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What is blood sugar
(glucose)?
One of the principle fuels for energy in the body is glucose and
glucose circulates through the body in the blood. You will
often hear us use the term blood glucose and what we are
referring to is glucose circulating throughout the body in the
blood and traveling to various tissues. That includes, muscle
and brain and organ tissue.
How does that glucose get into the blood? Much of it comes
from the food we eat. We eat carbohydrate that is found in a
wide range of foods we consume and they go into our stomach
and into our intestines and they get digested and broken down
into simple sugars. The main simple sugar that they get broken
down into is glucose. That glucose moves from our digestive
tract and into the bloodstream and it becomes blood glucose
and is fuel available for the body to use. Now if we think
about our bodies there are about four or five litres of blood.
When you look at your blood glucose meter you often see
readings in the range of 4, 4.5 or 5 mmols/L and if you think
of that concentration of glucose in 4-5 liters of blood in
your body, it adds up to about 4 grams of glucose that are
actual circulating at any one time in your body. One of the
small glucose tablets used to treat low blood sugars is a good
example. You can think of this as being roughly the amount of
sugar circulating in your blood throughout the body
Symptoms of High Blood
Sugar
The holy grail of
diabetes is testing your blood sugar and making sure that it
is to target. If your blood sugar is within target, you are
probably going to feel quite good. If however, your blood
sugar is above 10 you may notice that you feel tired and that
you have to go to the washroom to empty your bladder more than
you would normally. You will also notice that you are
thirstier than you were before. If your sugar is particularly
high you may find that you are losing weight. Those symptoms
are all due to high blood sugar. Once you control your blood
sugar, those symptoms will go away. Blurriness of the vision
is also associated with high blood sugar if your blood sugar
has been high for many weeks. Once you control your blood
sugar and keep it controlled for an equal number of weeks, say
6-8 weeks, the blurriness of your vision should once again be
resolved.
When the sugar levels are high in the blood that means, that
this sugar is not getting into the body cells and these body
cells are empty. They are starving and they are not getting
the energy they are supposed to have. That is why the
tiredness can happen because the energy is stuck in the blood
and is not getting into the body cells. Symptoms such as the
tiredness, the dry mouth, the thirstiness, the frequent
urination, these are the classic signs of high blood sugar.
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What
causes high blood glucose (hyperglycemia)?
High blood glucose can result when food, activity and
medication are not balanced. High blood glucose may also
happen when you are sick or under stress.
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What do I
do if I have high blood glucose?
Call or see your
doctor, you may need to:
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Symptoms of Low Blood
Sugar
You can also feel bad if your blood sugar is low. Since sugar
is the fuel for the brain, if the amount of sugar in the blood
is low, the brain will run out of gas and will stop. As it
slows down of course your powers of reasoning and thinking
will decrease. You may then become confused; you might pass
out, lose consciousness, have seizures and ultimately die. Low
blood sugar can be a big problem particularly when you are
taking medications that cause insulin release.
Low blood sugar is when your blood sugar drops down to less
than 4.0 mmols/L. That is considered to be too low. Low blood
sugar can happen if you have not eaten enough food or the food
might have come in a little bit late and you have planned to
have dinner at a certain time, got stuck in traffic and dinner
happens to be later than normal. It can happen because of too
much insulin being injected either on purpose or by mistake or
having had too much diabetes pills. It may happen by waking up
in the morning and taking diabetes pills and then having a
shower and then being unsure whether you took your pills or
not and then taking one again. So mistakenly taking your pills
twice. It can also happen from increased physical activity,
where you may plan on normally walking one or two miles a day
and then one day on the weekend you walk around Stanley Park
(seven miles) without making any compensation for food. Having
too much alcohol can also cause the blood sugar to drop down
too low.
Most people will have very clear symptoms or signs when their
blood sugar is dropping down too low and often those symptoms
start off as if you have gone too long without eating. When
you go too long without eating, what happens is that you get
really hungry and might start to feel a little bit weak like
all the energy is draining out of you. If people were to look
at you they will say why do you look so pale. In addition, you
might start to feel a bit shaky and often people will say, “I
feel the shakiness inside”. In addition, people might start to
feel sweaty, a different kind of sweat than if you are out
mowing a lawn on a hot summer day. Often people will say that
it is a “cold clammy sweat”. Some people will say that they
feel they’ve got numbness or a tingling around their lips and
tongue. As the blood sugar continues to drop the symptoms
start to get even stronger and the later signs are as if
people are awake but their mind is actually falling asleep.
People are not able to think as clearly as they normally
would, their speech becomes very slurred and if you ask them
to walk in a straight line or to do something that takes
tremendous co-ordination they would be unable to do that.
These are very clear signs and symptoms of low blood sugar. We
hope that people will recognize these symptoms very early and
treat them when they first come on. The best way to a treat
low blood sugar is by having simple carbohydrate and that
would be about 15 grams of carbohydrate. Examples of 15 grams
of carbohydrates could be taking glucose tablets the
equivalent to 3 glucose tablets would be a ¾ cup of
unsweetened orange juice or a ¾ cup of unsweetened apple juice
or about a half a can of pop. Not diet pop but regular pop and
maybe about 5 Life Savers would also be the equivalent to 3
glucose tablets. Once a person chews these tablets they start
to get absorbed in their mouth and start to raise the blood
sugar right away. We would ask people to wait 15 minutes after
having consumed these and then re-check the blood sugar level.
