Preventing Low Blood Sugar
Preventing low blood sugar is better than having to treat it. Always have a source of fast-acting sugar with you.
- When you exercise, check your blood sugar levels. Make sure you have snacks with you.
- Talk to your provider about reducing insulin doses on days that you exercise.
- Ask your provider if you need a bedtime snack to prevent low blood sugar overnight. Protein snacks may be best.
DO NOT drink alcohol without eating food. Women should limit alcohol to 1 drink a day and men should limit alcohol to 2 drinks a day. Family and friends should know how to help. They should know:
- The symptoms of low blood sugar and how to tell if you have them.
- How much and what kind of food they should give you.
- When to call for emergency help.
- How to inject glucagon, a hormone that increases your blood sugar. Your provider will tell you when to use this medicine.
If you have diabetes, always wear a medical alert bracelet or necklace. This helps emergency medical workers know you have diabetes.
How To Lower Your A1c
Now that you have a thorough understanding of A1c and time-in-range, as well as why looking at your A1c in isolation isnt optimal, the obvious question is:
How do you lower your A1c while improving or sustaining your time-in-range?
I will cover the four most important things you can do below but its always recommended that you start by having a conversation with your medical team before making changes to your diabetes management.
Treating & Managing Diabetic Ketoacidosis
Theres no arguing that DKA is absolutely life-threatening, and should be treated with great concern and immediate action.
First, test your blood sugar. Call your doctor, and take an appropriate dose of insulin to help bring your blood sugar levels and ketones down. You may find that when you have moderate to large ketones, normal doses of insulin wont have any impact on your blood sugar. Talk to your doctor about increasing your insulin dose to make an impact on your blood sugar and ketone levels.
Secondly, drink some water. Ketones are flushed out through your urine. To help your body do this, drink more water . However, be careful, you can drink so much water in an effort to flush out the ketones that you can induce vomiting by putting too much pressure on your digestive system.
Thirdly, if you begin to vomit for any reason visit your local urgent care or emergency room immediately. When a person with type 1 diabetes begins vomiting from ketones, it means your ketosis has surpassed a level that can be treated and managed at home. By visiting a clinic or hospital, you can get your body rehydrated and blood sugars regulated through intravenous fluid and insulin.
Left untreated, DKA can and likely will be fatal. It should be addressed with great concern and prevented as much as possible.
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Signs You May Have Hypoglycemia
Many people – even those without diabetes – exhibit signs of low blood sugar. Read on for 5 subtle signs of hypoglycemia. Feeling suddenly weak or shaky is one of the better known signs of low blood sugar, but that doesnt mean its always easy to notice. Weakness, particularly in the arms or legs, or a feeling of being jittery or trembling could also mean its time to eat. Physical symptoms arent the only signs of low blood sugar emotional instability can also occur. In fact, if you suspect you have fluctuating blood sugar, your symptoms might include things such as feeling suddenly overwhelmed, frustrated, angry, irritated, or like you could burst into tears. Find yourself breaking into a cold sweat for no reason? Low blood sugar may be to blame. The stress on your body means that it has to work harder, and a cold sweat is a classic sign that your body is having to work too hard to function. Other symptoms might be a rapid or irregular heartbeat, or even blurred vision. Hypoglycemia can bring on feelings of nausea or extreme hunger. Traditionally, eating sugar helps raise blood sugar levels, but try to eat a balanced snack or meal soon afterward, to avoid a repeat sugar crash. When blood sugar is low, it can make you a little spacey. You may find yourself rambling, or others may have a tough time following your conversation. But slurred speech or confusion are more serious signs of dangerously low blood sugar, and should not be taken lightly.Continue reading > >
Who Is Most At Risk For Developing Diabetes
The following categories of people are considered “high-risk” candidates for developing diabetes:
- Individuals who are overweight or obese
- Individuals who are 45 years of age or older
- Individuals with first-degree relatives with diabetes
- Individuals who are African-American, Alaska Native, American Indian, Asia American, Hispanic/Latino, Native Hawaiian, Pacific Islanders,
- Women who developed diabetes while they were pregnant or gave birth to large babies
- Individuals with high blood pressure
- Individuals with high-density lipoprotein below 25 mg/dl or triglyceride levels at or above 250 mg/dl
- Individuals who have impaired fasting glucose or impaired glucose tolerance
- Individuals who are physically inactive engaging in exercise less than three times a week
- Individuals who have polycystic ovary syndrome, also called PCOS
- Individuals who have acanthosis nigricans — dark, thick and velvety skin around your neck or armpits
In addition to testing the above individuals at high risk, the American Diabetes Association also recommends screening all individuals age 45 and older.
