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What constitutes the determination of a normal blood glucose level?

What constitutes the determination of a normal blood glucose level?


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Several on-line resources (e.g. MedlinePlus) suggest:

Normal range for non-diabetic people who are fasting should range between: 70 and 100 milligrams per deciliter (mg/dL)

Non-diabetic people who are not fasting should have a blood glucose level below 125 mg/dL

What I am interested in however, is the coverage interval of the population that was used to determine these 'normal' values.

Also are there differences based on age, sex or any other factors.


Determining what is considered to be "normal" is quite challenging indeed. Both the ADA and the WHO look at upgrading diagnosis limits and both have a conservative approach, primarily due to the difficulties in conducting large scale studies and the anomalies between assumptions of plasma glucose distribution and what is probably actually present in populations. Digging through, I found a very good WHO document here:

http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf

I am not going to regurgitate from this document, but I believe Issue 2 provides a detailed answer to your question detailing several determination methodologies.

As to your second question on age/sex variations, are you asking if the criteria are different? At least with reference to FPG, they don't appear to be so.


What Is a Normal Blood Sugar Level?

The answer to the question what is a normal blood sugar level is as follows:

Fasting normal blood sugar
Normal for person without diabetes: 70–99 mg/dl (3.9–5.5 mmol/L)
Official ADA recommendation for someone with diabetes: 80–130 mg/dl (4.4–7.2 mmol/L)

Normal blood sugar 2 hours after meals
Normal for person without diabetes: Less than 140 mg/dl (7.8 mmol/L)
Official ADA recommendation for someone with diabetes: Less than 180 mg/dl (10.0 mmol/L)

HbA1c
Normal for person without diabetes: Less than 5.7%
Official ADA recommendation for someone with diabetes: Less than 7.0%


This test is a blood check at any time of the day when you have severe diabetes symptoms.

Before people develop type 2 diabetes, they almost always have "prediabetes"—blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Doctors sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when it was detected. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

Symptoms

There are no clear symptoms of prediabetes, so you may have it and not know it.

Some people with prediabetes may have some of the symptoms of diabetes or even problems from diabetes already. You usually find out that you have prediabetes when being tested for diabetes.

If you have prediabetes, you should be checked for type 2 diabetes every one to two years.

Results indicating prediabetes are:

  • An A1C of 5.7%–6.4%
  • Fasting blood sugar of 100–125 mg/dl
  • An OGTT 2 hour blood sugar of 140 mg/dl–199 mg/dl

Preventing type 2 diabetes

You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood sugar levels to the normal range.

Research shows that you can lower your risk for type 2 diabetes by 58% by:

  • Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds) (such as brisk walking) 30 minutes a day, five days a week

Don't worry if you can't get to your ideal body weight. Losing even 10 to 15 pounds can make a huge difference.


Normal Blood Sugar Levels for Adults With Diabetes

Normally, your pancreas releases insulin when your blood sugar, or “blood glucose,” gets high -- after a meal, for example. That signals your body to absorb glucose until levels get back to normal.

But if you have diabetes, your body doesn’t make insulin (type 1 diabetes) or doesn’t respond to it normally (type 2 diabetes). That can leave your blood sugar too high for too long. Over time, that can damage nerves and blood vessels and lead to heart disease and other problems.

If you have diabetes, your doctor may ask you to keep track of your blood sugar by testing it at home with a special device called a blood glucose monitor or home blood sugar meter. It takes a small sample of blood, usually from the tip of your finger, and measures the amount of glucose in it.

Follow your doctor’s instructions about the best way to use your device.

Your doctor will tell you when and how to test your blood sugar. Each time you do it, log it in a notebook or online tool or in an app. The time of day, recent activity, your last meal, and other things can all affect whether a reading will be of concern to your doctor. So try to log relevant information like:

  • What medication and dosage you took
  • What you ate, when you ate, or whether you were fasting
  • How much, how intense, and what kind of exercise you were doing, if any

Continued

That will help you and your doctor see how your treatment is working.

Managing type 1 and type 2 diabetes well can delay or prevent complications that affect your eyes, kidneys, and nerves. Diabetes doubles your risk for heart disease and stroke, too. Fortunately, controlling your blood sugar will also make these problems less likely.

Tight blood sugar control, however, means a greater chance of low blood sugar levels, so your doctor may suggest higher targets.

Sources

American Academy of Family Physicians: “Monitoring Your Blood Sugar Level.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Prediabetes & Insulin Resistance.”

Mensing, C. The Art and Science of Diabetes Self-Management Education Desk Reference, 2nd Ed., American Association of Diabetes Educators, 2011.

American Diabetes Association: "Standards of Medical Care in Diabetes—2014."


