk of diabetes

– First of all, overweight people.

– Is diabetes directly related to being overweight?

– Undoubtedly! And overweight can be due to some hereditary factors. But the main reason for it is unhealthy diet.

– What exactly is wrong? Dry food? Overeating?

– Overeating first. But overeating is still different. Because you can eat a small piece of some high-calorie food, or you can eat a huge amount, for example, cabbage, it is actually without calories, and it will not provide the energy reserve that we need, the stomach will simply be full.And after all, until we fill the stomach, we do not feel full.

– Why is it so important how much insulin is produced? What is its role?

– Insulin “grabs” the glucose that has entered the bloodstream and drives it into the cells as a source of energy. And glucose is a source of energy for the brain, and for muscles, heart muscles in the first place. Once we have been energized, we feel comfortable.

There is a certain mechanism by which the cell and this bundle of glucose and insulin recognize each other, that is, it turns out like a keyhole and a key: they must come up, the “lock” of the cell must open in order for glucose to “enter” it.And if for some reason this “keyhole” or “key” is changed, then insulin together with glucose enter the cell with great difficulty.

When glucose is not “driven” into the cell, its level in the blood is high, the receptors catch it, and a signal is sent to produce additional insulin. And instead of 100%, we have 120-130-140%, and this massive volume of glucose still “shoves” through the cells. But an excess of insulin exacerbates our hunger, we want to eat something again. However, this process is not endless.Once insulin begins to dry up, it starts to decrease from 150%, from 140%, it turns out to be less than 100% at some point. And there is thirst, frequent urination at night. However, all the same, the processes are not as rapid as in type 1 diabetes, when a life-threatening condition can develop in three days. Type 2 diabetes can develop over a year or even several years.

What should alert

– What are the statistics for both types of diabetes?

– The ratio of the incidence of type 1 diabetes to type 2 diabetes is 1 in 6 or even 7–8.And all those who have type 1 diabetes are always registered, they all always know about their disease. They are getting insulin.

There are about 600 million people with diabetes in the world. And half of them do not know that they have diabetes!

According to statistics, in the world about 250-300 million people suffer from diabetes. And about 10% are type 1 diabetes patients. And the rest are patients with diabetes mellitus of the second type, which they identified.It is believed that the disease is detected in at least 50% of patients. So in the world there are actually about 600-700 million people with diabetes. And half of them do not know that they have diabetes! As a rule, these are people of age who already have some kind of complications. And when these complications are superimposed on diabetes mellitus, which causes its complications, the so-called secondary complications of diabetes begin. Therefore, sometimes they get to the endocrinologist through an ophthalmologist: the patient came with complaints of deterioration of vision, and the ophthalmologist sees specific diabetic changes in the fundus.

This is the insidiousness of type 2 diabetes, that it undermines the body on the sly. Well, I began to get up often at night to go to the toilet, well, I lost weight, began to get tired quickly … People believe that this is due to spring vitamin deficiency, with some kind of stress, overstrain at work. And these are all the symptoms of incipient diabetes.

– What else should alert you?

– Pain in the legs may appear, especially at night. This is a classic complaint in type 2 diabetes mellitus.And sometimes neurologists refer patients to an endocrinologist who came to them with this problem. Moreover, the legs hurt exactly at rest, when the blood flow is reduced.

– In what places?

One of the signs of diabetes is constantly freezing feet, especially at night, at rest

– In the calves, it drives them, they go numb. And the feet are cold all the time, so patients sometimes wear woolen socks at night to keep them warm.And even during the day, such sensations can be. Plus, the sensitivity in the legs decreases

– So, what is the most important thing every person should know about diabetes?

– First, the symptoms: frequent urination, dry mouth, thirst. Usually a person drinks 2-2.5 liters of water per day. In type 1 diabetes mellitus – 5-7 liters per day to replenish fluid loss; with type 2 diabetes – up to 3 liters, although thirst may not even bother you.

Second: blurred vision. Third: pain in the legs.

You need to be on your guard if you cut yourself and the wound does not heal for a week, two, three

Diabetes mellitus is considered an immunodeficiency condition. And one of the manifestations of a decrease in immunity is poor wound healing. Therefore, you need to be on your guard if, for example, you cut yourself and suddenly the wound does not heal for a week, two, three.

And overweight people should be especially careful.

– Are they particularly susceptible to this disease?

– Yes. There is the so-called metabolic syndrome. This is a violation of carbohydrate metabolism, a violation of fat metabolism, an increase in blood pressure, that is, cholesterol is also increased. If there is a hereditary factor, then this aggravates the situation. Such people are at risk. They are “monitored” in the clinic, they are offered to undergo certain tests that can tell whether they have diabetes or not.But even if not, we can offer a specific therapy that corrects this condition.

– And will he fix it?

– We must strive for this. To say that everything will be 100% corrected is probably wrong.

