Ultimate Bloodsugar levels:what’s normal and how 2 measure them
Blood sugar levels: what’s normal, what’s not and how to measure them
We all want to keep track of our health in every way we can — you may weigh yourselfdaily, measure your waist-to-hip ratio, keep track of your blood pressure or monitor your resting heart rate. But how close of an eye do you keep on your blood sugar?
People with diabetes are all too familiar with their blood sugar levels, but the rest of us might not even think about them. However, consistently high blood sugar levels can coexist with Type 2 diabetes and cause serious health conditions like kidney disease, nerve problems or stroke.
If you checked your blood sugar level two hours after lunch, and it clocked in at 287 mg/dl, what could you tell me about the effect of your lunch on your glucose level?
You don’t know anything about the effect of the meal because you don’t know what your blood glucose level was before the meal. Sure, most people would agree that 287 mg/dl is above target for an after-meal glucose reading, but this single number by itself is highly uninformative. It has no context. If your glucose reading had been 114 mg/dl before the meal, then of course you would know that either your choice of foods or your mealtime diabetes treatment is in serious need of adjustment.
But what if you were at 250 mg/dl before lunch? In that case, your blood glucose level rose by only 37 “points.” There was nothing wrong with the meal. Sure, there’s a problem that needs to be fixed, but it has nothing to do with lunch.
How often should you check Your Bloodsugar ?
How many pairs of blood glucose checks you deploy in a day likely has more to do with your health insurance coverage than with your specific health situation – and it may be fewer than you ideally “should” do. Insurance plans are notoriously stingy when it comes to covering blood glucose test strips, a position that is based on a wrong interpretation of medical guidelines.
For a number of years, the standards of care for diabetes from the American Diabetes Association (ADA), which are the guidelines under which most people in the United States receive treatment (other specialty medical associations, such as the American Association of Clinical Endocrinologists [AACE], offer competing guidelines), stated that people taking only oral drugs should monitor at least once a day, and that those taking insulin should monitor at least three times a day. Somehow, both the Centers for Medicare and Medicaid Services (CMS), and then commercial health insurance plans, latched onto this guideline while ignoring the “at least” part of each sentence. So for many years, the default number of strips covered by insurance was a woefully sparse one or three per day, depending on a person’s type of therapy.
In January 2013, however, the ADA strongly clarified its intent, saying that anyone who uses an insulin pump or takes multiple daily insulin injections “should do SMBG [self-monitoring of blood glucose] at least prior to meals and snacks, occasionally postprandially [after meals], at bedtime, prior to exercise, when they suspect low blood sugar, after treating low blood sugar until they are normoglycemic, and prior to critical tasks such as driving.” The ADA went on to spell out what this means in terms of coverage: “For many patients, this will require testing 6—8 times daily, although individual needs may be greater.” It will take some time, unfortunately, for these new guidelines to take hold among insurance companies.
On the subject of people with Type 2 diabetes who take only oral drugs, the ADA declined to recommend a set number of sugar checks in its new guidelines, saying instead: “The frequency and timing of SMBG should be dictated by the particular needs and goals of the patient.” Later, in the fall of 2013, the AACE muddied the waters further by questioning whether people with Type 2 diabetes on some oral drugs need to be monitoring at all. I think we need to take a quick detour on this topic.
I think all people with diabetes should monitor their blood glucose levels, and I have seen clinically that monitoring can benefit anyone with diabetes. That said, the research on whether monitoring benefits certain people – particularly those with Type 2 diabetes who don’t take insulin – is conflicting.
Why is that?
Well, I can see how monitoring might do little good if a person were simply handed a meter with minimal instructions regarding how, when, where, and why to use it. On the other hand, a person empowered by knowledge who has the right tools is a well-equipped warrior, because diabetes is at least 50% a social disease. How you eat, move, and act has a large impact on your blood sugar levels, and monitoring is a tool that tells you how and when you should be doing these things.
If those of us with diabetes were to rely on the quarterly HbA1c test (a measure of blood glucose control over two to three months) instead of self-monitoring to evaluate our blood glucose control, we would risk kidding ourselves about the quality of our blood glucose control. Not all HbA1c results are created equal, even if they appear to be exactly the same, since the test is a reflection of average blood glucose level. So, for example, you can get an average of 150 from a set of numbers that ranges from 125 to 175, but you can get the same average from a set that ranges from 75 to 225. Given what we are learning about the relationship between glucose variability and diabetes complications, it’s clear that it’s important to not only maintain a certain average blood glucose level, but also to keep the range of numbers as small and as stable as possible. Without the real-time feedback of a meter to inform you of the relationship between your actions and your glucose readings, true diabetes control is impossible
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