Clinical Significance

Home Glucose Monitoring

In most hands, the glucose oxidase strip method is accurate and reliable. Since whole blood is used, the results tend to be slightly lower than simultaneous venous samples, but this is balanced by the fact that capillary blood has a higher glucose concentration than venous blood. Most patients can visually estimate the correct value, but a few patients consistently misread the visual charts and must use a reflectance meter. This may be due to an unexpectedly high prevalence of disturbances of color perception in diabetics. Most patients feel more comfortable with the digital readout of the reflectance meter, although it is not necessarily more accurate. The major sources of error are in failing to put a large enough drop of blood on the strip and inaccurate timing. For patients who use reflectance meters, another source of error is failure to keep the machine clean and calibrated. Once the color is developed, it is relatively stable, so patients can be instructed to bring developed strips to the physician's office so that the accuracy can be checked.

Glucose oxidase strips cost about 50 cents each and reflectance meters average $150. It has been estimated that if 20% of the Type I diabetics in the country were to be involved in a 4-time-a-day home glucose measurement program, the approximate annual cost would be $225 to $645 million. On the other hand, the estimated expenditure for the care of Type I diabetics in 1982 was in excess of $6 billion. The cost of reagents is decreasing. In fact, patients who visually read the reagent strips can realize a 50% reduction in cost by cutting the strips in half lengthwise. A patient who has a laboratory determination of blood sugar on a weekly or biweekly basis may save money by learning home glucose measurement. This author believes that all Type I (IDDM) diabetics should be on a frequent home blood glucose monitoring program. Patients with Type II diabetes mellitus should also be taught home glucose monitoring, although the measurements need not be as frequent.

With third-party hospital payments now tied to the diagnosis rather than to services rendered (DRGs), hospitals are looking for ways to reduce the cost of laboratory tests. Increasing numbers of hospitals are training ward staff to use glucose oxidase strips to monitor blood sugars, in the same fashion as urine sugars have traditionally been monitored in the hospital. Before such a plan is instituted, an effective educational program for the staff must be in place as well as an effective means of quality control.

Glycosylated Hemoglobin

Certain conditions, such as uremia, aspirin ingestion, and alcoholism, can cause spurious elevations of glycosylated hemoglobin. Falsely low percentages of glycosylate hemoglobins can be caused by uremia, anemia, variant hemoglobins such as hemoglobin S, and pregnancy. The sensitivity of the measurement of hemoglobin A1c is such that the test cannot be used to diagnose diabetes, but it is a useful means of following the blood glucose control of the diabetic patient. The measurement of other glycosylated proteins are being studied and may eventually supplant glycosylated hemoglobin measurements.

Glucose Tolerance Testing

The oral glucose tolerance test is fraught with potential problems, and strict adherence to protocol must be followed to reach a valid conclusion. Patients must not be experiencing acute medical or surgical stress. They should be tested several months after recovery. Patients who are chronically malnourished or who have been carbohydrate restricted will have exaggerated blood sugar responses. In general, the patient should have at least a 150 g carbohydrate intake and normal physical activity for 3 days preceding the test. Patients who have been confined to bed for 3 or more days should also have the test delayed until after recovery. If possible, patients should discontinue all medications for 3 days prior to testing. Patients who have undergone a recent gastrectomy should be watched carefully for alimentary hypoglycemia.

An abbreviated screening glucose tolerance test is recommended for all women between their 24th and 28th week of pregnancy. The test consists of 50 g of oral glucose and the measurement of venous plasma glucose 1 hour later. The test may be administered at any time of day and non-fasting. A 1 hour plasma glucose of 140 mg/dl or greater indicates the need for a full-scale glucose tolerance test as described above.


BSc 1407 MB Ch. 45: Hormones and the Endocrine System

Part A - Endocrine glands in the human brain
Each of the following phrases describes the structure, function, or regulation of either the hypothalamus, posterior pituitary, or anterior pituitary.

posterior pituitary:
- is an extension of the hypothalamus
- releases oxytocin and ADH

Part B - Regulation of prolactin in lactating mammals

Prolactin (PRL) is a pituitary hormone that regulates milk production in lactating mammals.

PRL production is controlled by hormones produced in the hypothalamus. In response to either the presence or absence of a specific stimulus, a signal is sent to the brain that triggers the hypothalamus to secrete either a releasing hormone or an inhibitory hormone. The flowchart below shows the pathways for PRL production and regulation.

Part C - Malfunction in a control pathway for prolactin
Suppose that a woman had to have part of her thyroid gland surgically removed. She would most likely suffer from a condition known as hypothyroidism due to too little thyroid function.

