WISH EACH ONE OF YOU A VERY HAPPY ONAM
Thursday, September 11, 2008
Sunday, September 7, 2008
HbA1c and estimated average Glucose
What is HbA1c?
Hemoglobin is the oxygen-carrying pigment that gives blood its red color and also the predominant protein in red blood cells. About 90% of hemoglobin is hemoglobin A. (The "A" stands for adult type) Hemoglobin A1c (HbA1c) is a minor component of hemoglobin A to which glucose is bound. HbA1c also is referred to as glycosylated or glucosylated hemoglobin.
In the normal 120-day life span of the red blood cell, glucose molecules join hemoglobin, forming glycated hemoglobin. Higher the amount of glucose in blood, more glucose gets attached to Hemoglobin there by increasing the percent of HbA1c.
Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell reflects the average level of glucose to which the cell has been exposed during its life cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months.[ HbA1c is most dependent on the blood glucose values of last 4 weeks.So it is not a very true average of 3 months]
How is HbA1c measured?
A chemical (electrical) charge is present on the molecule of HbA1c, and the amount of the charge differs from the charges on the other components of hemoglobin. The molecule of HbA1c also differs in size from the other components. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure (or performance) liquid chromatography (HPLC). HPLC separates mixtures (e.g., blood) into its various components by adding the mixtures to special liquids and passing them under pressure through columns filled with a material that separates the mixture into its different component molecules. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten.
Why measure HbA1c?
HbA1c levels depend on the blood glucose concentration. That is, the higher the glucose concentration in blood, the higher the level of HbA1c. Levels of HbA1c are not influenced by daily fluctuations in the blood glucose concentration but reflect the average glucose levels over the prior six to twelve weeks. Therefore, HbA1c is a useful indicator of how well the blood glucose level has been controlled in the recent past and may be used to monitor the effects of diet, exercise, and drug therapy on blood glucose in diabetic patients.
In healthy, non-diabetic patients the HbA1c level is less than 6% of total hemoglobin. It has been demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept close to 7%.
What are the limitations to measuring HbA1c?
Since HbA1c is not influenced by daily fluctuations in blood glucose concentration, it cannot be used to monitor day-to-day blood glucose concentrations and to adjust insulin doses nor can it detect the day-to-day presence or absence of hyperglycemia or hypoglycemia.
HbA1c may be increased falsely in certain medical conditions. These conditions include uremia (kidney failure), chronic excessive alcohol intake, and hypertriglyceridemia. Medical conditions that may falsely decrease HbA1c include acute or chronic blood loss, sickle cell disease or thalassemia. Diabetes during pregnancy, commonly referred to as gestational diabetes, may falsely increase or decrease HbA1c.
HbA1c is a difficult test to perform and lab errors are common especially if done after transportation of the sample in an improper way or if done at a less experienced centre.
What is eAG [estimated average glucose]
It is the HbA1C derived estimate of average glucose using a special formula.Now eAG is considerd more patient friendly than HbA1C though it is derived from measurement of A1C itself
The relationship between A1C and eAG is described by the formula 28.7 X A1C – 46.7 = eAG
Hemoglobin is the oxygen-carrying pigment that gives blood its red color and also the predominant protein in red blood cells. About 90% of hemoglobin is hemoglobin A. (The "A" stands for adult type) Hemoglobin A1c (HbA1c) is a minor component of hemoglobin A to which glucose is bound. HbA1c also is referred to as glycosylated or glucosylated hemoglobin.
In the normal 120-day life span of the red blood cell, glucose molecules join hemoglobin, forming glycated hemoglobin. Higher the amount of glucose in blood, more glucose gets attached to Hemoglobin there by increasing the percent of HbA1c.
Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell reflects the average level of glucose to which the cell has been exposed during its life cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months.[ HbA1c is most dependent on the blood glucose values of last 4 weeks.So it is not a very true average of 3 months]
How is HbA1c measured?
A chemical (electrical) charge is present on the molecule of HbA1c, and the amount of the charge differs from the charges on the other components of hemoglobin. The molecule of HbA1c also differs in size from the other components. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure (or performance) liquid chromatography (HPLC). HPLC separates mixtures (e.g., blood) into its various components by adding the mixtures to special liquids and passing them under pressure through columns filled with a material that separates the mixture into its different component molecules. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten.
