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diabetes FAQ: general (part 1 of 5)

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Archive-name: diabetes/faq/part1
Posting-Frequency: biweekly
Last-modified: 15 Dec 2006 (excludes change list and Table of Contents)

See reader questions & answers on this topic! - Help others by sharing your knowledge
Changes: add aspartame topic in research section (14 July 2005)
          fix Avogadro's number (15 Dec 2006)
          correct U of Louisville link (10 March 2009)


Subject: READ THIS FIRST Copyright 1993-2006 by Edward Reid. Re-use beyond the fair use provisions of copyright law and convention requires the author's permission. Advice given in m.h.d is *never* medical advice. That includes this FAQ. Never substitute advice from the net for a physician's care. Diabetes is a critical health topic and you should always consult your physician or personally understand the ramifications before taking any therapeutic action based on advice found here or elsewhere on the net.
Subject: Table of Contents INTRODUCTION (found in all parts) READ THIS FIRST Table of Contents GENERAL (found in part 1) Where's the FAQ? What's this newsgroup like? Abuse of the newsgroup The newsgroup charter Newsgroup posting guidelines What is glucose? What does "bG" mean? What are mmol/L? How do I convert between mmol/L and mg/dl? What is c-peptide? What do c-peptide levels mean? What's type 1 and type 2 diabetes? Is it OK to discuss diabetes insipidus here? What is it? How about discussing hypoglycemia? Helping with the diagnosis (DM or hypoglycemia) and waiting Exercise and insulin BLOOD GLUCOSE MONITORING (found in part 2) How accurate is my meter? Ouch! The cost of blood glucose measurement strips hurts my wallet! What do meters cost? Comparing blood glucose meters How can I download data from my meter? I've heard of a non-invasive bG meter -- the Dream Beam? What's HbA1c and what's it mean? Why is interpreting HbA1c values tricky? Who determined the HbA1c reaction rates and the consequences? HbA1c by mail Why is my morning bg high? What are dawn phenomenon, rebound, and Somogyi effect? TREATMENT (found in part 3) My diabetic father isn't taking care of himself. What can I do? Managing adolescence, including the adult forms So-and-so eats sugar! Isn't that poison for diabetics? Insulin nomenclature What is Humalog / LysPro / lispro / ultrafast insulin? Travelling with insulin Injectors: Syringe and lancet reuse and disposal Injectors: Pens Injectors: Jets Insulin pumps Type 1 cures -- beta cell implants Type 1 cures -- pancreas transplants Type 2 cures -- barely a dream What's a glycemic index? How can I get a GI table for foods? Should I take a chromium supplement? I beat my wife! (and other aspects of hypoglycemia) (not yet written) Does falling blood glucose feel like hypoglycemia? Alcohol and diabetes Necrobiosis lipoidica diabeticorum Has anybody heard of frozen shoulder (adhesive capsulitis)? Gastroparesis Extreme insulin resistance What is pycnogenol? Where and how is it sold? What claims do the sales pitches make for pycnogenol? What's the real published scientific knowledge about pycnogenol? How reliable is the literature cited by the pycnogenol ads? What's the bottom line on pycnogenol? Pycnogenol references SOURCES (found in part 4) Online resources: diabetes-related newsgroups Online resources: diabetes-related mailing lists Online resources: commercial services Online resources: FTP Online resources: World Wide Web Online resources: other Where can I mail order XYZ? How can I contact the American Diabetes Association (ADA) ? How can I contact the Juvenile Diabetes Foundation (JDF) ? How can I contact the British Diabetic Association (BDA) ? How can I contact the Canadian Diabetes Association (CDA) ? What about diabetes organizations outside North America? How can I contact the United Network for Organ Sharing (UNOS)? Could you recommend some good reading? Could you recommend some good magazines? RESEARCH (found in part 5) What is the DCCT? What are the results? More details about the DCCT DCCT philosophy: what did it really show? Is aspartame dangerous? IN CLOSING (found in all parts) Who did this?
Subject: Where's the FAQ? This FAQ attempts to answer the questions which have been most frequently asked in misc.health.diabetes (m.h.d). This is not a complete informational posting. My only criterion for inclusion is that the topic has frequently appeared in m.h.d, either by an explicit question, or implicitly by posting a related question or a common misconception. This FAQ is posted biweekly to the Usenet newsgroup misc.health.diabetes. If you obtained this article by some method other than reading Usenet, refer to the section on "Online resources: diabetes-related newsgroups" for brief information on how to obtain access to Usenet newsgroups and misc.health.diabetes in particular. Feel free to make copies of this FAQ for your personal use