Download Blood Glucose Control (Blood Sugar Levels)

Blood Glucose Control (Blood Sugar Levels)

Introduction to blood sugar levels

Why is controlling blood sugar levels so
important?

Who is blood sugar control important for?

Diabetic patients: How to test your blood sugar levels

What level should my blood sugar be?

When to contact the doctor

How to control blood sugar surges

Blood sugar control, diet and exercise

Diseases associated with poor sugar control

Medications and blood sugar control
Introduction to blood sugar levels
Our blood glucose level, or blood sugar level, is the amount of glucose
(sugar) in the blood. The amount of glucose in the blood is measured in
millimoles per litre (mmol/l). Glucose levels are measured most commonly to
diagnose or to monitor diabetes. It is also important to keep an eye on blood
glucose levels during certain situations - for example: during pregnancy,
pancreatitis and with increasing age. Normally, blood sugar levels stay within
a narrow range during the day. A good level is between 4 to 8mmol/l. After
you consume food, your blood sugar level will rise and after you have had a
night's rest, they will usually be lowest in the morning.
Diabetes is a common disease in our society, affecting 2-5% of the general
population, with many more people unaware that they may be affected by this
condition. Diabetes results from a lack of insulin, or insensitivity of the body
towards the level of insulin present. Thus if you have diabetes, your blood
sugar level may move outside the normal limits.
Why is controlling blood sugar levels so important?
Carbohydrate foods are the body's main energy source. When they are
digested, they break down to form glucose in the bloodstream. If you make
sure you eat regular meals, spread evenly throughout the day, you will help
maintain your energy levels without causing large rises in your blood sugar
levels. It is also important to maintain a stable and balanced blood sugar
level, as there is a limited range of blood sugar levels in which the brain can
function normally. Regular testing of your blood sugar levels allows you to
monitor your level of control and assists you in altering your diabetes
management strategy if your levels aren't within the expected/recommended
range.
Long term complications, including eye disease, kidney problems, nerve
problems, cerebrovascular disease such as strokes, and cardiovascular
disease such as heart attacks, heart failure and high blood pressure, can be
significantly reduced. Based on studies of people with type 1 diabetes
(Diabetes Control and Complications Trial : DCCT) and type 2 diabetes
(United Kingdom Prevention of Diabetes - UKPDS), maintaining near normal
blood sugars and glycated haemoglobin levels significantly reduces the risks
of complications arising from diabetes.
Who is blood sugar control important for?
Good blood sugar control is important for most people
in the general population. However, if you have a
condition such as diabetes, pancreatitis, hyperthyroidism
/ hypothyroidism or Cushing's syndrome, it becomes
even more important to achieve good sugar control. If
you are pregnant or planning to become pregnant, it is
also essential to maintain good sugar levels to ensure
both your own and your baby's wellbeing.
Stable blood sugar levels significantly reduces the risk
of developing diabetic complications at a later date.
Depending on the level of control achieved, these problems may start to
appear 10 - 15 years after diagnosis with type 1 diabetes and often earlier in
patients with type 2 diabetes.
Diabetic patients: How to test your blood sugar levels
Blood sugar levels are usually measured on a daily basis with a home blood
sugar level testing kit. There are several brands and varieties available, but
they will all consist of a measuring device and disposable paper strips. To
check your blood sugar level, you are usually required to prick your finger tip
with a lancet (a small, fine, sharp needle). Then you have to put a small
amount of blood on the paper strip and place the strip into the measuring
device. After about 15-30 seconds the blood sugar level will be displayed.
These blood sugar measuring devices are available at most local pharmacies
and also through Diabetes Australia.
There have been new meters that test alternative sites that have been
released. These meters allow you to test alternative sites,such as the
forearm, upper arm, base of the thumb and thigh. However, testing at
different sites may give you results that are different from those obtained from
the fingertip. It has been shown that blood sugar levels in the fingertips show
changes more quickly than those in alternative testing sites.
People who have type 1 diabetes should measure their blood sugar levels at
least once a day, either in the morning before breakfast or at bedtime. Those
with type 2 diabetes and are on insulin treatment should also measure their
blood sugar levels one - two times a day. For those type 2 diabetics who are
on a special diet or oral tablets, blood sugar levels should be measured once
or twice a week before mealtime or one to two hours after a meal.
What level should my blood sugar be?
The recommended range of blood sugar levels are:

4 to 7 mmol/l before meals.

< 10 mmol/l one to two hours after meals.