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How To Test Your A1c
Your doctor or endocrinologist should test your A1c regularly . The doctor simply pricks your finger and takes a tiny blood sample. If the doctors office has an A1c kit, you should get your result before your consultation is over.
You can also buy home A1c kits and do the test yourself. Home A1c kits can be useful if you go for more than three months between doctor visits and want to keep an eye on how your A1c is developing yourself.
The home kits are generally accurate within plus/minus 0.5 percentage points, which is more than good enough to give you a trustworthy result. The downside of the home kits is that they require a larger amount of blood than a regular blood sugar test, and if you dont apply enough blood, youll get an error message and will have lost a test strip.
You can find and in some pharmacies.
Hyperglycemia And Hypoglycemia In Type 2 Diabetes
If someone has diabetes that isnt treated properly, they have too much sugar in their blood . Too little sugar in the bloodstream is usually a side effect of treatment with blood-sugar-lowering medication.
Diabetes is a metabolic disease in which there’s a problem with insulin . It can affect your health in many ways. In type 2 diabetes, not enough insulin is released into the bloodstream, or the insulin cant be used properly. In type 1 diabetes, the body only produces very little insulin, or none at all.
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How To Lower Your A1c: The Complete Guide
We are always told that having a low A1c is an important goal in our diabetes management, but do you know why? Do you know what a good A1c target is, how to lower your A1c, and how quickly you can lower your A1c safely?
These are the questions I will answer in this comprehensive guide on what A1c is, how to lower your A1c, and why achieving a low A1c isnt the only goal when it comes to diabetes management.
Normal Vs Optimal Blood Sugar Ranges
Ive written extensively about the difference between normal and optimal blood markers here, and the same applies to your blood sugar ranges.
From the perspective of conventional medicine, a fasting blood sugar level of 100-125 mg/dL indicates prediabetes.
Two consecutive fasting glucose levels of 126 mg/dL indicates diabetes, as well as a random glucose reading of 200 mg/dL , and a 2-hour post-meal reading of 200 mg/dL .
But much of the data in conventional medicine comes from populations who are not enjoying optimal health.
So what does a healthy daily glucose response look like from the perspective of preventative medicine?
On waking: Research indicates that your optimal glucose after waking in the morning should be between 82-88 mg/dL . This level is associated with optimal aging, the lowest risk of chronic disease, and the lowest mortality risk.
After meals: Blood sugar peaks between 1 and 2 hours after the meal and should be back down to fasting levels by 3 hours post-meal. From the perspective of optimal health, you should avoid regularly eating foods that raise your blood sugar over 100 mg/dl .
One strategy to test the impact of your diet on your long-term health is to measure your blood sugar before and after meals.
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When Normal Blood Sugar Isnt Normal
In the last article I explained the three primary markers we use to track blood sugar: fasting blood glucose , oral glucose tolerance test and hemoglobin A1c . We also looked at what the medical establishment considers as normal for these markers. The table below summarizes those values. In this article, were going to look at just how normal those normal levels areaccording to the scientific literature. Well also consider which of these three markers is most important in preventing diabetes and cardiovascular disease.
|OGGT / post-meal||< 140|
But before we do that, Id like to make an important point: context is everything.
In my work with patients, I never use any single marker alone to determine whether someone has a blood sugar issue. I run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid and triglycerides , and I also have them do post-meal testing at home over a period of 3 days with a range of foods.
If they have a few post-meal spikes and all other markers or normal, Im not concerned. If their fasting BG, A1c and fructosamine are all elevated, and theyre having spikes, then Im concerned and I will investigate further.
On a similar note, Ive written that A1c is not a reliable marker for individuals because of context: there are many non-blood sugar-related conditions that can make A1c appear high or low. So if someone is normal on all of the other blood sugar markers, but has high A1c, Im usually not concerned.
How To Measure Blood Sugar Levels
There are two main ways to check your blood sugar levels:
Type 1 diabetics, along with some type 2 diabetics, who require insulin medication, must check their blood sugar at least four times per day, says Mathioudakis. Typically, this should be done before a meal, one to two hours after a meal, and at bedtime.
The timing of these measurements can help determine how much insulin to use. For example, it can be important to use more insulin after a high-sugar meal, or to avoid falling into hypoglycemia while you’re sleeping.
To check your blood sugar at home, you should use blood glucose tests, such as a glucose meter or continuous glucose monitor . Both devices measure blood sugar with the unit mg/dL, which means a milligram of sugar per deciliter of blood.
If you don’t have diabetes, but you may be at risk, your doctor might have you take an A1C test during a yearly check-up. This test reports results as a percentage the higher the percentage, the higher your blood sugar has been in the past three months. Those with diabetes should get an A1C test at least twice a year and sometimes every three months.