Why measure HbA1c?
HbA1c levels depend on the blood glucose concentration. That is, the higher the glucose concentration in blood, the higher the level of HbA1c. Levels of HbA1c are not influenced by daily fluctuations in the blood glucose concentration but reflect the average glucose levels over the prior six to twelve weeks. Therefore, HbA1c is a useful indicator of how well the blood glucose level has been controlled in the recent past and may be used to monitor the effects of diet, exercise, and drug therapy on blood glucose in diabetic patients.
In healthy, non-diabetic patients the HbA1c level is less than 6% of total hemoglobin. It has been demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept close to 7%.
What are the limitations to measuring HbA1c?
Since HbA1c is not influenced by daily fluctuations in blood glucose concentration, it cannot be used to monitor day-to-day blood glucose concentrations and to adjust insulin doses nor can it detect the day-to-day presence or absence of hyperglycemia or hypoglycemia.
HbA1c may be increased falsely in certain medical conditions. These conditions include uremia (kidney failure), chronic excessive alcohol intake, and hypertriglyceridemia. Medical conditions that may falsely decrease HbA1c include acute or chronic blood loss, sickle cell disease or thalassemia. Diabetes during pregnancy, commonly referred to as gestational diabetes, may falsely increase or decrease HbA1c.
HbA1c is a difficult test to perform and lab errors are common especially if done after transportation of the sample in an improper way or if done at a less experienced centre.
What is eAG [estimated average glucose]
It is the HbA1C derived estimate of average glucose using a special formula.Now eAG is considerd more patient friendly than HbA1C though it is derived from measurement of A1C itself
The relationship between A1C and eAG is described by the formula 28.7 X A1C – 46.7 = eAG
Monday, September 1, 2008
Insulins and other Injections to control blood sugar
What is Insulin and how it works?
Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots/injections to use glucose from meals.
People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin injections to help their bodies use glucose for energy.
Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.
There are many different insulins for many different situations and lifestyles and there are more than 10 types of Insulin in the market. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs/Cows].
Types of Insulin
Different types of insulin preparations are distinguished by the speed at which the injected insulin is absorbed from the layer under the skin into the blood (onset of action) and by the time it takes for all the injected insulin to be absorbed (duration of action).
It is important to note that the duration and absorption times described below are only approximate. Absorption of insulin always depends on individual factors.
Insulin analogues
Rapid-acting insulin analogue
Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots/injections to use glucose from meals.
People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin injections to help their bodies use glucose for energy.
Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.
There are many different insulins for many different situations and lifestyles and there are more than 10 types of Insulin in the market. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs/Cows].
Types of Insulin
Different types of insulin preparations are distinguished by the speed at which the injected insulin is absorbed from the layer under the skin into the blood (onset of action) and by the time it takes for all the injected insulin to be absorbed (duration of action).
It is important to note that the duration and absorption times described below are only approximate. Absorption of insulin always depends on individual factors.
Insulin analogues
Rapid-acting insulin analogue
Onset: 10-20 minutesMaximum effect: 1-3 hours Duration: 3-5 hours
Eg;insulin lispro (Eli Lilly), insulin aspart (Novo Nordisk), or insulin glulisine (sanofi-aventis),
Long-acting insulin analogue
Onset: 1 hour Duration: 24 hours
Eg;glargine[Lantus] and detemir[Levemir]
Biphasic insulin analogue
Onset: 10-20 minutesMaximum effect: 1-4 hours Duration: up to 24 hours
Eg; Novomix,Humalog
Human insulins
Short-acting insulin(soluble human insulin)
This insulin comes in a clear solution, and is intended to be given at meals. An injection should be followed by a meal or snack containing carbohydrates within 30 minutes.
Onset: within 30 minutesMaximum effect: 1-3 hours Duration: 8 hours
Eg;Actrapid,Humisulin R
Intermediate-acting insulin(isophane human insulin, NPH)
An insulin formulation that contains a substance, which delays the absorption of insulin. The combination of insulin and a delaying substance usually results in the formation of crystals that give the liquid a cloudy look. The insulin crystals must be homogenised (mixed) evenly before each injection. Intermediate-acting insulin takes approximately 1 1/2 hours before it begins to have an effect. The largest effect occurs between 4 and 12 hours after the injection, and after approximately 24 hours, the whole dose has been absorbed.
