Blood Sugar & Monitoring
The basic sugar that fuels all living cells is glucose. Blood glucose is
regulated by the cooperation of the pancreas, liver, muscles, fat cells,
hormones and your brain which responds to body signals and determines what and
how much you eat. Insulin is released from the pancreas when blood sugar levels
rise. Insulin’s main task is to allow glucose to enter cells. If liver and
muscle cells refuse to absorb glucose from the blood, for example, they are said
to be insulin resistant. Most type 2 diabetics begin with elevated insulin
production but blood glucose regulation does not work properly.
What should happen to blood glucose levels after you eat food? After eating a
meal, the glucose level should rise and peak in 30-60 minutes and then fall back
to a “normal” level in the next 60 minutes. When blood glucose regulation is
normal, the timing and height and duration of the peak level will vary with the
composition of the meal and activity level. Obviously, high sugar meals
and low activity levels lead to higher peaks and longer durations.
The idea of an orderly rise and fall of blood glucose after meals is
unrealistic, since continuous eating is more the norm rather than eating three
properly constructed meals a day. Sucrose intake in pop and snacks may be almost
continuous, leaving little or no opportunity for blood glucose levels to fall.
Excess glucose should be absorbed by muscles and liver. Glycogen is
synthesized in these tissues as temporary storage of glucose. If glycogen
synthesis is impaired, high blood glucose levels occur after eating and low
glucose levels occur when you haven’t eaten for 3 or more hours. Muscles that
are working hard absorb more glucose and synthesize more glycogen. They also
send positive signals to other organs that improve metabolic regulation of
glucose levels in the blood.
The basic idea of blood glucose regulation is to maintain glucose levels in a
fairly tight range of 4-7 mmol/L by regulating supply and demand. Blood glucose
is supplied by food and is also manufactured by the liver from amino acids. High
glucose levels are associated with an intoxicated feeling. You feel drowsy, it
is hard to concentrate, and your judgment is impaired. Levels above 15 mmol/L
are too high. You want to sleep at this level but the most effective way to
reduce the glucose levels is to exercise as vigorously as you can.
When sugar is excreted in the urine, urine volume rises
because more water is needed to dissolve the abnormal sugar load; hence, the two
characteristic symptoms - increased frequency of urination and excessive thirst.
A screening test for diabetes is a check for urine glucose - this can be done
simply and cheaply with a dipstick - a color change on the indicator pad reveals
the presence of sugar. Sugar is not detectable in normal urine. The diagnosis is
confirmed by finding elevated blood glucose levels especially in the morning
A random plasma glucose level greater than or equal to 160
mg/dl (7 mmol/l) is considered a positive screening test result. The diagnosis
of diabetes is made by measuring the Fasting Blood Glucose. A measurement of
glycosolated hemoglobin indicates blood glucose levels during the past 3 months.
The glucose tolerance test is seldom required to make the diagnosis and should
not be used for long term monitoring. Most people know that insulin is used to
treat diabetes and will assume that insulin deficiency causes all diabetes. The
problem is not that simple. In the early stages, blood insulin levels tend to be
high but glucose is not used properly.
As DB2 progresses, insulin secretion declines. The
progression of DB2 is from intermittent elevations in blood glucose (often
called “glucose intolerance”) to a full-blown disease with persisting high blood
sugars, sugar in the urine, chronic ill-health and a host of secondary diseases.
Low blood sugar concentrations occur in diabetics for several reasons.
Impaired glycogen storage in muscles and the liver explains both abnormally high
and low levels. Blood glucose levels below 4 mmol/L (50 mg/dL) are too low - you
feel strange, irritable and become confused; a tremor develops if the blood
glucose value falls lower and you may feel desperate to eat something sweet. The
brain depends on glucose for energy and supervises different systems that
control glucose production. An increase in hypothalamic glucose levels lowers
blood glucose by inhibition of glucose production in the liver.
When blood sugar drops, levels are increased by 2 hormones, epinephrine and
glucagon. A decrease in blood glucose should trigger the liver to release
glucose from glycogen and to begin the production of new glucose from amino
acids. If the drop in brain glucose supply is sudden, an emergency fight and
fight response is triggered with the release of epinephrine into the blood.