Predict how this woman's hypothyroidism would affect prolactin levels in her body.

b. body cells take up more glucose

c. liver takes up glucose and builds glycogen

d. blood glucose levels fall

e. alpha cells of pancreas release glucagon

f. liver breaks down glucgon and releases glucose

Part A - Understanding the experimental design

Part C - Reading and interpreting data from the table

Part G - Testing the hypothesis

Part A - What do a person's chromosomes indicate about sex?

You begin your investigation by examining the chromosomes of the two athletes with a karyotype analysis (a procedure that isolates an entire set of chromosomes when they are condensed for mitosis). The results are shown below, along with control samples from a normal female and a normal male.

Part B - How can someone with a Y chromosome develop as a female?
One key determinant of sex determination is the SRY gene itself. This gene is located on the Y chromosome, and the protein it encodes is a DNA binding protein that regulates other genes. The normal action of the SRY protein is to induce transcription of a second DNA binding protein, SOX9. The SOX9 gene is located on the X chromosome. The SOX9 protein acts to induce transcription of other genes that lead to the development of testes. Mutations that disrupt SRY or SOX9 protein function thus block the formation of testes. XY individuals with these types of mutations develop as sterile females.

To investigate the possibility that the two female athletes have defects in their SRY or SOX9 genes, you decide to perform a gel-shift assay. Because SRY and SOX9 function as DNA binding proteins, it is possible to detect when they bind to a target DNA fragment. DNA fragments bound to SRY or SOX9 protein will migrate more slowly in an electrophoretic gel, since the DNA-protein complex has a higher molecular weight than the target DNA fragment alone. Binding of the protein to the target DNA thus "shifts" the DNA band higher up on the gel.

Part D - Predicting the effects of different mutations on sex development

b. XY indvidual develops as anatomically female with internal testes

c. AR-testosterine complexes enter the nucleus AR-regulated target genes are transcribed at REDUCED levels

d. XY individual develops with partially masculinized genitailia and internalized testes

e. AR-testosterone complexes enter the nucleus AR-regulated target genes are NOT transcribed

f. XY individual develops as anatomically femail with internal testes

g. AR-testosterone complexes enter the nucleus AR-regulated target genes are trascribed at REDUCED levels


What should my blood sugar levels be?

Your blood sugar level changes depending on what you've eaten, whether you've exercised and other factors (more on that later) but we have some general guidelines to determine what levels are healthy.

For generally healthy individuals (without diabetes) who haven't eaten for eight hours or more, a normal blood sugar level is between 70-99 mg/dL. When you've eaten in the past two hours, it should be no higher than 140 mg/dL. To refresh your chemistry knowledge, that unit is milligrams per deciliter (one tenth of a liter) and it's measuring the amount of glucose present in your blood.

Only a medical professional can diagnose diabetes or another issue with your blood sugar, so if you're concerned about your blood sugar levels, check with a doctor.


Salivary Glucose Concentration and Excretion in Normal and Diabetic Subjects

The present report aims mainly at a reevaluation of salivary glucose concentration and excretion in unstimulated and mechanically stimulated saliva in both normal and diabetic subjects. In normal subjects, a decrease in saliva glucose concentration, an increase in salivary flow, but an unchanged glucose excretion rate were recorded when comparing stimulated saliva to unstimulated saliva. In diabetic patients, an increase in salivary flow with unchanged salivary glucose concentration and glucose excretion rate were observed under the same experimental conditions. Salivary glucose concentration and excretion were much higher in diabetic patients than in control subjects, whether in unstimulated or stimulated saliva. No significant correlation between glycemia and either glucose concentration or glucose excretion rate was found in the diabetic patients, whether in unstimulated or stimulated saliva. In the latter patients, as compared to control subjects, the relative magnitude of the increase in saliva glucose concentration was comparable, however, to that of blood glucose concentration. The relationship between these two variables was also documented in normal subjects and diabetic patients undergoing an oral glucose tolerance test.

1. Introduction

Many authors found higher glucose salivary levels in diabetic patients than in nondiabetics [1–11]. Such investigations aimed mainly at exploring whether diabetic control could be monitored by a noninvasive method of salivary glucose measurement [1–4]. The latter remains, however, a matter of controversies [5–8]. Several factors may account for the poor correlation between blood and saliva glucose concentrations prevailing in diabetic subjects. They include oral retention of alimentary carbohydrates [12, 13], glucose utilization by oral bacteria [14], release of carbohydrates from salivary glycoproteins [15, 16], and contamination of saliva by a large outflow of crevicular fluid in patients with a poor gingival status [17, 18].

In considering the relationship between salivary glucose concentration and salivary flow, the present study mainly aimed at re-evaluating salivary glucose concentration and excretion in unstimulated and mechanically stimulated saliva in both normal and diabetic subjects.