Onset: within 1.5 hours Maximum effect: 4-12 hours Duration: 24 hours
eg;Human Insulin N,Insulatard
Premixed insulin(biphasic human insulin consisting of e.g. 30% soluble and 70% isophane insulin)
Insulin containing a combination of a short-acting and an intermediate-acting insulin in standard proportions. These products eliminate the difficulty some individuals have while mixing insulin. The products come in several different premixed combinations containing 10-50% short-acting insulin and 90-50% intermediate-acting insulin, with the ratio of 30% short acting and 70% intermediate acting being the most used.
Onset: within 30 minutes Maximum effect: 2-8 hours Duration:24 hours
eg; Human Mixtard,Huminsulin 30/70
Two new injectable drugs that are not Insulins recently been approved for use in Diabetes
Pramlintide (brand name Symlin) is a synthetic form of the hormone amylin, which is produced along with insulin by the beta cells in the pancreas. Amylin, insulin, and another hormone, glucagon, work in an interrelated fashion to maintain normal blood glucose levels.
Pramlintide injections taken with meals have been shown to modestly improve A1C levels without causing increased hypoglycemia or weight gain and even promoting modest weight loss. The primary side effect is nausea, which tends to improve over time and as an individual patient determines his or her optimal dose.
Because of differences in chemistry, pramlintide cannot be combined in the same vial or syringe with insulin and must be injected separately. Pramlintide has been approved for people with type 1 diabetes who are not achieving their goal A1C levels and for people with type 2 diabetes who are using insulin and are not achieving their A1C goals.
Exenatide (brand name Byetta) is the first in a new class of drugs for the treatment of type 2 diabetes called incretin mimetics. Exenatide is a synthetic version of exendin-4, a naturally-occurring hormone that was first isolated from the saliva of the lizard known as a Gila monster. Exenatide works to lower blood glucose levels primarily by increasing insulin secretion. Because it only has this effect in the presence of elevated blood glucose levels, it does not tend to increase the risk of hypoglycemia on its own, although hypoglycemia can occur if taken in conjunction with a sulfonylurea. The primary side effect is nausea, which tends to improve over time.
Like pramlintide, exenatide is injected with meals and, as with pramlintide, patients using exenatide have generally experienced modest weight loss as well as improved glycemic control. Exenatide has been approved for use by people with type 2 diabetes who have not achieved their target A1C levels using metformin, a sulfonylurea, or a combination of metformin and a sulfonylurea.
Modified and adapted from ADA and Novo Nordisk websites
Friday, August 22, 2008
Medicines to Control your Blood Sugar
There are six main groups of tablets you may be prescribed to control your diabetes. The way in which they work to help control your diabetes is described below.
1. METFORMIN
This belongs to a group known as Biguanides
Taken 2- 3 times a day with or after food.
How It Works: Metformin improves your body’s responses to insulin and also stops it making too much sugar. Metformin may be used alone or in combination with other treatments e.g Gliclazide or any of those listed below.
2. GLIBENCLAMIDE, GLICLAZIDE, GLIPIZIDE,GLIMEPIRIDE
These belong to the group known as Sulphonylureas
Taken 1-3 times daily, shortly before food.
How It Works: These stimulate the body to make more insulin because it may not be making enough for your needs. This should then lower your blood sugar levels. These may be used alone or in combination with other treatments such as those below.
3. ACARBOSE, Miglitol,Voglibose;
Belongs to a group known as Alpha-Glucosidase Inhibitors
Taken 1-3 times day
How It Works: by delaying the rate at which you digest sugar, which in turns slows down the rate at which your blood sugar rises after you have eaten. It slows down the uptake of starchy and sugary foods from the intestines.It may be used alone or in combination with other medications. It should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.
4. ROSIGLITAZONE and PIOGLITAZONE
These belong to a group called Thiazolidinediones
Taken 1-2 times a day with or without food.
How It Works: Glitazone tablets increase the action of your body’s insulin by helping it work more effectively. It may be used alone or in combination with other medication.