– Roughly speaking, in some cases diabetes is programmed, it is difficult to get rid of it?

– Undoubtedly. Diabetes mellitus is not usually treated. Because this is a very difficult process.In the first type, when the pancreas is affected, there are options for transplanting the pancreas or replacing these cells in the abdomen that will work. But if the second type of diabetes mellitus began to develop, then we cannot rebuild the body.

There is such a term in endocrinology – “glucose toxicity”. This means that excess glucose is toxic to the inner wall of the vessel. The vessel has several layers, including the muscular one. This muscle layer is needed so that the vessel can expand or contract.For example, you ran to the metro now, you need to pump more blood in order to get more oxygen, so the vessels expand at that moment. And if an excess of sugar plus atherosclerosis is deposited on the walls of this vessel, then the vessel cannot expand. It is during physical exertion that the blood cannot circulate intensively – and the person begins to suffocate.

– Do you have shortness of breath?

– Yes, right.

– How does stress affect the development of diabetes mellitus?

– Stress can affect in different ways.What do we mean by stress? Stress is the body’s defensive response to the external environment. There are more than 7.5 billion people on earth, and everyone is stressed every day. But there are people who are especially prone to stress, others know how to keep peace of mind. Of course, if a person is under stress, he can get diabetes. But this is still a rare case.

On the other hand, under any stress, the hormone cortisol is released from the adrenal glands, which can raise blood glucose levels.

If the work is sedentary, it is advisable to give up nuts and honey: these products are very high in calories

Fasting offers us a specific set of foods that should make up for the loss of calories. Those who work physically need high-calorie foods such as honey, nuts, which are very high in calories. But there are foods that are less nutritious: vegetables and fruits. And if the work is sedentary, it is advisable to give up nuts.

– And honey for diabetes?

– Not recommended.But if a person has type 1 diabetes, then everything is “tied” to the amount of insulin introduced into the body. Let’s say you know that this spoonful of honey contains a certain amount of glucose, you can eat it, and by introducing insulin, we neutralize glucose; you can eat such a huge cake, but, having counted the amount of sugar, introduce the appropriate dose of insulin. When insulin is injected, the sugar is neutralized very quickly.

In type 2 diabetes, most patients receive pills. But any pill that lowers blood sugar lowers it with its own insulin.There is no other substance that lowers sugar in the body – only insulin.

But! Sugar also reduces exercise.

Is Sugar Always Bad?

– And when you really want something sweet, does that mean something?

– This suggests that, probably, low blood sugar. For example, let’s say you came to the dacha, you were given the task of digging up the whole garden for potatoes. And when you did everything, you really wanted to eat, right up to shaking.Have eaten some piece – and it became easier. And if such symptoms occur frequently, it is necessary first of all to check the blood for sugar.

– So sugar is not always harmful?

– So you spent some energy or now you woke up in the morning, slept for eight hours, before sleep you did not eat for an hour, then did not eat for some time, but since you are active, the brain requires energy, so what bad sugar in a spoon? I think that eating sugar wisely is not harmful.Especially if you know that you will have physical activity during the day, that is, you will not go to work by car, but walk some part of the way. By the way, in the subway, instead of standing on the escalator, you climb and along its steps. And do not use the elevator, but go up the stairs to your floor. Energy must be spent.

Any physical activity is useful, not just walking. And consider the energy value of products and your energy consumption.For example, if you iron for half an hour, very few calories are spent, brushing your teeth is minimal. The biggest thing is to climb the stairs.

Unfortunately, most people do not move much: they left the entrance, got into the car, drove to work, took the elevator, all day at the computer, and in one position, then fast food, calories were not spent …

– But you get tired at work …

– We are morally or emotionally tired at work, physically not.For example, our work, doctors, is morally difficult. Communicating with patients is energy intensive. The patient needs to be given a lot so that he leaves happy, contented, in a cheerful mood. So that he knows: he has a hope for which it is necessary to do this and that. We expend nervous energy, but physically we do not get tired, but there are calories, we have to digest them. So people are starting to gain weight. This is a pattern.

– Is it true that before 12 noon the body processes energy faster and therefore you need to eat sweets in the morning?

– There are many different theories.What is morning? It starts at different times for different people, because there are “owls” and there are “larks”: for some, the morning starts at five or six in the morning, and for some at 10, and maybe even 12.

Diabetes mellitus – not a sentence

– In the Russian Federation, endocrinology is quite accessible. If you come to our clinic, you will see that we have an appointment with an endocrinologist two or three days in advance, not a month. The main thing is to come.In any case, in Russia, according to the law, there is a so-called prophylactic medical examination program. That is, once a year, any institution – public or private – must conduct a medical examination of its employees. The program of medical examination also includes an analysis of glucose levels. And if an increase in sugar is detected, then these patients are referred to an endocrinologist so that he can determine the reasons, see if this is an accidental violation of the sugar level or there is a pattern in which a person must already be registered as a diabetic.