2. Materials and Methods

2.1. Subjects

The present report deals with five sets of experiments. The first set of experiments was conducted in 38 normal subjects, including 16 males and 22 females with respective mean ages (±SEM) of

years. The second set of experiments was conducted in 84 diabetic patients, including 36 males and 48 females with mean respective ages of

and years. The third set of experiments was restricted to 9 normal subjects and 18 diabetic patients. At variance with the first two sets of experiments, it did not include measurements of salivary flow and, hence, glucose excretion rates. The fourth set of experiments consisted of an oral glucose tolerance test conducted in 4 normal subjects and 2 diabetic patients. The last set of experiments concerned 3 healthy subjects and 2 diabetic patients, examined at the occasion of successive samplings of stimulated saliva in the absence of any change in glycemia. The diabetic patients were treated and appropriate control subjects were recruited from the Endocrinology Department, Istanbul University Medical School, Istanbul, Turkey, and the Stomatology Department, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium. All experiments and sample collections, as well as saliva glucose measurements, were performed by the same investigator either in Turkey or Belgium.

The present research was conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki.

2.2. Saliva Sample Collection

To collect saliva, a standardized tube with two compartments and a standardized cotton were used. Both the cotton and two-compartment tube were obtained from the same manufacturer (SalivetteTM, Starstedt, Nümbrecht, Germany). The upper part of the tube containing the cotton presented a hole, so that, after centrifugation, the saliva was recovered in the lower part and became available for analysis.

Saliva was collected in fasting subjects, immediately after rinsing the oral cavity two times with 150 mL of water and drinking this water, by means of cotton kept in the oral cavity for 1 to 3 minutes either in the unstimulated state or during mastication (stimulated saliva). The cotton was transferred in the upper part of the tube. Salivary flow was determined by weighing the device with the cotton before and after saliva collection, assuming that 1 g of saliva corresponds to 1 mL. Centrifugation of the device at 2000 g for 5 minutes allowed the saliva adsorbed to the cotton to pass through the orifice into the lower compartment of the device, the saliva being then immediately frozen at

Although salivary flux could be affected by the use of salivette, the latter was used to standardize the collection of saliva, for hygiene reasons, and to remove particles from the saliva.

Blood was taken from finger tip, and blood glucose concentration was measured by the glucose oxidase method [19].

2.3. Salivary Glucose Assay

Salivary D-glucose concentration was determined by the hexokinase method adapted from [20]. 100

L centrifuged saliva was mixed with 95 L of reagent medium containing 2.0 mM MgCl2, 0.5 mM ATP, 0.5 mM NADP + , and 0.06 units of yeast glucose 6-phosphate dehydrogenase in TRIS-HCl buffer (200 mM, pH 8.1). After a first reading of the absorbance at 340 nm, the reaction was started by the addition of 5 L yeast hexokinase in reagent medium (0.06 units). The absorbance at 340 nm was recorded after 30-minutes incubation at room temperature. The assay was simultaneously conducted on glucose standards (final concentration comprised between 5 and 250 M). The results were calculated as nmol of glucose/mL saliva after the subtraction of reading in the absence of hexokinase and taking into account glucose standards and saliva volume.

The coefficient of variation is, respectively,

) for D-glucose standards and saliva samples. The standard curve of glucose between 5 to 250 M is linear with a correlation coefficient of 0.999. Our method can measure as little as 0.5 nmol of glucose with a variation coefficient of 4.3%.

2.4. Statistical Analaysis

All results are presented as mean values (±SEM) together with the number of individual determinations (n) or degree of freedom (d.f.). The statistical significance of differences between mean values was assessed by the use of Student’s t-test.

3. Results

In a large series, the glucose concentration was

(111) and M (126), respectively, in unstimulated and stimulated saliva from normal subjects.

A first study was conducted in 38 normal subjects, including 16 males and 22 females. The glucose concentration averaged

M ( ) in unstimulated saliva, as distinct (

) from only M ( ) in stimulated saliva. The salivary flow increased ( ) from a basal value of mL/min to a stimulated value of mL/min ( in both cases). The glucose excretion rate failed, however, to differ significantly (

) in unstimulated saliva ( nmol/min ) and stimulated saliva ( nmol/min ), with a mean paired difference between unstimulated and stimulated saliva of nmol/min ( ). As a rule, these variables did not differ significantly in male versus female subjects (Table 1). The stimulated salivary flow, however, was higher ( ) in male than in female subjects.