5. REPAGLINIDE and NATEGLINIDE
These belong to a group called Prandial Glucose Regulators
Taken up to 3 times a day before food.
How It Works: These help your body produce the right amount of insulin after meals to cope with the increase in sugar in your blood stream.They work very quickly and should be taken shortly before each main meal.
6. Sitagliptin,Vildagliptin
These belong to a group called DPP4 Inhibitors.
How it works: It works by increasing Insulin secretion and also by decreasing sugar production by Liver.
1. METFORMIN
This belongs to a group known as Biguanides
Taken 2- 3 times a day with or after food.
How It Works: Metformin improves your body’s responses to insulin and also stops it making too much sugar. Metformin may be used alone or in combination with other treatments e.g Gliclazide or any of those listed below.
2. GLIBENCLAMIDE, GLICLAZIDE, GLIPIZIDE,GLIMEPIRIDE
These belong to the group known as Sulphonylureas
Taken 1-3 times daily, shortly before food.
How It Works: These stimulate the body to make more insulin because it may not be making enough for your needs. This should then lower your blood sugar levels. These may be used alone or in combination with other treatments such as those below.
3. ACARBOSE, Miglitol,Voglibose;
Belongs to a group known as Alpha-Glucosidase Inhibitors
Taken 1-3 times day
How It Works: by delaying the rate at which you digest sugar, which in turns slows down the rate at which your blood sugar rises after you have eaten. It slows down the uptake of starchy and sugary foods from the intestines.It may be used alone or in combination with other medications. It should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.
4. ROSIGLITAZONE and PIOGLITAZONE
These belong to a group called Thiazolidinediones
Taken 1-2 times a day with or without food.
How It Works: Glitazone tablets increase the action of your body’s insulin by helping it work more effectively. It may be used alone or in combination with other medication.
5. REPAGLINIDE and NATEGLINIDE
These belong to a group called Prandial Glucose Regulators
Taken up to 3 times a day before food.
How It Works: These help your body produce the right amount of insulin after meals to cope with the increase in sugar in your blood stream.They work very quickly and should be taken shortly before each main meal.
6. Sitagliptin,Vildagliptin
These belong to a group called DPP4 Inhibitors.
How it works: It works by increasing Insulin secretion and also by decreasing sugar production by Liver.
Wednesday, August 13, 2008
Type 2 Diabetes Patients Who Lost Weight Soon After Diagnosis Had Better Control
People diagnosed with type 2 diabetes who lose excess weight soon after their diagnosis are up to twice as likely to maintain control of their disease than those who do not lose weight or who gain weight, according to a new study. The study is published in online in Diabetes Care, the journal of the American Diabetes Association.
Even if they regain the weight, as most in this study did, the benefits remain, the researchers found.
People who lose (excess) weight are more likely to attain their blood sugar and blood pressure goals than people who gain weight or maintain a stable weight.
When a patient is newly diagnosed with type 2 diabetes, he/she might already have lost some weight, but may still be over-weight for their height. If they try to control blood sugar with medications alone(especially medicines that increase secretion of Insulin), they will gain weight. So, if an already over-weight patient gains weight on treatment for diabetes, the chances of them attaining target treatment goals is remote.
If vigorous exercise and dieting along with Insulin sensitisers like Metformin are used, the patients may continue to loose weight while attaining normal blood sugar levels. In the long run, such patients attain treatment goals more often, as per the study.
So in management of type 2 diabetes in over-weight patients, the most important treatment is life style modification with low-carb diet and exercise.
Even if they regain the weight, as most in this study did, the benefits remain, the researchers found.
People who lose (excess) weight are more likely to attain their blood sugar and blood pressure goals than people who gain weight or maintain a stable weight.
When a patient is newly diagnosed with type 2 diabetes, he/she might already have lost some weight, but may still be over-weight for their height. If they try to control blood sugar with medications alone(especially medicines that increase secretion of Insulin), they will gain weight. So, if an already over-weight patient gains weight on treatment for diabetes, the chances of them attaining target treatment goals is remote.
If vigorous exercise and dieting along with Insulin sensitisers like Metformin are used, the patients may continue to loose weight while attaining normal blood sugar levels. In the long run, such patients attain treatment goals more often, as per the study.