Diabetics may lose effective low blood glucose responses and can experience
episodes of low blood sugar with overnight fasts and between meals.
Insulin and oral drugs used to treat diabetics cause low blood sugar if food
intake is inadequate. Low blood sugar can be a crisis that leads to coma, even
death. A long list of unrelated prescription drugs can lead to
hypoglycemia such as haloperidol, salicylates, quinine, pentamidine,
sulfonamides, and fluoro-quinolone antibiotics - -ciprofloxacin, gatifloxacin,
clinafloxacin, and levofloxacin.
A 56-year-old male developed hypoglycemia after losing 70 pounds. He
experienced episodes of confusion occurring 3 to 4 hours after eating.
Coming home from work, he drove through three red lights. His wife found him in
a confused state and unable to operate the television remote control. She
gave him orange juice to drink and he promptly recovered. While weight loss is a
solution for DB2, there is a period of metabolic adjustment that lasts for
several months and is characterized by unstable blood sugar regulation. The
strategy to stabilize blood sugar levels is incorporated into the Alpha
Nutrition Program. You have to stay with the recommended foods, follow the food
portioning plan, have frequent small feedings and use Alpha DMX to supply extra
Blood Glucose Monitoring
Home testing of blood glucose levels is useful for the self-managing
diabetic. You have to remember that the reason for doing a test is to provide
you with information that influences the decisions you make. An insulin
dependent diabetic will make decisions about the dose and timing of
insulin injections based on blood glucose levels. Frequent measurements are
essential for good decisions. A person with early type 2 diabetes will need less
frequent blood glucose measurements to guide food choices and adjust activity
Blood glucose values in medical publications are measured from venous blood
drawn from your arm. Test results vary depending on the age of the blood sample
and the calibration of lab instruments. There are no measurements without error.
A properly calibrated machine will have a known error range.
See Glucose Monitoring
High levels of blood glucose lead to glycosylation reactions with a variety
of proteins. Glycated protein macromolecules become malformed, cross-linked
polymers and are believed to play a significant role in the development of
the complications of diabetes. Therapy is aimed at minimizing the formation
of these cross-linked proteins by lowering the average blood glucose
Diabetic patients are encouraged to undergo routine
monitoring of the levels of the cross-linked molecule, hemoglobin A1C (HbA1c)
as a marker of long-term glycemic control. Glycated hemoglobin is assayed in
a sample of blood. Red blood cells have a life span of 90 to 120 days,
HbA1c readings provide a good indication of the average glucose control over
the past 90 days but will not show a recent change. The goal is to keep
HBA1c at less than 7 percent (of the total hemoglobin).
Three glucose measurements are useful for different reasons:
1. Fasting blood glucose levels, taken in the morning before eating, should
fall in a normal range. The goal is to keep this value under 7 mmol/L or 120
mg/dL (venous blood sample). For long term monitoring of stable DB2, daily
fasting glucose is the most useful measurement. Morning blood pressure and body
weight can be added to a daily record to provide good information about
stability or change.
2. Two hours after eating; blood glucose rises and then falls to a baseline
level. By sampling blood glucose levels one and two hours after eating, you
determine if glucose is being removed from your blood in a reasonable time. The
goal is to show values less than 7 mmol or 120 mg/dL at two hours. Higher values
tell you that you must do three things: (i) Reduce the amount of food.
(ii) Change the food choices that caused high glucose level. (iii) You need to
exercise after the meal to increase glucose utilization.
3. Checking symptomatic episodes: you measure blood glucose when you are not
feeling well to find out how your symptoms correlate with the blood glucose
level. High levels are associated with an intoxicated feeling - drowsy, hard to
concentrate, and judgment is impaired. Levels above 15 mmol are oo high.
You are drowsy and want to sleep at this level but the most effective way to
reduce the glucose levels is to exercise as vigorously as you can.
4.0 capillary (60 mg.) cause hypoglycemic symptoms - you feel strange, anxious,
irritable; your heart rate increases and a tremor develops if the blood glucose
value falls lower and you become desperate to eat something. If you take a quick
glucose hit - a glass of orange juice will do - your blood glucose level should
rise within minutes. As you feel better, do another blood glucose check in 30
minutes to determine the blood glucose value that feels more normal.