My Blood Glucose Levels are High! What should I do?

Diabetes mellitus is a chronic condition characterized by high blood glucose levels due to the body's inability to make or properly use insulin.

There are two main types of diabetes:

Type 1 diabetes is a condition that occurs when the body's immune system attacks and destroys the insulin-producing cells in the pancreas, resulting in a complete lack of insulin. 

Type 2 diabetes occurs when the body shows resistance to the effect of insulin or does not produce enough insulin levels at a later stage to maintain normal glucose levels in the blood. In addition to these two types, there are also other less common forms of diabetes, such as gestational diabetes, which occurs during pregnancy, and various gene-related diabetes which usually have onset in the early period of life.

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Monitoring blood glucose levels plays a crucial role in the management of diabetes mellitus. It allows individuals with diabetes to track their blood sugar levels, identifies patterns, and make adjustments to their medication, diet, and physical activity as needed. 

By monitoring blood glucose levels regularly, individuals with diabetes can better manage their condition and reduce the risk of complications associated with high or low blood sugar levels. It also helps healthcare providers to assess the effectiveness of treatment plans and make necessary adjustments to optimize the individual's diabetes management.

Overall, monitoring blood glucose levels is an essential aspect of diabetes care and empowers individuals with diabetes to take control of their health.

What should be measured?

HbA1c (glycated hemoglobin) and blood glucose are measurements used to monitor blood sugar in people with diabetes. However, they represent different aspects of glucose control.

• Blood glucose refers to the amount of glucose that is present in the blood at a specific point in time. It can be measured using a glucose meter or by performing a laboratory test. Blood glucose levels can fluctuate throughout the day, depending on various factors such as food intake, physical activity, and medication.

• HbA1c, alternatively, is a measure of the average blood glucose levels over the past 2-3 months. It reflects the percentage of hemoglobin molecules that have become glycated (chemically bound to glucose). As red blood cells have a lifespan of around 3 months, HbA1c gives an indication of blood glucose levels over this time frame. HbA1c can also be used to monitor how well diabetes is being managed over time and is a good indicator of the risk of developing complications.

If you are living with diabetes, there are several important things that you should keep in mind to make your life easier and healthier. 

By taking control of your condition and making a few simple adjustments to your daily routine, you can live a full and active life while managing your diabetes effectively. Here are some helpful tips to keep in mind:

1. Target levels of Blood glucose and HbA1c

Proper blood glucose level management is vital in preventing hyperglycemia or hypoglycemia, both of which can lead to serious consequences. It is achieved by monitoring blood glucose levels and adjusting insulin dosage accordingly.

The following provides the targets of blood glucose and HbA1c:

In males and non-pregnant healthy females 

Blood Glucose Targets (mg/dL [mmol/L]) 

✅ Premeal glucose 90–130 (5–7.2) 1-hour peak < 180 (10)

✅ 2-hour peak < 150 (8.3)

HbA1c Target (% [mmol/mol])

 

✅ It must be < 7 (53). Aim for < 6.5 (48) if it can be achieved without significant hypoglycemia or polypharmacy) 

( Current Medical Diagnosis and Treatment 2021)

2. Methods for Monitoring Blood Glucose Levels:

Blood glucose levels can be monitored using various methods such as as blood glucose meter or a continuous glucose monitoring system. Frequent testing is necessary, particularly before meals and physical activity, as well as when experiencing hyperglycemia or hypoglycemia symptoms.

👉Blood glucose monitors for capillary blood glucose detection:

☝The One Touch by LifeScan is a user-friendly and compact blood glucose meter that is ideal for patients who prefer a simple and convenient monitoring solution. 

☝Bayer Corporation has two popular models:

Breeze and Contour. 

The Breeze requires only a small blood sample and is suitable for patients who need to monitor their blood glucose levels frequently. 

On the other hand, the Contour is known for its high level of accuracy and ease of use, making it a popular choice for many patients.