So in management of type 2 diabetes in over-weight patients, the most important treatment is life style modification with low-carb diet and exercise.
Saturday, August 9, 2008
Hypoglycemia
If you are a diabetic and is taking medicines to reduce your blood sugar, you should know about Hypoglycemia (low blood sugar).
Hypoglycemia (also known as an "insulin reaction," or just "low blood glucose") occurs when blood glucose goes too low. Hypoglycemia can be caused by many things: too much insulin, too much tablets, not enough food, too much exercise, eating late, or eating too little carbohydrate. In short, it happens when insulin and blood glucose are out of balance.
People without diabetes usually don't get hypoglycemia. Their body can tell when it has enough insulin and stops releasing it automatically, but people with diabetes have to figure out how much insulin or how much Insulin-secreting tablets they need. Once the insulin is injected, or tablet is taken, it keeps working until it's gone, even if the blood glucose goes too low.
Mild or moderate hypoglycemia is pretty common for children and adults who take insulin or Insulin-secreting drugs like Daonil, Glimepride, Glipizide, or Gliclazide, but it can be dangerous if it's not treated right away. Mild or moderate hypoglycemia can get dangerously low pretty quickly. Severe hypoglycemia could lead to coma. So knowing about hypoglycemia is very important, not just for you, but for family, friends, co-workers etc.
Each person reacts to hypoglycemia differently. You may only have a few symptoms. It's important for you and your family to observe what symptoms are unique to you. That way, you can recognize it sooner, and treat it before it becomes serious.
Most common triad of symptoms of hypoglycemia are
Shivering
Excessive Sweating (clothes drenched with sweat)
Unusual Hunger
If this three happens together, especially just before your next meal and if the symptoms reverse quickly on eating, then you are having a mild hypoglycemia.
Other symptoms include
Nervousness
Irritability, sadness, or anger
Impatience
Chills and cold sweats
Fast heartbeat
Light-headedness or dizziness
Drowsiness
Lack of coordination
Blurred vision
Nausea
Tingling or numbness of lips or tongue
Nightmares or crying out during sleep
Headaches
Strange behavior
Confusion
Personality change
Passing out
Treating Hypoglycemia
When you notice symptoms of hypoglycemia, it's important to treat it right away. If you're feeling a little "off" but not too bad, you should do a blood glucose check first. A blood sugar value below 70mgs means it is hypoglycemia, but if you feel fairly sick and is not able to check, go ahead and treat for hypoglycemia. Here's how.
Step 1
Eat food or drink fluid that is easily digestible that contain at least 10 to 15 grams of carbohydrate.For example you can eat Iddly, Rice, Kanji, Roti, Glucose biscuits, toffees, Bun, Sweet Bread, Honey, Glucose tablets or powder, or you can drink a sugary tea or a sugary fruit juice ,or even a soft drink.
Step 2
Wait for 15 minutes and if possible check your blood sugar again. If you feel better and sugar is rising up take a complete meal so that it wont become low again.
Step 3
If blood sugar is not rising up or if you don't feel better eat another 15 grams of carbohydrate. If you feel better with this eat a complete meal.
Step 4
If your blood glucose is still too low (or you don't feel better), go to a hospital directly and tell the duty doctor or nurse that you are a diabetic on Insulin/tablets, and you think it is hypoglycemia.Don't wait for an appointment to see the doctor who is treating you.
Don't use fear of hypoglycemia as an excuse to eat your favourite sweet stuff. You will have the opposite problem - high blood glucose - later in the day. Also, stick to sugary foods that don't have a lot of fat. Fat slows down the movement of sugar into your blood. So oily sweets are not the best choices for treating hypoglycemia, unless they're the only high-carb foods nearby.
If mild or moderate hypoglycemia is not treated promptly, it can turn into severe hypoglycemia. People with severe hypoglycemia have so little glucose in their system that it affects their brain. When that happens, they pass out.
The best way to avoid severe hypoglycemia is catch it early. Be alert to any symptoms of hypoglycemia. Check your blood glucose if you have any doubt. Always carry some glucose tabs or other carbohydrate with you to treat hypoglycemia.