A comparable study was then conducted in 84 diabetic patients, including 15 subjects with type-1 diabetes (6 males and 9 females) and 69 subjects with type-2 diabetes (30 males and 39 females). The glucose concentration averaged M ( ) in unstimulated saliva and M ( ) in stimulated saliva. The salivary flow increased ( ) from a basal value of mL/min to a stimulated value of mL/min ( in both cases). The glucose excretion rate, however, failed to differ significantly ( ) in the unstimulated saliva ( nmol/min ) and stimulated saliva ( nmol/min ). None of these variables differed significantly in type-1 and type-2 diabetic patients of the same gender. Likewise, the glucose concentration failed to differ significantly in male and female diabetic patients, whether in unstimulated or stimulated saliva. The basal salivary flow and glucose excretion rate were lower ( or less), however, in female diabetic patients than in male diabetic subjects (Table 1). Moreover, a significant increase in salivary flow ( ) and glucose excretion rate ( ), in response to stimulation, was only observed in the female diabetic patients (Table 1).

The glycemia in the diabetic patients averaged mM ( ), representing about twice the mean value otherwise found in normal subjects (see below). Likewise, the glucose concentration in unstimulated saliva was about twice higher in the diabetic patients ( M ) than in the control subjects ( M ). In the diabetic patients, as compared to control subjects, the relative magnitude of the increase in unstimulated saliva glucose concentration thus failed to differ significantly ( ) from that in glycemia. The unstimulated saliva flow was also somewhat higher ( ) in the diabetic patients ( mL/min ) than in the control subjects ( mL/min ). Hence, the mean basal glucose excretion rate was about thrice higher ( ) in diabetic patients ( nmol/min ) than in the control subjects ( nmol/min ).

In a further set of experiments, the glucose concentration in stimulated saliva was again found to decrease ( , paired comparison) from an unstimulated value of to M ( ) in healthy subjects, whilst no significant decrease ( ) was observed in 18 diabetic patients. In this set of experiments, the glycemia averaged in diabetic patients mM ( ) as compared ( ) to mM ( ) in control subjects, yielding a diabetic/control ratio of 177%. Likewise, the glucose concentration in basal and stimulated saliva averaged in the diabetic patients 179.7% of the mean corresponding values found in control subjects. In the diabetic patients, as compared to control subjects, the relative magnitude of the increase in saliva glucose concentration was thus, once again, comparable ( ) to that of blood glucose concentration, with an overall diabetic/control ratio of % ( versus the reference value of % ).

In order to investigate further the relationship between blood and saliva glucose concentration, an oral glucose tolerance test (75 g) was conducted in 4 normal subjects and 2 diabetic patients (Figure 1). The glucose concentration in unstimulated saliva progressively increased during the first 30 minutes of the test, reaching a peak value which averaged % ( ) of paired basal measurement. Thereafter, the glucose concentration in unstimulated saliva samples progressively decreased, eventually reaching at minutes 120–180 nadir values representing no more than % ( ) of paired basal measurement.


(a)
(b)
(a)
(b) Time course for the changes in glycemia and unstimulated saliva glucose concentration in 4 normal subjects and 2 diabetic patients during an oral glucose tolerance test. Geometric mean values (±SEM) refer to results expressed in percent of paired basal value.

The unexpected fall in saliva glucose concentration below basal value observed during the late part of the oral glucose tolerance test led us to measure such a concentration at the occasion of successive samplings in the absence of change in glycemia. As illustrated in Figure 2, which refers to a study conducted in 3 healthy subjects and 2 diabetic patients from whom 8 successive samples of stimulated saliva were collected over a period of 17 minutes, a progressive fall in glucose concentration was indeed recorded under these experimental conditions.


Time course for the changes in glucose concentration during successive samplings of stimulated saliva in 5 subjects. Geometric mean values (±SEM) refer to results expressed in percent of paired first measurement.

Figure 3 illustratesthe mean values for saliva glucose concentrations, salivary flow, and glucose excretion rate in all unstimulated and stimulated samples collected in this study. It emphasizes the decrease in glucose concentration ( ), increase in salivary flow ( ), but unchanged glucose excretion rate ( ) recorded in normal subjects when comparing stimulated to unstimulated saliva. It also documents the increase in salivary flow ( ) with unchanged salivary glucose concentration ( ) and glucose excretion rate ( ) observed under the same experimental conditions in diabetic patients. Last, it illustrates the marked increase ( ) in salivary glucose concentration and glucose excretion rate found in diabetic patients, as compared to normal subjects, whether in unstimulated or stimulated saliva. The latter finding contrasts with more modest differences ( or less) between normal subjects and diabetic patients for unstimulated or stimulated salivary flow, the results collected in the latter patients averaging

% ( ) of the corresponding mean values recorded under the same experimental conditions in normal subjects ( % ).