And if the blood sugar level is still less than 4 continue
with the same treatment and have another 3 glucose tablets. If
next meal or snack is more than 45 minutes later, the person
should also have a snack and that snack should be a protein
and a carbohydrate and that would be, as an example, half a
peanut butter sandwich or some crackers and cheese.
In addition, people should check their blood sugar counts
before they get into the car and drive. The Canadian Diabetes
Association recommends for everybody who has diabetes to check
their blood sugar levels before getting behind the wheel of a
vehicle and driving. The blood sugar count they recommend is
to have at least at 6.0 mmols/L. People can prevent low blood
sugar by doing a number of different things and one of these
is to try to take your diabetes medication as advised by your
physician and try to eat your meals and snacks on time and try
to be consistent with your portion sizes. You can try to plan
to exercise shortly after a meal or snack if that is possible.
If you are planning on doing additional exercise more than
what you normally would do you could eat extra to prevent that
low blood sugar. It is really a great idea to have some form
of simple carbohydrate on hand just in case of a low blood
sugar. In addition, have some form of identification on hand
such as a medical alert bracelet or a medical alert necklace
and some people should also carry some extra food with them,
particularly if they are traveling in airports. Having
something in their car is also very helpful in case of a low
blood sugar.
Low blood
glucose can happen quickly, so it is important to take care of
it right away.
Make sure you always wear your MedicAlert identification, and
talk to your doctor or diabetes educator about prevention and
emergency treatment for severe low blood glucose.
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Why should I test
blood sugar?
We now recommend that all people with diabetes should test
their blood sugar and it is absolutely essential people test
their blood sugar if they are taking insulin or even if they
are taking pills for their diabetes. A blood sugar test done
on a finger for example, takes maybe 20 seconds to do, is very
accurate and lets you know whether you are safe or are you in
trouble. Then we can determine what your own goals are.
How do I test blood
sugar?
Forearm Testing: We start the test on the soft fleshy part of
the arm that is clean and dry, away from the bone and away
from any visible veins or excess hair. Massage the test area
to stimulate blood to the skin surface. If necessary, set the
adjustable lancing device for a deeper puncture. Press and
hold the device to the site for a few seconds before pressing
the release button and continue to hold it there for a few
seconds or more. Allow enough time for an adequate blood drop
or as little as one microliter to develop. Gently touch the
top edge of the test strip to the drop of blood and capillary
action will draw a sample up the strip. In as little as five
seconds, today’s advanced meters will produce an accurate
result or inform you immediately if the sample is
insufficient. That is all there is to it.
How can I use the results?
It is important for you to realize that before a meal your
blood sugar should be between 4 and 7 mmols/L . Two hours
after a meal, your blood sugar should be between 5 and 10. If
you really are in good shape and want to be as close to normal
as possible, your blood sugars should be between 4 and 6
mmols/L before eating a meal and between 4 and 8 mmols/L, two
hours after eating a meal. It is obvious that after you eat
food the sugar will rise and there are some people who have a
particularly high rise in their blood sugar as a
characteristic with their diabetes and others are more
characterized by having a sugar that is high before they eat.
There is one particular group who measure their blood sugar at
bed time and they find that the value is 7. They do not eat
at that time or overnight and they get up in the next morning
and their blood sugar is 8 or 9 mmols/L. This is very
puzzling to a lot of people but it allows you to understand
“Oh, I’m one of those patients that has insulin resistance”.
It explains the fact that the liver makes sugar over night.
There are some people who have more insulin resistance at the
level of the liver and their liver does not shut down and it
just keeps making more and more sugar overnight even though it
is not needed. Such individuals will find that their blood
sugar is much higher in the morning than it was on going to
bed. That is insulin resistance at the liver level. It is a
very common finding and there are methods of treating that
such as taking medication or taking insulin at bedtime.
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Controlling blood sugar
In this century, we have the knowledge, the tools and the
treatments available to almost guarantee that most individuals
with diabetes can live a long, healthy and happy life free of
complications.
All the things that have to do with treating diabetes are
similar to health promotion, similar to things that people
should be doing even if they did not have diabetes. I have
met a number of people who prior to having diabetes got colds
and they felt terrible but since getting diabetes and
following a healthy diet and exercising, they do not get colds
anymore. They feel great, their weight is at a healthy weight
and they feel good about themselves. The upshot is the
prevention of the long-term complications that are associated
with uncontrolled diabetes.
To ensure that happening we need to make the blood sugar as
close to normal as possible. To keep the blood pressure as low
as possible, to control blood lipids and to treat any
complications that develop aggressively. Of course to do all
those things we are going to get you to buy into the lifestyle
modifications. We are going to talk about diet and exercise,
to follow the directions of your medical advisors and to take
medication when necessary.
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