Diabetes

A Guide to Blood Glucose
Diablo Clinical Research wants to help you take charge of your health! If you have diabetes the most important health strategy for you is to manage your blood glucose (sugar) levels.

When you have diabetes, controlling your blood glucose levels can help prevent the following:

• Kidney disease
• Leg and foot problems (including amputations)
• Eye complications
• Nervous system complications
• Heart disease and stroke
• Oral and dental complications

Types of Blood Glucose Tests—to regulate Diabetes
• Blood glucose (Daily)
• HbA1c (3-month average)

1. Blood glucose is a short-term measurement of blood sugar levels that you can test at home with a glucose meter or glucometer. It measures your blood sugar at the point in time you test.

Daily Blood Glucose Guidelines are as follows:

Fasting glucose (12 hr fast – water only)	≤ 100 mg/dL >100 mg/dl & < 126 mg/dl ≥ 126 mg/dl	NORMAL Impaired fasting glucose* Diabetes
Non-fasting glucose (3-4 hrs post meal)	≤ 140 mg/dL 140 mg/dl & < 200 mg/dl ≥ 200 mg/dl	NORMAL Impaired glucose tolerance* Diabetes

*Also called “pre-diabetes,” a condition that occurs when a person’s blood sugar levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. (American Diabetes Association) Prevention is the key so impaired glucose does not become diabetes.

2. HbA1c (also called A1c or hemoglobin A1c) is a long-term measurement of blood sugar control that is performed by your doctor. This test reflects your average blood glucose levels during the past two or three months and lets you know how you’ve done at controlling your blood glucose during that time.

An A1c test reveals how much glucose is attached to the hemoglobin in your red blood cells. The longer the glucose level remains high, the more glucose attaches to the hemoglobin and other substances. The greater the amount of sugar in your blood, the higher your A1c will be.

The A1c test may also indicate how likely you are to experience diabetes-related complications. It has been known that having an A1c close to the normal range can greatly decrease the chance of experiencing diabetes complications. A high A1c result, or high blood glucose, increases the risk of complications.

Below you will find an easy guide to relate your average daily blood glucose levels and A1c:

HbA1c Guidelines

Feel better today and tomorrow by keeping your
A1c at 7% or LESS!

Have your A1c tested every three months. (It is a simple finger stick test in our clinic and you do not need to be fasting to get an accurate result.)

An ideal A1c for a diabetic is 7% or less. Each 1% increase above normal (5-6%) raises the risk of heart disease by about 20%. An A1c of 8% or more requires the addition of one or more medications. See the chart below for a review of available oral and insulin treatments – taken from our medical director, Dr. Richard Weinstein’s feature article in Advancing Health Newsletter, Volume 1, Issue 4, November 2005.

Type 2 Diabetes Treatments Today*

* Note: Chart is not all-inclusive of available treatments in each class. Information on the benefits, risks and side effects of each of these treatments can be reviewed and discussed in more detail during a screening appointment.

Controlling your blood glucose levels can help prevent Hypoglycemic and Hyperglycemic events.

Hypoglycemia: Low Blood Sugar
Causes: Too little food, too much insulin or diabetes medicine, or extra exercise.
Onset: Sudden, may progress to insulin shock.

Blood Sugar
Results: Below 70 mg/dL
Normal range: 70-100 mg/dL.

Symptoms:
• Shaking
• Fast heartbeat
• Sweating
• Anxious
• Dizziness
• Hunger
• Impaired vision
• Weakness, Fatigue
• Headache
• Irritable

What you can do:
•  Drink a half cup of orange juice or milk, or eat several hard candies.
•  Test Blood Sugar and if symptoms don’t stop CALL YOUR DOCTOR.
•  Within 30 minutes after symptoms go away, eat a light snack (half a peanut
   butter or meat sandwich and a half glass of milk.)

Hyperglycemia: High Blood Sugar
Causes: Too much food, too little insulin, illness or stress.
Onset: Gradual, may progress to diabetic coma.

Blood Sugar
Results: Above 200 mg/dL.
Acceptable range: <125 mg/dL.

Symptoms:
• Extreme Thirst
• Frequent Urination
• Dry Skin
• Hunger
• Blurred Vision
• Drowsiness
• Nausea
• Lethargy

What you can do:
•  Test your blood sugar, and regulate your diet and exercise to best control
   changes in your blood sugar.
• Choose the right oral medications or insulin to achieve the best blood
   sugar control.
•  Review your blood sugar profile with your physician to understand the change
   in diet, exercise and medication to obtain the best treatment for yourself.

Dietary tips for Diabetics

Simple recommendations to improve blood glucose levels and prevent complications from diabetes
•  Lose weight if you are overweight. Excess body fat causes the body cells to     become resistant to insulin.
•  Eat small, frequent meals to keep blood sugars stable and in a healthy range.
   Eating large meals can produce excess glucose and insulin.
•  Eat generous amounts of non-starchy vegetables such as leafy greens,
   broccoli, green beans, etc.
•  Keep refined starches and sugars to a minimum (white bread, white rice,
   high-sugar cereals and juices), choose instead carbohydrates that are
   metabolized slowly (sweet potatoes, winter squash and beans are examples
   of better carbohydrate foods.)
•  Keep saturated fats from animal products and trans-fats from processed foods
   to a minimum, but have moderate amounts of monounsaturated rich oils, such
   as extra-virgin olive oil and most nuts.
•  Eat fish several times a week, emphasizing those cold-water fish high in
   omega-3 fatty acids, such as wild salmon and sardines.
•  Increase your activity level. Aerobic activity improves insulin resistance in
   muscle cells, which allows more glucose to enter the cells.

High fiber foods are the closest thing to a magic bullet for blood
sugar control and weight loss.
Foods with fiber take longer to eat, creating a feeling of fullness and keeping blood sugar levels steady. Studies have shown that fiber can help lower cholesterol levels, prevent certain cancers, and many intestinal problems. The best sources of dietary fiber, soluble or insoluble, are obtained from whole grains (particularly oats), nuts, legumes, fruits, and vegetables.

Fiber rich foods can also reduce the number of calories your body absorbs from the foods you eat. (Women who doubled their intake of fiber from 12 to 24 grams absorbed 90 fewer calories a day according to a USDA Study. The theory is that fiber helps mop up fat in the intestine).

Aim for 25-35 grams of fiber/day
Focus on the fiber in minimally processed foods, meaning more whole grains and less refined grains and sugars. Gradually boost your fiber intake to at least 25-35g per day. Whole grains and vegetables contain insoluble fibers that promote healthy digestion and excretion, while the soluble fibers in fruits, oats, beans and peas lower cholesterol and keep blood sugar steady, helping to prevent heart disease. Both kinds of fiber help control weight. Fiber should be added to the diet slowly, over a period of weeks because it takes the body awhile to become used to the added fiber.

Make sure to increase your fluid intake as well
There needs to be enough fluid for the fiber to pass through the digestive tract.