Glucose concentration, salivary flow, and glucose excretion rate for unstimulated (open columns) and stimulated (hatched columns) saliva in normal subjects and diabetic patients. Mean values (±SEM) are derived from all data collected in the present study and, hence, refer to 33–101 individual measurements.

Despite the high number of individual determinations, no significant correlation was found in the diabetic patients between glycemia and either glucose concentration (

d.f. = 91 ) or glucose excretion rate ( d.f. = 72 ) in unstimulated saliva. Likewise, no significant correlation could be found in the diabetic patients between glycemia and either glucose concentration ( d.f. = 98 ) or glucose excretion rate ( d.f.=81 ) in stimulated saliva.

4. Discussion

In the present study, the unstimulated salivary flow was higher compared to the unstimulated saliva flow of about 0.4 mL/min observed in many studies [21–26]. This situation is probably linked to the use of a salivette for the collection of saliva.

The present results confirm that the glucose concentration in saliva is higher in diabetic patients than in control subjects [1–11]. It extends this knowledge to both unstimulated and stimulated saliva. It also confirms that, in both normal subjects and diabetic patients, the salivary flow is higher in stimulated as compared to unstimulated saliva [7, 21–28]. Despite such an increase, the glucose excretion rate, taken as the product of saliva glucose concentration multiplied by salivary flow, failed to differ significantly under unstimulated and stimulated conditions, whether in normal subjects or diabetic patients. The latter finding argues in support of a dissociated regulation of salivary flow (increased by mechanical stimulation) and glucose release by salivary glands (unaffected by mechanical stimulation).

The dependency of saliva glucose concentration on glycaemia was further documented by the time course of changes in the former variable during an oral glucose tolerance test, as documented in both normal subjects and diabetic patients. During the glucose tolerance test (OGTT), the salivary glucose level increased twofold within 60 minutes, as observed previously [29, 30]. The measurements of saliva glucose concentrations made during such an oral glucose tolerance test led us to observe, in a further set of experiments, that such a concentration decreases at the occasion of successive samplings of stimulated saliva, such a decrease occurred despite unchanged salivary flow. Its pattern was reminiscent of the rapid clearance of exogenous glucose from the saliva of human subjects otherwise observed during the first 6 to 8 minutes, followed by a much slower clearance thereafter [30–32].

No significant difference between type-1 and type-2 diabetic subjects was detected in the present study, and no significant correlation between glycemia and glucose saliva concentration or glucose excretion rate was found in the diabetic patients, whether in unstimulated or stimulated saliva. These findings confirm the poor link between glycaemia and glucose concentration or excretion in saliva, at least on an individual basis [5–8]. Nevertheless, the present study may well set the scene for further investigations on the regulation of glucose output from salivary glands, as well as on the potentially unfavorable effect of a high glucose salivary concentration on selected variables of oral health status in diabetic patients.

Acknowledgment

This study was supported by the Belgian Foundation for Scientific Medical Research (Grant 3.4520.07).

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Copyright

Copyright © 2009 Cedric Jurysta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


What to know about fasting blood sugar?

Fasting blood sugar levels give vital clues about how a person’s body is managing blood sugar. Blood sugar tends to peak about an hour after eating and declines after that.

High fasting blood sugar levels point to insulin resistance or diabetes, while abnormally low fasting blood sugar could be due to diabetes medications.

Knowing when to test and what to look for can help keep people stay healthy, especially if they have diabetes or are at risk of developing the condition.

Share on Pinterest A healthcare professional may recommend using a glucometer to test daily levels of fasting blood sugar.

The body needs glucose for energy, and glucose comes from the food we eat. However, the body does not use all of this energy at once. Insulin makes it possible to store and release it as necessary.

Following a meal, blood sugar levels rise, usually peaking about an hour after eating.

How high blood sugar rises, and the precise timing of the peak depends on the person’s diet.

Factors relating to food that can trigger significant rises include:

  • eating large meals
  • consuming sugary foods and drinks
  • eating foods with simple carbohydrates, or carbs, such as bread and sweet snacks

As blood sugar rises, the pancreas releases insulin. Insulin lowers blood sugar, breaking it down so that the body can use it for energy or store it for later.

However, people who have diabetes have difficulties with insulin in one of two ways:

1. Those with type 1 diabetes do not produce enough insulin because their body attacks its insulin-producing cells.

2. Those with type 2 diabetes do not respond well to insulin in their body and, later, may not make enough insulin.

In both cases, the result is the same, with people experiencing high blood sugar levels and difficulty using glucose, or blood sugar.

