A Closer Look About Diabetes

Glucose levels in the blood and diabetes 

You could be curious (or at some point, wondering) what your blood sugar level (sugar) should be when you have diabetes. I hope you’ve received answers to that question from your doctor, nurse, doctor’s assistant, or someone that diagnosed you. Unfortunately, though, glucose targets are not given to everyone. Or it may have been a long while ago, in some cases, and they’ve been forgotten ever since. No worries, we’re going to get through this! 


What is blood glucose? 

Blood glucose, or sugar, is sugar (easy enough!) that is in your blood. It comes from the food you consume, including carbohydrates, such as bread, pasta, and fruit, being the major contributors to blood glucose. For energy, the cells in our bodies require glucose, and we all need the strength to move, think, learn, and breathe. Around half of all the energy from glucose in the body is used by the brain, the command center. 


When stuff is going wrong 

When we consume food, the pancreas (an organ that lies between the stomach and the spine) goes to work, releasing enzymes that help break down food and hormones that assist the body in regulating the inflow of glucose. One of these is insulin, and it plays a crucial function in regulating blood glucose levels.

And here’s where stuff can go wrong. If the pancreas does not secrete the right amount of insulin or stops producing it altogether, blood glucose levels can rise too high in type 1 diabetes. Another scenario is that the pancreas produces enough insulin, but the cells have trouble properly using it, causing a rise in blood sugar levels. This is known as insulin resistance and is the mark of diabetes type 2. 

High blood glucose levels in the short term can make you feel downright wrong. All of the symptoms of high blood glucose (hyperglycemia) are thirst, frequent trips to the bathroom, fatigue, and weight loss. More severe problems can occur if not treated, such as diabetic ketoacidosis. Chronic high blood glucose levels and nerve damage can lead to heart, kidney, and eye disease complications. So it’s all about glucose in the blood. 


How do you know what your level of blood glucose is? 

If your blood sugar level is reasonably high or low, for the most part, you can’t tell what it is. Most individuals with type 2 diabetes don’t have the usual signs of high blood glucose, and it’s not unusual for people to go undiagnosed for years for this reason. You do not even always have high or low blood glucose symptoms.

The best way to understand your blood glucose level is to use a glucose meter to check it. This means making a lancet finger stick and getting a drop of blood on a test strip, then inserting the strip for reading into the meter. Your doctor can give you a meter free of charge, but you will probably need to pay for test strips and lancets. But check with your health plan, as one or two “preferred” meters that they want you to use are likely. 

Using a continuous glucose monitor, or CGM, that reads glucose in the interstitial fluid (the fluid between cells) about every 5 minutes is another way to know what your glucose levels are up to. 


What do the numbers mean, now that you’re checking your blood glucose? 

Your doctor can encourage you to check once a week or once a day or as often as needed, depending on your course of care for diabetes (hint: if they don’t tell you, ask!). But what does it say when you see your meter at 67, 101, or 350? And anyway, what is ‘natural’ blood sugar? Breathtaking questions! After all, it’s hard to know how you are doing if you don’t know what the numbers say on your meter.

(Here’s where the word “normal” comes in as per the Merriam-Webster dictionary, one meaning of ordinary is “conforming to a style, standard, or regular pattern.” It’s a concept not taken kindly by anyone because if you’re not “normal,” you may be considered odd, which means “unusual in an unwanted or troublesome way.”

The American Diabetes Association (ADA) provides recommendations for blood glucose targets for people with diabetes, and the goals differ depending on when you monitor your glucose:

Fasting and before meals (before eating the first meal of the day): 80-130 mg/dl (4.4-7.2 mmol/L) 

Postprandial (one to two hours following a meal): less than 10.0 mmol/L (180 mg/dl) 

These guidelines are for non-pregnant adults suffering from type 1 or type 2 diabetes. There may be different objectives for children, teenagers, and pregnant women. 

However, your blood glucose goals may be different. If you’re young and have had diabetes for a shorter period or don’t take any diabetes medicine, your glucose targets maybe a little “tighter” or lower. Similarly, if you’re older, have diabetes complications, or don’t get symptoms when your blood glucose is low, your blood glucose goals may be greater than what ADA recommends. 

Bottom line: Discuss this with your health-care provider about the following: a.) When to have your blood glucose checked. b.) How often to check the glucose in your blood and c.) What your blood glucose targets are (don’t forget to also ask about your A1C target).


Know the numbers

Consider keeping a log of the levels of your glucose. You can use a good old-fashioned pencil and paper, a spreadsheet, a logbook, or a smartphone app to track your levels. Your measurement will capture up to a certain number of sugar values and let you download them to a computer for your viewing pleasure. 

It’s essential to look at all of your glucose values. You can spot patterns (for example, your fasting blood sugar levels are frequently above goal or you seem to go low every afternoon around 4 pm). To learn how your diabetes treatment plan works for you, your numbers are information for both you and your health care team. Bring all of your regular provider visits with your logs or at least your meter and ensure that your provider looks at your numbers. 

Remember: Ask your provider or diabetes educator what you can do to tweak your diabetes treatment plan if your blood glucose levels are not targeted. Not every blood sugar test needs to be at the target, but the closer you keep it within the target range, the lower  likelihood of complications. The more frequently you monitor your sugar in the blood, the more information you have (literally) at your fingertips to do a course correction.

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