Glucose control

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Blood glucose (which can be abbreviated BG) or blood sugar is our
constant source of energy. Maintaining healthy levels of glucose is
intrinsic to good health. The brain, in particular, requires a constant
supply of glucose.

When the body is functioning properly, glucose is maintained in a fairly
narrow range. When glucose levels rise, the pancreas releases insulin
which moves glucose from the blood to the cells. When glucose levels
are too low, the body has a variety of ways to correct them.

Blood glucose levels are directly affected by:
• Food
• Cortisol levels
• Exercise
• Medications
• Supplements

Glucose levels and insulin resistance
Glucose levels fluctuate throughout the day, as it is normal for glucose
to rise after eating and then return to fasting levels over a period of
time. Glucose in the blood is controlled by insulin and glucagon,
hormones secreted by cells within the pancreas.

Insulin, which allows glucose is be absorbed by cells from blood, is
increased in response to the elevation of glucose levels and/or the
need for glucose in the body. As blood glucose falls, insulin secretion is
reduced. When blood glucose is low, such as between meals or during
sleep, glucagon is secreted to make the liver release the glucose
stored in its cells, which results in increased blood glucose.

It is very common for someone with ongoing high blood glucose levels
to develop insulin resistance, requiring more and more insulin to control
blood glucose.

Excess insulin can:
• Elevate sodium
• Elevate blood pressure
• Cause edema
• Contribute to congestive heart failure
• Contribute to cardiovascular disease
• Negatively affect magnesium storage
• causing blood vessels to constrict
• elevating blood pressure
• possibly causing coronary arterial spasm and heart attack

Insulin resistance is made worse by:
• Low thyroid
• High reverse T3
• Low estrogen and/or testosterone

While insulin itself cannot be accurately tested, C peptide levels are a
useful substitute.

Elevated Insulin may indicate a need for testosterone or estrogen, and
insulin resistance may be helped by optimizing testosterone and
thyroid.

Insulin resistance leads to impaired glucose tolerance resulting in Type
2 Diabetes. The insulin resistance can develop as much as ten years
before the diagnosis of Type 2 Diabetes. People with insulin resistance
will often have normal fasting glucose levels for many years, while
having high post-prandial (after meal) glucose that isn't caught on
fasting glucose labs. (Fasting glucose is generally included as part of a
BMP or CMP for routine screening.)

A Hemoglobin A1c (HbA1c or A1c) lab that provides a measure of
average glucose over the previous two to three months is used to
diagnose Type 2 Diabetes. The dysregulation of glucose is often first
recognized when an A1c lab is ordered because the patient complains
of other issues that have resulted from chronically high glucose levels.

These can include:
• Obesity (glucose not moved into cells for energy is stored as fat)
• Atherosclerosis
• Peripheral neuropathy (nerve damage and pain, particularly of hands
and feet)
• Diabetic retinopathy (eye damage)
• Diabetic nephropathy (kidney disease)

There is a wide range of both fasting glucose and HbA1c results that
are considered "normal" by medical standards that are not, in fact,
healthy. By the time a person receives a diagnosis of Type 2 Diabetes,
she or he will often be suffering from many serious complications
caused by chronically elevated glucose and insulin.

Studies have demonstrated an approximately 35 percent decrease in
relative risk for microvascular disease for every one percent reduction
in A1c.

Intensive home glucose testing
Testing at home can help identify how the foods eaten affect blood
glucose, allowing informed choices about what to eat and drink. A
home blood glucose meter and test strips are needed. The strips are
generally quite expensive. However, this testing is for a limited time,
after which a daily check of fasting glucose may be enough to monitor
blood glucose. Some large chain stores offer store brands of meters
and strips which are less expensive. Google the accuracy of the meters
before choosing.

Method
• Just before a meal that is high in carbohydrates (starches, including
whole grains, and sweets, including fruits), test glucose and write down
the result

• Weigh the foods to be eaten and record the result
• Set a timer to go off every 15 minutes beginning with the first bite
• Every 15 minutes, test glucose again and write that down
• Test for at least two hours; more is better, particularly as hypothyroid
people tend to have slower digestion than others

Do this around several meals over the course of a few days.  If glucose
routinely rises above 120 mg/dL (6.7 mmol/L), reduce the carbs in
meals and test some more.

Addressing high glucose
• Reduce carbohydrates, particularly starches and sweets
• Take magnesium to help reduce insulin resistance
• Take supplements that may help control glucose
• some also lower cortisol, which are not appropriate for those who
have low cortisol issues or are taking a replacement dose of
hydrocortisone
 
• Exercise
• use of the large muscles of the body depletes glucose in those
muscles, in turn causing glucose to be drawn out of the blood to
restore glucose in the muscles
 
• for those who have issues with cortisol production or are taking
replacement glucocorticoids, should be very mild and gentle such
as slow walks, yoga, T'ai Chi, and similar activities (without
breaking a sweat)
  
• Use prescription medication
• metformin to improve insulin resistance
• medication which primarily causes the pancreas to excrete more
insulin can have two negative consequences and should be
avoided:
 
• hypoglycemia becomes more likely
• over the long term, beta cells which create and store insulin will
burn out, becoming less effective, a consequence that is not
reversible

For more information on achieving truly healthy levels of glucose
control, visit Dr Bernstein's website, http://www.diabetes-book.com/
For someone with an HbA1c over 5.0 (US) or 30 (outside the US),
consider following Dr Bernstein's guidelines to control BG levels and
get one's A1c down to a truly non-diabetic level.

Hypoglycemia
Blood glucose levels below 65 mg/dL (or 3.6 mmol/L) are considered
hypoglycemic. (A person whose glucose levels are usually elevated
above 100 mg/dL may feel hypoglycemic at levels above 65, but not
actually be suffering from hypoglycemia.) Hypoglycemia occurs when
the usual mechanisms which correct low glucose do not work properly.
Hormonal dysfunction is the most common cause. It can also occur in
diabetics from too much insulin or other diabetes medications such as
sulfonylureas.

Other medications which can cause hypoglycemia include:
• Quinine
• Quinidine
• Haloperidol
• Trimethoprim-sulfamethoxazole (Bactrim)
• Pentamidine
• MAO inhibitors
• Diuretics

Hypoglycemia can also be caused by:
• Disease or dysfunction of the liver, the pancreas and pituitary or
adrenal glands
• Excessive alcohol without eating

• Fasting hypoglycemia occurs after not eating for a period of time,
such as overnight. Reactive hypoglycemia usually occurs after eating a
meal high in carbohydrates.

• Symptoms of hypoglycemia can include
• shakiness
• severe hunger
• confusion
• becoming weak, tired, sleepy or dizzy
• difficulty speaking
"brown-out" of vision
• headache
• trouble concentrating

• Someone suffering from severe hypoglycemia may appear drunk.

• If adrenaline is released by the body to combat hypoglycemia,
symptoms can include:
• anxiety
• sweating
• elevated heart rate
• nausea
• trembling

• Nighttime hypoglycemia may cause awakening between 2 and 3 a.m.
as a result of the adrenal reaction to very low glucose.

• In pregnancy, hypoglycemia can occur from gestational diabetes.

• Hypoglycemic symptoms can come on gradually or suddenly.

Severe hypoglycemia can be life-threatening. Anyone suspecting
hypoglycemia should treat it immediately with fast-acting glucose
tablets or a beverage such as juice or milk. The best approach is to test
glucose with a home meter, then take just the amount of glucose
tablets needed to raise glucose to about 80-85 mg/dL (or 4.4-4.7
mmol/L). If the hypoglycemia is due to an overdose of insulin,
emergency responders should be immediately called.
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