This means that fasting blood sugar depends on three factors:

  • the contents of a person’s last meal
  • the size of their previous meal
  • their body’s ability to produce and respond to insulin

Blood sugar levels between meals offer a window into how the body manages sugar. High levels of fasting blood sugar suggest that the body has been unable to lower the levels of sugar in the blood.

This points to either insulin resistance or inadequate insulin production and, in some cases, both.

When blood sugar is very low, diabetes medications may be lowering blood sugar too much.

There are two methods that individuals or healthcare professionals use for assessing fasting blood sugar levels:

1. A conventional blood sugar test

2. A glycosylated hemoglobin (HbA1c) test

The HbA1c test

The HbA1c test measures how the body is managing blood sugar over time, usually the last 2–3 months.

The person will undertake this test at the doctor’s office or in a lab. If levels are very high, the individual may need a second test. The results show as a percentage.

HbA1c is the main test that doctors use to manage diabetes.

Blood sugar testing at home

A person can test their blood sugar levels at home.

In most cases, doctors ask people to measure fasting blood sugar immediately upon waking and before they have anything to eat or drink. It may also be appropriate to test blood sugar before eating or sometimes 2 hours after a meal when blood sugar has returned to normal levels.

The right time to test is dependant on treatment goals and other factors. For example, most people with diabetes do not need to test between meals unless they are using a diabetes drug that can lower blood sugar. Other people may test between meals if they feel their sugar levels may be low.

Since they do not make any insulin, some people with type 1 diabetes need to test several times a day. They do this because they need to check their levels regularly in order to adjust their insulin dose at that time.

To do the blood sugar test, a person will:

  • Prepare the testing strip and glucose monitor to be ready for the blood sample.
  • Clean the testing area, usually the side of a fingertip, using an alcohol swab.
  • Lance the testing area. Bracing against a firm surface can help with the impulse to pull away.
  • Squeeze the testing area around the wound to maximize blood flow.
  • Squeeze a drop of blood onto the test strip.
  • Put the strip into the monitor.
  • Record the time, blood sugar reading, and recent food intake in a log.

Find out more here about blood sugar testing at home.

Blood glucose monitoring kits for use at home are available for purchase online.

Continuous glucose monitoring

Another option for daily use is continuous glucose monitoring (CGM).

For CGM, a person wears a monitor 24 hours a day. The monitor records their blood glucose levels on an ongoing basis.

CGM can give a more accurate picture of a person’s levels and fluctuations throughout the day. However, this type of kit is more expensive to buy.

There are also non-fasting blood tests.

Random plasma glucose (RPG): The doctor does a conventional blood sugar test when the person is not fasting. Find out more here.

Oral glucose tolerance test (OGTT): A healthcare provider takes samples of a person’s blood several times. The analysis begins with a fasting blood test. The individual with diabetes then drinks a liquid containing glucose, and the healthcare provider draws their blood every hour, three times. Learn more here about the glucose tolerance test.

Blood sugar levels vary throughout the day and with food intake, so no single blood sugar reading can reveal how well or not someone is processing sugar.

HbA1C results

According to the American Diabetes Association (ADA), the results of an HbA1C test will be one of the following:

  • Normal: less than 5.7 percent
  • Prediabetes: between 5.7 and 6.4 percent
  • Diabetes: 6.5 and over

Prediabetes is when blood sugar is high but not as high as in diabetes. People can take measures that may reverse it and stop diabetes from developing. Find out more here.

Home testing

Target blood sugar numbers are as follows , in milligrams per deciliter (mg/dl):

  • Fasting (morning testing before food or water): 80–130 mg/dl
  • Two hours after starting a meal: Under 180 mg/dl

However, the target numbers will vary between individuals. A healthcare professional will help a person identify their own target levels.

It is vital to follow a healthful diet to keep fasting blood sugar from rising too high. Strategies include:

  • Limiting the intake of sugar and salt.
  • Choosing whole-grain bread and pasta instead of white bread and pasta.
  • Eating foods that are rich in fiber to help the body lower blood glucose levels.
  • Eating high-protein foods to support feelings of fullness.
  • Choosing non-starchy vegetables that are less likely to trigger blood glucose spikes.

People who are taking diabetes drugs and who are at risk of dangerous blood sugar dips should follow a similar diet. They also need to take proactive steps to prevent blood sugar from dropping. Those include:

  • Eating regular meals throughout the day.
  • Increasing food intake and snacking frequency during intense physical activity.
  • Avoiding or limiting alcohol beverages.
  • Consulting a doctor if vomiting or diarrhea make it difficult to manage blood sugar.

People are likely to experience symptoms if their blood sugar levels are too low or too high.