☝Roche Diagnostics'  

Accu-Chek is a reliable and accurate blood glucose meter that provides precise readings for patients who require a high level of accuracy in their blood glucose monitoring.

☝Abbott Laboratories 

It offers two popular models: Precision and FreeStyle.

The Precision is a compact and easy-to-use blood glucose meter that requires only a small blood sample. Meanwhile, FreeStyle offers a continuous glucose monitoring system that provides frequent blood glucose readings for patients who require frequent monitoring.

👉Continuous monitoring systems:

These systems require the insertion of a subcutaneous sensor, similar to an insulin pump cannula, which continuously measures glucose concentrations in the interstitial fluid for a period of 6 to 10 days.

☝DexCom system: 

  -Transmits glucose data wirelessly to a separate pager-like device with a screen
  - Displays data on smartphones, smart watches, or on the screens of several insulin pumps
  - Displays arrows indicating the rate and direction of change
  - Alarms can be set for extremely low or high glucose values
  - Requires periodic fingerstick glucose level calibration

☝FreeStyle Libre (Abbott Diagnostics) sensor system:

  - Requires a person to hold a reading device close to the sensor patch for nearly a second to see the real-time glucose levels.
  - Glucose readings are available 12 hours after the insertion of sensors
  - Does not require calibration

☝Minimed system:

  -Displays arrows indicating direction and rate of change
  - Alarms can be set for extremely low or high glucose values
  - Requires periodic fingerstick glucose level calibration

3. Adjusting Insulin Dosage:

Insulin dosage should be adjusted based on blood glucose levels and other factors like physical activity, diet, and illness. Healthcare provider consultation is necessary to determine the appropriate insulin dosage and adjust it based on blood glucose levels. In general, increasing insulin dosage is recommended if blood glucose levels are consistently high while decreasing insulin dosage is advised if blood glucose levels are consistently low.

Proper dosage of insulin depends on age, activity status, and personalized blood glucose levels. For more detail, one must consult a healthcare provider nearby.

Closed loop systems involve the integration of continuous data monitoring and then using algorithms to adjust the need for insulin through subcutaneous pumps according to the needs of a person. They are also termed artificial pancreas.

4. Tips for Blood Glucose Monitoring and Insulin Adjustment:

Logging blood glucose levels and insulin dosage using a logbook or mobile app helps monitor diabetes management. Consult with a healthcare provider before adjusting insulin dosage, and be aware of hyperglycemia and hypoglycemia symptoms. Lifestyle changes like increasing physical activity and modifying diet can also aid in managing blood glucose levels.

👉CONCLUSION: 

1. Diabetes mellitus is a chronic condition characterized by high glucose levels in the blood.

2. There are two main types of diabetes: Type 1 and Type 2. 

3.  Monitoring blood glucose levels is crucial in the management of diabetes. 

4.  Blood glucose refers to the amount of glucose present in the blood at a specific point in time.

5. HbA1c is a measure of the average blood glucose levels over the recent 2-3 months. 

6.    There are several important things to keep in mind when living with diabetes.

7. Blood glucose levels should be managed properly to prevent hyperglycemia or hypoglycemia.

8. Blood glucose levels can be monitored using various methods such as a blood glucose meter or a continuous glucose monitoring System.

9.   The target levels of blood glucose and HbA1c are different for  males and non-pregnant females.

10. Common devices for monitoring blood glucose levels include One Touch by LifeScan, Breeze, and Contour by Bayer, Accu-Chek by Roche Diagnostics, Precision and FreeStyle by Abbott Laboratories, and continuous monitoring systems such and DexCom, FreeStyle Libre, and Minimed.

11. Signs and symptoms of high blood sugar levels include frequent urination, increased thirst, blurred vision, fatigue, and slow healing of wounds. 

12. Signs and symptoms of low blood sugar levels include sweating, shakiness, confusion, irritability, and dizziness.

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