Research Design And Methods
Four men and seven women diagnosed with type 2 diabetes who were not taking insulin completed the study. Participants provided a clinically determined A1C reading from a recent blood analysis. All participants gave written informed consent, and the study was approved by the institutional review board at Arizona State University.
Participants maintained 24-h diet records for 3 days and measured fasting glucose at 0700 h for 3 consecutive days with a calibrated glucometer before the start of the study. Participants were instructed to continue usual prescription medication use during the study. Utilizing a randomized crossover design with a 3- to 5-day washout period between treatments, participants followed a standardized meal plan for 2 days, consuming either 2 Tbsp apple cider vinegar or water at bedtime with 1 oz cheese . The standardized meal plan was designed to reflect the individual’s typical diet. Participants were instructed to record all foods and beverages ingested during each 2-day treatment period.
Fasting glucose was recorded with a calibrated glucometer by each participant during the trial: at baseline and day 2 at 0700 h. These results were downloaded by the research staff from each participant’s glucometer memory. A multivariate repeated-measures ANOVA test with body weight as a covariate was used to determine a significant time-by-treatment effect using SPSS .
Causes Of Low Blood Sugar
Low blood sugar is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications. The average person with type 1 diabetes may experience up to two episodes of mild low blood sugar each week, and thats only counting episodes with symptoms. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher.
How Is Hypoglycemia Diagnosed
The only way to know if you have hypoglycemia is to check your blood sugar with a blood glucose meter. Its a small machine that measures blood sugar. Most of these devices use a tiny prick of the finger to take a small amount of blood.
People with hypoglycemia unawareness may need a continuous glucose monitor. These wearable devices measure glucose every few minutes, day and night. An alarm sounds if blood sugar drops too low.
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What Extreme Conditions Can Occur If Hypoglycemia Is Left Untreated
Although severe episodes which can trigger potentially life-threatening comas are rare, they require immediate emergency room care, so its best to make sure you are tracking your blood sugar so that you never have to worry about getting to that point. A drop in blood sugar means less fuel for your brain, so its critical for your body to receive enough glucose. Hypoglycemia that leads to extended, reduced brain function is the biggest concern, as this can lead to seizures and loss of basic bodily functions controlled by the brain, which can ultimately lead to death, explains Dr. Dyer.
Caution: Birth Control Pills
Types that have estrogen can affect the way your body handles insulin. Still, oral contraceptives are safe for women with diabetes. The American Diabetes Association suggests a combination pill with norgestimate and synthetic estrogen. The group also says birth control shots and implants are safe for women with the condition, though they can affect your blood sugar levels.
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Increasing Blood Sugar When Fasting
Why does my blood sugar level increase from 86 to 112 mg/dl when I do a 20-hour fast? Is that normal? Im on an LCHF diet.
Thank you doctor,Alvaro
Answer:This is a normal process. When you fast, insulin levels start to drop and this triggers a surge of counter-regulatory hormones, including noradrenalin and growth hormone. This is normal, and meant to pull some of the stored sugar from the liver into the blood. If your liver is full of sugar, it may release lots of sugar into the blood, causing the blood sugar to rise.
So, yes, blood sugar may rise during fasting. The most important question to consider, though, is where this sugar came from. If you are not eating, the rise in blood sugar may only come from your own body. You are simply moving sugar from the liver to the blood. It means that there is too much sugar stored inside your body and you need to empty it out, either with LCHF diet or intermittent fasting
Dr. Jason Fung
Symptoms Of Low Blood Sugar
If your blood sugar levels drop too low, you may experience early symptoms including:
- Irregular or fast heartbeat
- Tingling or numbness of the lips, tongue, or cheek
If hypoglycemia isn’t treated, more severe symptoms may occur such as :
- Loss of consciousness
Barnathan says if hypoglycemia goes untreated for too long, it can lead to dangerous complications, including coma and even death.
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When To See A Doctor
According to the University of Michigan, blood sugar levels of 300 mg/dL or more can be dangerous. They recommend calling a doctor if you have two readings in a row of 300 or more.
See your doctor if you have consistently high blood sugar levels. Symptoms of this include:
- increased thirst
- high levels of sugar in urine
Ask your doctor how often to check your blood sugar and about your ideal blood sugar levels.
If you dont currently see a doctor who specializes in diabetes, known as an endocrinologist, you can find one by searching the American Association of Clinical Endocrinologists website.