About 8 mmol/l at bedtime.
When to contact the doctor
When your blood sugar levels are in the extreme ranges - either a fasting
blood sugar greater than 15-20mmol/L or less than 3-4mmol/L, and especially
if there are two or more abnormal readings, you should seek medical
attention. However, you will find out the normal value of blood sugars for your
own body and these levels provided are just arbitrary values - some people
will feel no symptoms at a level of 20mmol/L whereas others may have
symptoms of a high blood sugar such as thirst, urinating frequently, lethargy
and vomiting. Regardless, you should contact your local doctor to see if better
control of your blood sugar levels can be obtained.
How to control blood sugar surges
If your blood sugar reaches very high levels at any time, you will need to
adjust your food intake or insulin dose. Blood sugar levels rise in the blood
after breakdown of carbohydrates in the food we consume.
The Glycaemic Index (GI) is a measure of the effect that a carbohydrate
containing food has on blood sugar levels, compared to the effect of the same
amount of pure sugar, on blood sugar levels. Foods with a low GI (less than
55) means that they cause a slower and lower rise in blood sugar levels.
These include types of bread such as mixed-grain and fruit and oat breads,
barley, pasta, noodles, beans, sweet potatoes, green peas and milk. Foods
with a high GI (greater than 70) means that they cause a faster and higher
rise in blood sugar levels. High GI foods include white bread, brown rice,
jasmine rice, French fries and coffee.
Limiting your intake of high GI foods will help bring down the average GI of
your meal and prevent marked surges in blood sugar. If you are a diabetic,
high blood sugar levels may need to be controlled by increased amounts of
insulin, if you are already on insulin treatment. If you are only taking tablets to
control the blood sugar levels, this may need to
be reviewed, to optimize treatment of your
diabetes. In any case, high sugar levels can
make you feel unwell, with symptoms as
described above and you should consult your doctor if this arises.
Blood sugar control, diet and exercise
Diet and exercise play a very important role in helping control blood sugar
levels. Research has shown that by eating a diet with a lower GI and rich in
healthy foods, people with diabetes can reduce their average blood sugar
levels and reduce the risk of complications. There are various factors that
affect the GI of a food. These include: the types of sugar in the food, the way
it is prepared, the type of starch, and it's fat and fibre content. Although you
don't have to avoid all high GI foods, you should try and combine them with
low or intermediate GI foods when possible.
Some tips for maintaining a healthy diet and incorporating the GI index into
your daily routine include:

Follow the dietary guidelines for Australians, trying to incorporate a
variety of foods into your eating plan.

Try and use low GI foods instead of high GI foods when possible.