If you do develop severe hypoglycemia, you will need help from the people around you. You cannot drink juice or chew glucose tablets when you're unconscious. Glucagon is useful here, but is not widely available in India. Glucagon is a substance that makes the liver release sugar into your bloodstream. It can be injected to treat severe hypoglycemia.If no glucagon is available you must be taken to the hospital right away.
Do not forget to wear a medical ID bracelet or necklace that says you have diabetes and take insulin/tablets. You cannot tell anyone about your diabetes if you're unconscious or confused, but the medical ID can.
Keep something containing sugar like glucose powder or toffees with you at all times to treat hypoglycemia.
Tips to prevent hypoglycemia.
1.Always take the correct dose of Insulin/tablets.
2.If you plan to do some unusual physical activity, eat an additional snack before doing that.
3.If you feel unwell or have some illness like loose motions or vomiting and is not able to consume your usual calories, reduce the dosage of Insulin/tablets.
4.Never delay your meal
Hypoglycemia (also known as an "insulin reaction," or just "low blood glucose") occurs when blood glucose goes too low. Hypoglycemia can be caused by many things: too much insulin, too much tablets, not enough food, too much exercise, eating late, or eating too little carbohydrate. In short, it happens when insulin and blood glucose are out of balance.
People without diabetes usually don't get hypoglycemia. Their body can tell when it has enough insulin and stops releasing it automatically, but people with diabetes have to figure out how much insulin or how much Insulin-secreting tablets they need. Once the insulin is injected, or tablet is taken, it keeps working until it's gone, even if the blood glucose goes too low.
Mild or moderate hypoglycemia is pretty common for children and adults who take insulin or Insulin-secreting drugs like Daonil, Glimepride, Glipizide, or Gliclazide, but it can be dangerous if it's not treated right away. Mild or moderate hypoglycemia can get dangerously low pretty quickly. Severe hypoglycemia could lead to coma. So knowing about hypoglycemia is very important, not just for you, but for family, friends, co-workers etc.
Each person reacts to hypoglycemia differently. You may only have a few symptoms. It's important for you and your family to observe what symptoms are unique to you. That way, you can recognize it sooner, and treat it before it becomes serious.
Most common triad of symptoms of hypoglycemia are
Shivering
Excessive Sweating (clothes drenched with sweat)
Unusual Hunger
If this three happens together, especially just before your next meal and if the symptoms reverse quickly on eating, then you are having a mild hypoglycemia.
Other symptoms include
Nervousness
Irritability, sadness, or anger
Impatience
Chills and cold sweats
Fast heartbeat
Light-headedness or dizziness
Drowsiness
Lack of coordination
Blurred vision
Nausea
Tingling or numbness of lips or tongue
Nightmares or crying out during sleep
Headaches
Strange behavior
Confusion
Personality change
Passing out
Treating Hypoglycemia
When you notice symptoms of hypoglycemia, it's important to treat it right away. If you're feeling a little "off" but not too bad, you should do a blood glucose check first. A blood sugar value below 70mgs means it is hypoglycemia, but if you feel fairly sick and is not able to check, go ahead and treat for hypoglycemia. Here's how.
Step 1
Eat food or drink fluid that is easily digestible that contain at least 10 to 15 grams of carbohydrate.For example you can eat Iddly, Rice, Kanji, Roti, Glucose biscuits, toffees, Bun, Sweet Bread, Honey, Glucose tablets or powder, or you can drink a sugary tea or a sugary fruit juice ,or even a soft drink.
Step 2
Wait for 15 minutes and if possible check your blood sugar again. If you feel better and sugar is rising up take a complete meal so that it wont become low again.
Step 3
If blood sugar is not rising up or if you don't feel better eat another 15 grams of carbohydrate. If you feel better with this eat a complete meal.
Step 4
If your blood glucose is still too low (or you don't feel better), go to a hospital directly and tell the duty doctor or nurse that you are a diabetic on Insulin/tablets, and you think it is hypoglycemia.Don't wait for an appointment to see the doctor who is treating you.
Don't use fear of hypoglycemia as an excuse to eat your favourite sweet stuff. You will have the opposite problem - high blood glucose - later in the day. Also, stick to sugary foods that don't have a lot of fat. Fat slows down the movement of sugar into your blood. So oily sweets are not the best choices for treating hypoglycemia, unless they're the only high-carb foods nearby.
