Specific Advice For Older Adults
Many older adults with diabetes who are otherwise healthy and independent can try to achieve the same SMBG targets as their younger counterparts.
However, in some people, aiming for these near-normal blood sugars may increase the risk of hypoglycemia, or low blood sugar a side effect of insulin or certain diabetes pills which can increase the risk of falls, confusion or accidents.
To avoid hypoglycemia, ADA recommends that physicians individualize and relax blood sugar targets in older adults who have multiple chronic illnesses, cognitive impairment or those who rely on others for daily care.
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How To Do A Finger
Your healthcare team will show you how to do it the first time, but these are the key steps:
- Wash your hands with soap and warm water. Dont use wet wipes as the glycerine in them can affect the test result. Make sure your hands are warm so its easier to get blood and wont hurt as much.
- Take a test strip and slot it into the meter to turn it on. Some meters will have tests strips built in.
- Remove the cap from your finger prick device and put in a new lancet. Then put the cap back on and set the device by pulling or clicking the plunger.
- Choose which finger to prick but avoid your thumb or index finger . And dont prick the middle, or too close to a nail. Place the device against the side of your finger and press the plunger. Use a different finger each time and a different area.
- Take your meter with the test strip and hold it against the drop of blood. Itll tell you if the test strip is filled, usually by beeping.
- Before you look at your reading, check your finger. Use a tissue to stop bleeding, then use it to take out the lancet and throw it away in your sharps bin.
- You can use the same tissue to take out the test strip and throw that away too. Taking out the strip will usually turn the meter off.
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When Things Go Awry
When we eat food, the pancreas goes to work, releasing enzymes that help to break down food and hormones that help the body handle the influx of glucose. One of these hormones is insulin, and it plays a key role in managing glucose levels in the blood.
And here is where things can go wrong. If the pancreas doesnt make enough insulin or stops making it altogether, in the case of type 1 diabetes glucose levels in the blood can rise too high. Another scenario is that the pancreas makes enough insulin but the cells have trouble using it properly, causing blood glucose levels to rise. This is called insulin resistance and is the hallmark of type 2 diabetes.
In the short term, high blood glucose levels can make you feel downright bad. Thirst, frequent trips to the bathroom, fatigue and weight loss are all symptoms of high blood glucose . If not treated, more serious issues can occur, such as diabetic ketoacidosis. Chronic high blood glucose levels can lead to complications such as heart, kidney and eye disease, as well as nerve damage. So, its all about the blood glucose.
How Do You Know What Your Blood Glucose Level Is
For the most part, you cant feel what your blood glucose level is unless its fairly high or its low. You may not even always have symptoms of either high or low blood glucose in fact, many people with type 2 diabetes dont have the usual symptoms of high blood glucose, and for this reason, its not uncommon for people to go undiagnosed for many years.
The best way to know your blood glucose level is to check it with a glucose meter. This means doing a fingerstick with a lancet and getting a drop of blood onto a test strip, then inserting the strip into the meter for a reading. Your doctor may be able to give you a meter free of charge, but youll likely need to pay for test strips and lancets. But check with your health plan, as there are likely one or two preferred meters that they want you to use.
Another way to know what your glucose levels are up to is to use a continuous glucose monitor, or CGM, which reads glucose in the interstitial fluid about every 5 minutes. Continuous glucose monitoring is expensive and may or may not be covered by your health plan.
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Low Blood Sugar: What To Watch Out For
Hypoglycemia can occur in people with diabetes who:
- Take too much medication or insulin
- Are late eating a meal or snack
- Have increased physical activity
- Drink too much alcohol
Symptoms of low blood sugar include feeling weak, sweaty or clammy, confused, hungry and/or irritable. Sometimes people experience a fast heartbeat and some symptoms may make a person appear to be drunk. A severely low blood sugar can result in unconsciousness, seizures, coma or death especially when a low occurs during the night.
Low blood sugar affects many parts of the body, but the most frustrating part can be that hypoglycemia can happen anytime and anywhere even when you think you are closely following the plan for your diabetes care. If low blood sugar is severe, people may need to go to the hospital to help raise their glucose level or miss work due to the side effects.
It can happen during a date, during a business meeting, or even while driving, which is the most dangerous scenario if there is confusion or loss of consciousness while behind the wheel. Its important to use your blood glucose meter to check your blood sugar before you drive to keep yourself and others safe. Frequent testing with your blood sugar meter and taking action when blood sugar is trending low can prevent a severe low and keep your life on track.
Fasting Glucose Goal: 72
Why? Previously we discussed that the ADA considers normal fasting glucose as anything < 100 mg/dl. However, multiple research studies show that as fasting glucose increases, there is an increased risk of health problems like diabetes and heart disease even if it stays within the normal range. The highlights of some of the study results include:
- Men whose fasting blood glucose was greater than 85 mg/dl had a significantly higher mortality rate from cardiovascular diseases than men with blood sugars less than 85 mg/dl.