Try and have at least 3 low GI foods throughout the day, especially
during mealtimes.
Physical activity is an important part of optimizing glucose / diabetic control. It
has many benefits, including: helping lower blood sugar levels, reducing
weight, improving blood pressure and cholesterol levels and also improving
muscle strength and stability. It also helps the body decrease it's insulin
resistance and burn excess sugar. The National Physical Activity Guidelines
for Australians recommends that at least 30 minutes of moderate intensity
physical activity be performed on most days of the week.
If you are thinking about starting regular physical activity, it is important that
you slowly build up achievable goals over the next few weeks, gradually
increasing the intensity. It is essential to closely monitor your blood sugar
levels during physical activity. When you first start exercising, it is
recommended that you test your blood sugar levels before, during and after
physical activity. This gives you an idea of the way your body responds to
exercise. Some of the signs of a low blood sugar level include feeling light
headed, faint, sweating and weak. If this occurs, you should stop what you
are doing and take some quickly absorbed glucose such as jellybeans or
glucose tablets. Everyone is different, so it is important to know how you
respond to exercise.
Overall, the long term benefits of eating a good diet and exercising regularly
far outweigh the short term excuses and effort that is needed to initiate these
changes.
Diseases associated with poor sugar control
Glucose control has been shown to be very important in helping prevent
particular diseases, especially if you have diabetes. Studies have been done,
which show that in adults with diabetes, persistently elevated blood sugar
levels is associated with an increased risk of peripheral arterial disease, (a
condition affecting the arteries which results in reduced blood flow). There
have also been studies which show that poor blood sugar control and an
unhealthy diet is linked to cardiovascular disease (affecting the heart and
major blood vessels). This is because the body's ability to use sugar for
energy is not optimized and the blood fats (triglycerides) are increased,
leading to cardiovascular disease.
In the long term, poor control of blood sugar levels in diabetic patients leads
to both heart and blood vessel disease, kidney failure, nerve damage, eye
problems and heart disease. Gaining optimal control over blood sugar levels
is therefore essential to ensure that these long term consequences are
avoided.
Medications and blood sugar control
If you are affected by type 2 diabetes, medications may
be used as an adjunct to manage your condition at a
later stage. Factors such as diet, exercise and loss of
weight are very important in managing blood sugars - if
you have tried to make changes in all these areas and
are still not successful in gaining good control of your
blood sugars, there are many types of medications that
can help you manage your diabetes. These medications
are usually taken orally, to help lower blood sugar levels.
There are different classes of medications, which work
on different parts of the body, to try and alter the levels of
insulin and sugar in the body.
Biguanides
Biguanides are becoming increasingly popular in helping patients with
diabetes gain control over their blood sugars, especially in those who are
overweight. For example: Glucophage, Diabex and Diaformin (Metformin)
belong to this class. These medications work by helping the body use insulin
more effectively. Some side effects include nausea, diarrhoea and on rare
occasions - lactic acidosis, especially in patients who have kidney, liver or
heart disease.
Sulfonylureas
Sulfonylureas are one of the commonly prescribed medications to help
control diabetes. This group of medication works by acting on cells, to help
your body make insulin. Some examples of this group include: Daonil
(Glibenclamide) and Diamicron (Glicazide). They have few side effects, such
as bloating, weight gain, allergic skin rashes and gastrointestinal disturbances
(ie nausea, diarrhoea) and should be avoided by people who are allergic to
sulpha. Due to the fact that this class of drugs increases the release of
insulin, an important side effect to be aware of is hypoglycaemia. You should
learn to recognize the signs and symptoms that you experience when your
blood sugar levels are low - light headedness, sweating, hunger, etc.
Alpha-glucosidase inhibitors
This group includes medications such as Glucobay (Acarbose), which work
by blocking an enzyme called alpha glucosidase, resulting in a slower
absorption of sugar in your digestive system. These medications are often
used in combination with another diabetes medication, such as a biguanide or
sulfonylurea. Alpha glucosidase inhibitors are often associated with side
effects such as abdominal discomfort and flatulence.
Thiazolidinediones
Thiazolidinediones act to make cells more sensitive to insulin. Examples of
this group of medication include: Avandia (Rosiglitazone) and Actos
(Pioglitazone). Side effects which may be experienced with this group of
medication include: swelling (retention of fluid), weight gain, and liver
problems.
Meglitinides
This is a newer group of oral agents developed to help control blood sugar
levels. Novonorm / Prandin (Repaglinide) work by causing a rapid, transient
increase in insulin secretion from the pancreas, helping control blood sugar
especially after meals. It is usually taken with meals and adjusted according
to the number and timing of meals eaten. Some side effects that may be
experienced include: nausea, diarrhoea and blurred vision.
Insulin
Insulin is the body chemical that is responsible for lowering blood sugar levels
and in patients with type II diabetes the body becomes resistant to its effects
and can eventually stop producing it at all. So if your blood sugar levels are
not controlled well enough on antidiabetic tablets, then your doctor many
consider using insulin injections, along with your tablets, to lower it.
You will usually start on a fairly small injected dose of long-acting insulin, or a
mixture of long and short acting insulins, which will have an effect for up to 24
hours. These injections are often given in the morning, the evening, or both,
but always at the same time. The dose starts at around 10 units per day
(although this will vary from person to person) and is injected below the skin
(not into the muscle) of the arm, belly or thigh. This can be extremely effective
in lowering blood sugar levels, but precautions must be taken because if too
much insulin is given there is the risk of your blood sugar going too low and
causing a 'hypoglycaemic' episode. To avoid this, measurements of blood
sugar level should be taken at least once every day and preferably more
often. One reason for this is to make sure that the dose is as effective as
possible, because it means adjustments to the dose can be made by the
patient every few days.
Below is a table describing one system, although your doctor may prefer a
different method and they should always be consulted if you are unsure about
what dosage is correct for you.
Fasting blood sugar
previous
3 consecutive days
for
the
Titration
every
3
managed by the patient
days;
< 5.5 mmol/l
No change or reduction of 2 units
(at
the
discretion
of
the
investigator)
5.5–6.7 mmol/l
No change or increase of 2 units
(at
the
discretion
of
the
investigator)
> 6.7 mmol/l
Increase of 2 units
It is important to know that this should always be concurrent with frequent
blood glucose measurement and discussion with a physician.
More information
For more information on nutrition, including information on types
and composition of food, nutrition and people, conditions related
to nutrition, and diets and recipes, as well as some useful videos
and tools, see Nutrition.
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