Low blood sugar levels

Blood sugar that is too low can cause symptoms such as:

  • shaking and sweating
  • feeling jittery
  • difficulty concentrating
  • lack of energy
  • pale skin or tiredness or muscle aches
  • fast or irregular heartbeat
  • weakness
  • lack of coordination

In extreme cases, low blood sugar can trigger seizures, loss of consciousness, confusion, and the inability to drink or eat.

Very high blood sugar, or hyperglycemia, can cause the following symptoms:

  • increased hunger or thirst
  • excessive urination
  • blurred vision
  • headache
  • tiredness

As with low blood sugar, high blood sugar may cause loss of consciousness or seizures if people leave them untreated. Persistent high levels can increase the risk of serious complications that doctors relate to diabetes, such as cardiovascular disease.

If a person’s blood sugar levels are high more than three times in a 2-week period without an apparent reason, the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) recommend that they seek medical help.

Any significant change in blood sugar patterns warrants a visit to a doctor. People with diabetes and those at risk of diabetes should also consult a doctor if:

  • blood sugar levels become unusually high or low
  • well-managed blood sugar levels are suddenly start fluctuating
  • people have new or worsening symptoms of diabetes
  • they change their medication or stop using it
  • they experience abnormally high blood pressure
  • they develop an infection or sore that will not heal

Diabetes needs ongoing monitoring, and the treatment can change over time. Information about diet and exercise is vital to enable a doctor to outline a proper treatment plan for each person individually.

People with diabetes can assist their doctor by keeping detailed logs and being transparent and accurate about dietary or lifestyle changes.


Diabetes Mellitus - The Work Pays Off

Diabetes mellitus, commonly referred to as diabetes, means sweet urine. It is a chronic medical condition associated with abnormally high levels of sugar (glucose) in the blood. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes mellitus, the absence or insufficient production of insulin causes hyperglycemia.

Diabetes mellitus is a chronic medical condition, meaning it can last a life time. Over time, diabetes mellitus can lead to blindness, kidney failure, and nerve damage. Diabetes mellitus is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart diseases, and other blood vessel diseases in the body.

Diabetes mellitus affects 12 million people (6% of the population) in the United States. The direct and indirect cost of diabetes mellitus is $40 billion per year. It is the third leading cause of death in the United States after heart disease and cancer.

In the United States, diabetes mellitus is the leading cause of new blindness in adults, kidney failure, and amputations (not caused by injury). The lack of insulin, insufficient production of insulin, production of defective insulin, or the inability of cells to use insulin leads to elevated blood glucose (sugar) levels, referred to as hyperglycemia, and diabetes mellitus.

Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. After meals, food is digested in the stomach and the intestines. The glucose in digested food is absorbed by the intestinal cells into the bloodstream, and is carried by blood to all the cells in the body. However, glucose cannot enter the cells alone. It needs assistance from insulin to penetrate the cell walls.

Without insulin, cells become starved of glucose energy despite the presence of abundant glucose in the blood. In diabetes mellitus, the cells' inability to utilize glucose gives rise to the ironic situation of starvation in the midst of plenty. The abundant, unused glucose is wastefully excreted in the urine. Insulin is a hormone which is produced by specialized cells (islet cells) of the pancreas. In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood.

The pancreas is a deeply seated organ in the abdomen located behind the stomach. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels. When the blood glucose levels are lowered, the insulin release from the pancreas is turned off. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range.

In patients with diabetes mellitus, the insulin is either missing (as in type I diabetes mellitus), or insulin regulation is defective and insufficient (as in type II diabetes mellitus). Both cause elevated levels of blood glucose (hyperglycemia).

The long-term complications of diabetes mellitus result from the effect of hyperglycemia on the blood vessels. Blood vessel damage eventually leads to disease of the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy) For patients with type I diabetes mellitus, tight control of the blood sugar was ultimately proven in 1993 to decrease the frequency and intensity of the effects of diabetes on the eyes, nerves, and kidneys.

For patients with type II diabetes mellitus, proof of the benefit (in terms of reduction of long-term complications) of careful control of blood sugar has awaited further research studies. A study published in Annals of Internal Medicine (1997127:788-795) documents substantial benefit from careful control of the blood sugar in patients with type II diabetes mellitus.

Sandeep Vijan, M.D. and colleagues at the University of Michigan found that patients with type II diabetes mellitus who diligently kept their blood sugar levels as close as possible to normal over time had far less kidney and eye disease than those who did not. This effect was especially significant for patients whose diabetes was detected at younger ages (less than 50 years of age).

This important study suggests that good control of the blood sugar over time is extremely important for patients with type II diabetes mellitus as well as type I. Therefore, while meticulous sugar control in patients with diabetes mellitus can take substantial effort from both patient and doctor, in the long run it pays off.


Watch the video: Die Regulation des Blutzuckers (July 2022).


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