You can find a certified diabetes educator by visiting the American Diabetes Associations website and searching by zip code.
Talk to your doctor if you have consistently high blood sugar readings or symptoms of chronic hyperglycemia.
Checking your blood sugar and then treating hyperglycemia early will help prevent any complications.
Health problems can arise when someone has high blood sugar regularly and without treatment.
Examples of complications include:
- nerve damage, called diabetic neuropathy, that may affect sensations in the feet and hands
- diabetic retinopathy, or damage to the blood vessels in the eyes that affects vision
- increased risks for kidney problems
- increased risks for heart problems
Taking steps to keep your blood sugar at target levels can help to minimize the likelihood that these complications will occur.
What Causes Low Blood Glucose In People With Diabetes
Low blood glucose levels can be a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. Taking these can lower your blood glucose level.
Two types of diabetes pills can cause low blood glucose
- sulfonylureas, usually taken once or twice per day, which increase insulin over several hours
- meglitinides, taken before meals to promote a short-term increase in insulin
The following may also lower your blood glucose level
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Surprising Things That Can Spike Your Blood Sugar
When you first found out you had diabetes, you tested your blood sugar often to understand how food, activity, stress, and illness could affect your blood sugar levels. By now, youve got it figured out for the most part. But thenbam! Something makes your blood sugar zoom up. You try to adjust it with food or activity or insulin, and it dips really low. Youre on a rollercoaster no one with diabetes wants to ride.
Do you know all of these blood sugar triggers?
Knowledge is power! Look out for these surprising triggers that can send your blood sugar soaring:
How To Treat A Low Blood Sugar Level Yourself
Follow these steps if your blood sugar level is less than 3.5mmol/L or you have hypo symptoms:
You do not usually need to get medical help once you’re feeling better if you only have a few hypos.
But tell your diabetes team if you keep having hypos or if you stop having symptoms when your blood sugar level is low.
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Treating Severely Low Blood Sugar
Blood sugar below 55 mg/dL is considered severely low. You wont be able to treat it using the 15-15 rule. You also may not be able to check your own blood sugar or treat it by yourself, depending on your symptoms. Make sure your family members, friends, and caregivers know your signs of low blood sugar so they can help treat it if needed.
Injectable glucagon is the best way to treat severely low blood sugar. A glucagon kit is available by prescription. Speak with your doctor to see if you should have a kit. Be sure to learn how and when to use it. Let family members and others close to you know where you keep the glucagon kit and make sure theyve been trained in how to use it too.
Its important to contact a doctor for emergency medical treatment immediately after receiving a glucagon injection. If a person faints due to severely low blood sugar, theyll usually wake up within 15 minutes after a glucagon injection. If they dont wake up within 15 minutes after the injection, they should receive one more dose. When the person is awake and able to swallow:
- Feed the person a fast-acting source of sugar .
- Then, have them eat a long-acting source of sugar .
Its also important that friends, family, co-workers, teachers, coaches, and other people you may be around often know how to test your blood sugar and treat severely low blood sugar before it happens.
If any of the following happens, your friend, relative, or helper should call 911:
What Causes A Low Blood Sugar Level
In people with diabetes, the main causes of a low blood sugar level are:
- the effects of medicine especially taking too much insulin, medicines called sulfonylureas , medicines called glinides , or some antiviral medicines to treat hepatitis C
- skipping or delaying a meal
- not eating enough carbohydrate foods in your last meal, such as bread, cereals, pasta, potatoes and fruit
- exercise, especially if it’s intense or unplanned
- drinking alcohol
Sometimes there’s no obvious reason why a low blood sugar level happens.
Very occasionally, it can happen in people who do not have diabetes.
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Blood Sugar Testing At Home
A person can test their blood sugar levels at home.
In most cases, doctors ask people to measure fasting blood sugar immediately upon waking and before they have anything to eat or drink. It may also be appropriate to test blood sugar before eating or 2 hours after a meal, which is when blood sugar returns to normal levels.
The right time to test depends on treatment goals and other factors. For example, most people with diabetes do not need to test between meals unless they are using a diabetes drug that can lower blood sugar. Other people may test between meals if they feel their sugar levels may be low.
Since people with type 1 diabetes do not make any insulin, they need to test their blood sugar levels several times a day so they can adjust their insulin doses.