- People with fasting glucose levels in the high normal range had significantly increased cardiovascular disease risk than people whose levels remained below 80 mg/dl.
- Children with fasting glucose levels 86-99 mg/dl had more than double the risk of developing prediabetes and type 2 diabetes as adults when compared with children whose levels were less than 86 mg/dl.
- People with fasting glucose levels between 91-99 mg/dl had a 3-fold increase in type 2 diabetes risk compared to those with levels less than 83 mg/dl.
- Among young, healthy men, higher fasting plasma glucose levels within the normal range constitute an independent risk factor for type 2 diabetes. This means that as fasting glucose increases, even if the level is still considered normal, it could indicate a significantly higher risk of developing diabetes, and this is particularly pronounced if BMI is greater than 30. .
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Why Your Blood Sugar Level May Be Low
If blood sugar drops below 70 mg/dL, it is below normal levels. This can be caused by a variety of factors, such as:
- Not eating enough or missing a meal or snack
- Reducing the amount of carbohydrates you normally eat
- Alcohol consumption especially if youre drinking on an empty stomach
- Taking too much insulin or oral diabetes medication based on carbohydrates or activity levels
- Increased physical activity
- Side effects from medications
If you have diabetes, keep your blood glucose meter and sources of fast-acting glucose close by in case your blood sugar drops. This is especially important for people with hypoglycemia unawareness, which is a condition that causes symptoms of low blood sugar to go unnoticed.
Eating balanced meals and snacks at regular times throughout the day is a big part of maintaining normal blood glucose levels. Check out our article on meal planning for diabetes to better understand the three macronutrients where calories come from and which have the biggest effect on blood sugar.
Everyone will respond differently to certain factors, which is why its important to have individualized target glucose levels. To help you reach your target blood glucose goals, work with your healthcare provider to discuss modifications to your diet, physical activity, or medications, and alert them of other factors like a recent illness or stressful event.
What Are Blood Sugar Levels
Your blood sugar levels, also known as blood glucose levels, are a measurement that show how much glucose you have in your blood. Glucose is a sugar that you get from food and drink. Your blood sugar levels go up and down throughout the day and for people living with diabetes these changes are larger and happen more often than in people who don’t have diabetes.
You can check your sugar levels yourself by doing a finger-prick test, by using a flash glucose monitor or with a continuous glucose monitor . You can do this a number of times a day helping you keep an eye on your levels as you go about your life and help you work out what to eat and how much medication to take. Find out your ideal target range.
But not everyone with diabetes needs to check their levels like this. Youll need to if you take certain diabetes medication. Always talk to your healthcare team if youre not sure whether thats you theyll give you advice on whether to check them yourself and how often.
And theres also something called an HbA1c, which measures your average blood sugar level from the previous few months. Everyone with diabetes is entitled to this check.
High blood sugar levels increase your risk of developing serious complications. However you manage your diabetes, stay in the know about your blood sugar levels.
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How To Control Blood Sugar Surges
If your blood sugar reaches very high levels at any time, you will need to adjust your food intake or insulin dose. Blood sugar levels rise in the blood after breakdown of carbohydrates in the food we consume.
The Glycaemic Index is a measure of the effect that a carbohydrate containing food has on blood sugar levels, compared to the effect of the same amount of pure sugar, on blood sugar levels. Foods with a low GI means that they cause a slower and lower rise in blood sugar levels. These include types of bread such as mixed-grain and fruit and oat breads, barley, pasta, noodles, beans, sweet potatoes, green peas and milk. Foods with a high GI means that they cause a faster and higher rise in blood sugar levels. High GI foods include white bread, brown rice, jasmine rice, French fries and coffee.
Limiting your intake of high GI foods will help bring down the average GI of your meal and prevent marked surges in blood sugar. If you are a diabetic, high blood sugar levels may need to be controlled by increased amounts of insulin, if you are already on insulin treatment. If you are only taking tablets to control the blood sugar levels, this may need to be reviewed, to optimize treatment of your diabetes. In any case, high sugar levels can make you feel unwell, with symptoms as described above and you should consult your doctor if this arises.
Times To Check More Often
There will be times when you need to check more often, however you should first discuss this with your doctor or Credentialled Diabetes Educator. Example of these times include when you are:
- Being more physically active or less physically active
- Sick or stressed
- Experiencing changes in routine or eating habits, e.g. travelling
- Changing or adjusting your insulin or medication
- Experiencing symptoms of hypoglycaemia
- Experiencing night sweats or morning headaches
- A female planning pregnancy or are pregnant.