If mild or moderate hypoglycemia is not treated promptly, it can turn into severe hypoglycemia. People with severe hypoglycemia have so little glucose in their system that it affects their brain. When that happens, they pass out.
The best way to avoid severe hypoglycemia is catch it early. Be alert to any symptoms of hypoglycemia. Check your blood glucose if you have any doubt. Always carry some glucose tabs or other carbohydrate with you to treat hypoglycemia.
If you do develop severe hypoglycemia, you will need help from the people around you. You cannot drink juice or chew glucose tablets when you're unconscious. Glucagon is useful here, but is not widely available in India. Glucagon is a substance that makes the liver release sugar into your bloodstream. It can be injected to treat severe hypoglycemia.If no glucagon is available you must be taken to the hospital right away.
Do not forget to wear a medical ID bracelet or necklace that says you have diabetes and take insulin/tablets. You cannot tell anyone about your diabetes if you're unconscious or confused, but the medical ID can.
Keep something containing sugar like glucose powder or toffees with you at all times to treat hypoglycemia.
Tips to prevent hypoglycemia.
1.Always take the correct dose of Insulin/tablets.
2.If you plan to do some unusual physical activity, eat an additional snack before doing that.
3.If you feel unwell or have some illness like loose motions or vomiting and is not able to consume your usual calories, reduce the dosage of Insulin/tablets.
4.Never delay your meal
Saturday, August 2, 2008
How often I should test my Blood sugar?
How often I should test my blood sugar?
All Diabetes patients need to know this.
Usually my answer is, if I have the choice I want to know your blood sugar 24 hrs a day, 7 days a week and 365 days a year. Then only I can be sure that your blood sugar is under control, but I can do that only by CGMS [Continuous Glucose Monitoring System] which is very expensive. So as a compromise, I decide a schedule for testing of Blood sugar. The schedule depends on the type of diabetes, its duration, presence of complications, affordability of the patient etc.
For example, in case of type 1 diabetes patients, I want them to check their blood sugar at least once a day. In many type 1 patients, it is much better if they could check several times a day.
In case of type 2 diabetes, the chances of fluctuation of blood sugar is less, especially if the duration of diabetes is short. So, in such patients I will want them to check their blood sugars at least once a week or if not possible once in 2 weeks.
If the blood sugar values are very high or very low you may need frequent testing till the sugars stabilise.
The easiest method of testing is by Blood glucose meter [Glucometer] at home. This is called SMBG [Self Monitoring of Blood Glucose].
Unfortunately, the practise in India is that type 2 diabetics test their blood sugars only once in a month. Many do it still less often. The less number of tests they do, the poorer the blood sugar control.
Increasing the number of blood sugar measurements is one of the easiest [may be expensive] way of keeping your blood sugar under control.
All Diabetes patients need to know this.
Usually my answer is, if I have the choice I want to know your blood sugar 24 hrs a day, 7 days a week and 365 days a year. Then only I can be sure that your blood sugar is under control, but I can do that only by CGMS [Continuous Glucose Monitoring System] which is very expensive. So as a compromise, I decide a schedule for testing of Blood sugar. The schedule depends on the type of diabetes, its duration, presence of complications, affordability of the patient etc.
For example, in case of type 1 diabetes patients, I want them to check their blood sugar at least once a day. In many type 1 patients, it is much better if they could check several times a day.
In case of type 2 diabetes, the chances of fluctuation of blood sugar is less, especially if the duration of diabetes is short. So, in such patients I will want them to check their blood sugars at least once a week or if not possible once in 2 weeks.
If the blood sugar values are very high or very low you may need frequent testing till the sugars stabilise.
The easiest method of testing is by Blood glucose meter [Glucometer] at home. This is called SMBG [Self Monitoring of Blood Glucose].
Unfortunately, the practise in India is that type 2 diabetics test their blood sugars only once in a month. Many do it still less often. The less number of tests they do, the poorer the blood sugar control.
Increasing the number of blood sugar measurements is one of the easiest [may be expensive] way of keeping your blood sugar under control.
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