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Symptoms Of High Blood Sugar :
- Feeling fatigued and sleepy, especially after meals
- Poor brain function and focus
- Increased thirst
- Dry mouth
- Weight fluctuations
But what does it mean if you eat something clearly unhealthy, like a candy bar or burger, and your blood sugar does not elevate over the 120 mg/dL mark?
This means your body is adapting to the rise in blood sugar very well!
This is a good thing. You have a very healthy body. However, if you continue to eat processed foods high in starch and sugars, over time your body will slowly lose this ability to adapt. This is not a good practice.
Want to know some foods that commonly convert quickly to sugar and cause a rapid high spike in blood sugar?
- White foods: white rice, white potato, all forms of sugar
- Refined grains: bread, pasta, crackers, baked goods, cereals, chips
- Candy and sweets
- Soda, juice, sweetened drinks
Consumption of processed sugar increases your risk for many chronic diseases including obesity, cardiovascular disease, diabetes, and non-alcoholic fatty liver disease .
If your blood sugar is too high, or if youre simply experiencing some of the symptoms of high blood sugar after eating, the best thing you can do is to exercise. Exercise clears sugar from the blood so that it can be used as a fuel source for your muscles.
If your test results are consistently outside the healthy range, heres what you do:
Need a blood test to check your blood sugar related biomarkers? if you are in the US, to order your own blood test.
Why You Shouldnt Lower Your A1c Too Quickly
It can be a good idea to approach lowering your A1c with a bit of caution. Just as crash dieting isnt healthy, there can be some serious health risks associated with lowering your A1c too quickly. I turned to Dr. Peters for an explanation:
If you lower your A1c too quickly, many bad things can happen. First, weight gain and total body swelling. Next, it can cause bleeding in the retina which can lead to blindness, and third, it can cause painful neuropathy that never goes away. Its slightly different for newly diagnosed patients, but, in general, no one should try to go from an A1c of 10% to 6% quickly. Take slow steps. Wanting to get to a low number very fast only causes harm. Diabetes is a long-term disease, so slow steps to establish new habits that can last a lifetime is the way to go. Anything too sudden and the body reacts badly.
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How Can Continuous Glucose Monitoring Help You Maintain Optimal Glucose Levels
It is not uncommon for your glucose levels to increase after a meal: you just ate food that may contain glucose, and now your body is working on getting it out of the bloodstream and into the cells. We know that we want to prevent excessive spiking of glucose levels because studies show that high post-meal glucose spikes over 160 mg/dl are associated with higher cancer rates. Spikes are also associated with heart disease. Repeated high glucose spikes after meals contribute to inflammation, blood vessel damage, increased risk of diabetes, and weight gain. Additionally, the data shows that the big spikes and dips in glucose are more damaging to tissues than elevated but stable glucose levels. Therefore, you should strive to keep your glucose levels as steady as possible, at a low and healthy baseline level, with minimal variability after meals.
Keeping your glucose levels constant is more complicated than just following a list of eat this, avoid that foods. Each person has an individual response to food when it comes to their glucose levels studies have shown that two people can have different changes in their glucose levels after eating identical foods. The difference can be quite dramatic. One study found that some people had equal and opposite post-meal glucose spikes in response to the same food.
Common Causes Of Sudden Mild Or Severe Dka
- A failure in your insulin pump site or pod
- A drastic mismatch of insulin versus food
- Forgetting to take your insulin
- Using insulin accidentally damaged by cold or hot temperatures
- Purposefully consuming a large quantity of food without taking insulin
- Severe illness like a stomach virus or flu
- Certain medications with a risk of inducing DKA, like Invokana
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A1c Goals Should Be Individualized
A1c goals should be individualized based on the individual capabilities, risks, and prior experiences, explains Gary Scheiner, MS, CDE, founder of Integrated Diabetes, and author of Think Like a Pancreas.
For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly.
However, Scheiner highlights important factors that could justify aiming for a higher A1c, like hypoglycemia unawareness, which is described as when a person with diabetes no longer feels the oncoming warning signs of low blood sugar. This can put you at significant risk for severe low blood sugars resulting seizures or death. To reduce that risk, you would aim for higher target blood sugar ranges.
Someone with significant hypoglycemia unawareness and a history of severe lows should target higher blood glucose levels than someone who can detect and manage their lows more effectively, adds Scheiner. And certainly, someone who has been running A1cs in double digits for quite some time should not be targeting an A1c of 6% better to set modest, realistic, achievable goals.
Learn how to lower your A1c in DiabetesStrongsA1C Guide.