- Pre/post minor surgical day procedures
- Post dental procedures
Your Credentialled Diabetes Educator can help you work out self-monitoring approach especially for you.
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The Nuances Of Low Glucose
In a recent study, researchers reviewed the published literature to see if low fasting glucose levels affected healthy peoples long term risks of health problems, like strokes and heart attacks. They found that healthy non-diabetic people who had baseline fasting glucose levels of less than 72 mg/dl had a 56% increase in all-cause mortality compared to people with normal fasting blood glucose levels. Also, the risks for heart attacks and strokes were higher in people with baseline fasting glucose levels less than 72 mg/dl. This result is likely due to the body releasing more epinephrine to counteract the low glucose levels too much epinephrine for too long leads to heart problems. Interestingly, people with low fasting glucose levels of less than 83 mg/dl but higher than 72 mg/dl did not have an increased risk of future heart attacks and strokes.
While there has been an association between low fasting plasma glucose levels and worse health outcomes, it is not clear whether transient dips in glucose levels during a continuous 24-hour period are unhealthy for nondiabetic individuals. Part of the reason that this is unknown is that continuous glucose monitoring is a relatively new technology and has been studied more extensively in diabetic individuals than in healthy individuals.
Does Blood Sugar Level Change With Age
Many factors changes with age and even sometimes co-morbidities gets added. To adopt with these certain conditions, optimum levels of different substances in blood also changes. So the same goes for the blood sugar. It has been confirmed by different studies that fasting blood sugar level increases with age considering different factors like obesity.
But, now the question comes, how much increment will be considered as normal? Obviously not random! It has a specific level but the increment varies depending on various conditions.
It is said that the ideal level of blood sugar increases with the passing of decade through your adult years due to benign physiological changes which decrease the glucose tolerance.
Basically, if you are quite healthy then, 2mg per 100 ml rise is considered as normal through the advancing years. But this issue is seen to bewilder both clinicians and investigations alike.
However, this small extent is only for fasting. Besides this, you may notice that your postprandial sugar levels are also escalating. Be conscious! Because it must not increase more than 4mg per 100ml. Again, sugar level may elevate up to 8 to 13mg per 100 ml per decade following a glucose challenge.
The above-mentioned levels are for those who are comparatively healthy and are not suffering from any other disease apart from diabetes.
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Tooth Decay And Sugar
Sugar is one of the main causes of tooth decay.
To prevent tooth decay, reduce the amount of food and drinks you have that contain free sugars such as sweets, chocolates, cakes, biscuits, sugary breakfast cereals, jams, honey, fruit smoothies and dried fruit and limit them to mealtimes.
The sugars found naturally in fruit and vegetables are less likely to cause tooth decay, because they’re contained within the structure.
But when fruit and vegetables are juiced or blended into a smoothie, the sugars are released. Once released, these sugars can damage teeth.
Limit the amount of fruit juice and smoothies you drink to a maximum of 150ml in total per day, and drink it with meals to reduce the risk of tooth decay.
Squashes sweetened with sugar, fizzy drinks, soft drinks and juice drinks have no place in a child’s daily diet.
If you’re looking after children, swap any sugary drinks for water, lower-fat milk or sugar-free drinks.
Summary Of Normal Glucose Ranges
In summary, based on ADA criteria, the IDF guidelines, a persons glucose values are normal if they have fasting glucose < 100 mg/dl and a post-meal glucose level < 140 mg/dl. Taking into account additional research performed specifically using continuous glucose monitors, we can gain some more clarity on normal trends and can suggest that a nondiabetic, healthy individual can expect:
- Fasting glucose levels between 80-86 mg/dl
- Glucose levels between 70-120 mg/dl for approximately 90% of the day
- 24-hour mean glucose levels of around 89-104 mg/dl
- Mean daytime glucose of 83-106 mg/dl
- Mean nighttime glucose of 81-102 mg/dl
- Mean post-meal glucose peaks ranging from 99.2 ± 10.5 to 137.2 ± 21.1 mg/dl
- Time to post-meal glucose peak is around 46 minutes 1 hour
These are not standardized criteria or ranges but can serve as a simple guide for what has been observed as normal in nondiabetic individuals.
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Medications And Blood Sugar Control
If you are affected by type 2 diabetes, medications may be used as an adjunct to manage your condition at a later stage. Factors such as diet, exercise and loss of weight are very important in managing blood sugars if you have tried to make changes in all these areas and are still not successful in gaining good control of your blood sugars, there are many types of medications that can help you manage your diabetes. These medications are usually taken orally, to help lower blood sugar levels. There are different classes of medications, which work on different parts of the body, to try and alter the levels of insulin and sugar in the body.