Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Home blood sugar (glucose) testing
is an important part of controlling blood sugar for people with diabetes. One important goal of
diabetes
treatment is to keep the blood glucose levels near the normal range of 70 to 120 mg/dl before meals and under 140 mg/dl
at 2 hours after eating.
Blood glucose levels are usually tested before and
after meals, and at bedtime.
The blood sugar level is typically determined by
pricking a fingertip with a lancing device and applying the blood to a glucose
meter, which reads the value.
There are many meters on the market, for example-
Accu-Check Advantage, One Touch Ultra, Sure Step and Freestyle. Each meter has
it's own advantages and disadvantages (some use less blood, some have a larger
digital readout, some take a shorter time to give you results, etc).
The test
results are then used to help patients make adjustments in medications, diets,
and physical activities.
Since blood glucose levels can fluctuate widely, even
frequent home glucose
testing may not accurately reflect the degree of success in controlling blood
sugar. The hemoglobin A1C test is a valuable measure of the overall
effectiveness of blood glucose control over a period of time.
What is a hemoglobin A1c (A1c)?
To explain what an A1c is, think in simple terms. Sugar sticks, and when it's
around for a long time, it's harder to get it off. In the body, sugar sticks
too, particularly to proteins. The red blood cells that circulate in the body
live for about three months before they die. When sugar sticks to these cells,
it gives us an idea of how much sugar has been around for the preceding three months. In
most labs, the normal range is 4-5.9 %. In poorly controlled diabetes, its 8.0%
or above, and in well controlled patients it's less than 7.0%. The benefits of
measuring A1c is that is gives a more reasonable view of what's happening over
the course of time (3 months), and the value does not bounce as much as finger
stick blood sugar measurements.
There is a correlation between A1c levels and average blood sugar levels as
follows:
While there are no guidelines to use A1c as a screening tool, it gives a
physician a good idea that someone is diabetic if the value is elevated. Right
now, it is used as a standard tool to determine blood sugar control in patients
known to have diabetes.
A1c(%)
Mean blood sugar (mg/dl)
6
135
7
170
8
205
9
240
10
275
11
310
12
345
The American Diabetes Association
currently recommends an A1c goal of less than 7.0%, while other groups such
as the American Association of Clinical Endocrinologists recommend a goal of
less than 6.5%.
Of interest, studies have shown that there is a 10% decrease in relative risk
for every 1% eduction in A1c. So, if a patients starts off with an A1c of 10.7
and drops to 8.2, though there are not yet at goal, they have managed to
decrease their risk of microvascular complications by about 20%. The closer to
normal the A1c, the lower the absolute risk for microvascular complications.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of si...
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