A person will test blood sugar levels by:
- preparing the testing strip and glucose monitor to be ready for the blood sample
- using an alcohol swab to clean the testing area, which is usually the side of a fingertip
- lancing the testing area and bracing against a firm surface to help resist the impulse to pull away
- squeezing the testing area around the wound to maximize blood flow
- squeezing a drop of blood onto the test strip
- putting the strip into the monitor
- recording the time, blood sugar reading, and recent food intake in a log
Reflect On The Amount Of Sugar In Your Diet
Hyperglycemia occurs when there is too much glucose in the blood.
Therefore, one way of reducing your blood glucose levels is reflecting on where sugar may be consumed in the diet. Think about any refined and processed foods that may be in your diet as these are often high in sugar. This can be achieved through a low carbohydrate diet.
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Intermittent Fasting Reduces Blood Sugar
The benefits of intermittent fasting extend far beyond weight loss. Studies show it can reduce your risk for type 2 diabetes and heart disease because it improves the regulation of your blood sugar, increases your resistance to stress, and suppresses inflammation.
A case study published in the US National Library of Medicine showed patients with type 2 diabetes who participated in an intermittent fasting protocol lost weight and managed to stop insulin therapy. In studies where weight loss didnt occur, fasting still improved the glucose levels of participants.
This latter finding is significant because it confirms that a reduction in bloodstream glucose is not a secondary benefit of weight loss, but a direct result of intermittent fasting. This reduction in blood sugar could be due to the changes in signaling pathways and metabolic rhythm that fasting invokes, as well as an increase in ketones.
Improvements in blood sugar tend to be dependent on fasting. Your blood sugar will typically improve after 2-4 weeks of compliance with a fasting protocol, and it dissipates if you return to eating three meals or more per day.
You may be able to maintain your weight loss after you stop fasting, but long-term fasting is recommended if you need to continue to regulate your blood sugar.
Take A Pass On The Bread Bowl
Its obvious that sugary stuff leads to an increase in blood sugar, but starchy foods can do the same thing. Your body processes simple carbs quickly and turns them into sugar, and it needs a lot of insulin to absorb them. That means a bag of Doritos is as likely as a candy bar to cause a spike.
If youre in the middle of a blood sugar spike, its best to curtail your carb intake. Check the glycemic index if youre not sure about a food.
Surprisingly, popcorn and white potatoes are worse than ice cream, according to the index. If you stick to low-carb/low-glycemic-index foods, your blood sugar will return to normal much more quickly.
Ultimately, its best to limit your carb intake. A 2004 study found that a diet of 20 percent carbs, 30 percent protein, and 50 percent fat lowered fasting blood sugar and kept blood sugar from spiking after meals.
This was a very small study, but the results suggest that lower carb intake can lead to generally lower blood glucose. In general, most people with diabetes eat 40 to 45 percent of their calories in the form of carbohydrates. Choosing nutrient-rich sources of carbs is best.
Another promising study found that after two years on a low-carb diet, many participants with type 2 diabetes were able to manage their condition without medication or resolve it entirely.
The occasional baked potato isnt a problem, but frequent trips to the drive-through are not a good idea. Find a few veggie-and-protein-heavy meals and make them your go-tos.
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What Complications Can Be Caused By Hypoglycemia
Passing out from low blood sugar because you have not recognized the early signs and symptoms is called hypoglycemia unawareness, and can be quite dangerous depending on where you are, explains Dr. Klonoff. As doctors are required to report such incidents to the Department of Motor Vehicles, it can also mean a suspended drivers license.
If this is something youre worried about, Wearing a continuous glucose monitor with an alarm for hypoglycemia can alert a person who is prone to developing low blood sugar levels that their blood glucose concentration is becoming dangerously low, so appropriate preventive action can be taken before they lose consciousness, explains Dr. Klonoff.
Strike The Spike Ii: How To Manage High Blood Glucose After Meals
Dealing With High Blood Sugar After Meals
Several years ago, I wrote an article for Diabetes Self-Management about the management of high blood glucose after meals. It was called Strike the Spike and no article Ive ever written has led to greater reader response. To this day, I still receive calls and e-mails thanking me for offering practical answers to this perplexing challenge. Ive even been asked to speak on the topic at some major conferences. So when presented with the opportunity to readdress the issue, I jumped at the chance.
A lot has changed in recent years: we know more than ever about the harmful effects of after-meal blood sugar spikes, but we also have a number of potent new tools and techniques for preventing them. And now that I know how meaningful this topic is to so many people, Ill do my absolute best to provide some answers.
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