or for a friend or relative, including to share with health care providers. If you want to make this FAQ available to others on an ongoing basis (for example, on a BBS), please do *not* post or copy the entire FAQ. Instead, post only this section, entitled "Where's the FAQ?". This will enable others always to retrieve the most recent version. I have removed the outdated informational posting on insulin pumps. An informational posting on diabetes-related software is posted to m.h.d at the same time as this FAQ. See below for retrieval information. It was developed and is maintained by Rick Mendosa <mendosa(AT)mendosa.com>. I've used ideas and information from many people in writing this FAQ. With a few exceptions I haven't attempted to identify them, but I thank them all. The words herein are mine unless otherwise credited. If you read this and it helps you, please let me know what part helped, and why. If you read this and can't find what you want, let me know that too. Such comments will help me decide what is worth working on, and whether. You'd be surprised how little feedback I get. If you are reading this on the newsgroup, just reply to this article. If you found this on the web, send email to <edward@paleo.org>. These documents -- the FAQ and the software overview -- are available from the news.answers archives at rtfm.mit.edu. Using anonymous ftp, get the files: /pub/faqs/diabetes/faq/part1 /pub/faqs/diabetes/faq/part2 /pub/faqs/diabetes/faq/part3 /pub/faqs/diabetes/faq/part4 /pub/faqs/diabetes/faq/part5 /pub/faqs/diabetes/software or in web browser format: ftp://rtfm.mit.edu/pub/faqs/diabetes/ If your net access is by email only, send an email message to mail-server(AT)rtfm.mit.edu, subject ignored, body containing: send faqs/diabetes/faq/part1 send faqs/diabetes/faq/part2 send faqs/diabetes/faq/part3 send faqs/diabetes/faq/part4 send faqs/diabetes/faq/part5 send faqs/diabetes/software If you are using the World Wide Web, you can reach a WWW-formatted version of the FAQ and other documents via the URL http://www.faqs.org/faqs/diabetes/ You can also retrieve the plain text by FTP from the rtfm.mit.edu site mentioned above, which has long been the most reliable source. However, it only offers the simplest retrieval capability.
Subject: What's this newsgroup like? Posting topics range through emotional support, treatment techniques, psychological factors, health care practices, and insurance. We talk about our problems, frustrations, depressions and complications to find out how others handle the same issues and for mutual support. The atmosphere is generally a highly supportive one, and most participants believe strongly that this is an important aspect. As in other parts of the net, there are one or two regular participants who believe that it is important to question the motives and/or knowledge of anyone posting a new problem. If you find that the first response is antagonistic, please wait a few hours. Every antagonistic response will elicit a dozen sympathetic responses. Meta-topics include discussions of how to best convey health information on the Usenet, ethical treatment of other participants, what topics and information are appropriate for m.h.d, where to find diabetes information, and what the newsgroup should be like. Betsy Butler says eloquently: The positive posts of people who are in great control are very motivating, but it is also helpful to hear from people who don't find it so easy. I'm sure there are a lot of people who struggle to keep control. The people who are having trouble also need to know that there are others who struggle, and that they are not alone. It can be very intimidating, and a blow to self-esteem for people to suggest that if you would just do X, Y and Z, you will be in control. There are 100s of factors to balance, and I think people need to be reassured that "yes, it's hard to balance so many things, many of which can't be measured or that don't act predictably." Topics closely related to diabetes mellitus which do not have their own place in Usenet are welcome. Examples are diabetes insipidus, hypoglycemia, glucose intolerance, legal and employment ramifications of chronic illness, effects on family members, how family members can best provide support, and so on. misc.health.diabetes tends to be inclusive of anyone who needs it. The same caveat applies here as in all newsgroups: the advice is worth what you paid for it. This applies in spades to a critical health topic such as diabetes. Never substitute informal advice for a physician's care. Advice given in m.h.d is *never* medical advice. The variety of individual responses to diabetes is exceeded only by the variety of individual responses to life. No two patients respond alike, and many respond *very* differently from others. These differences are physiological, not just psychological. They reflect not only varying responses, but the fact that diabetes itself probably has many causes, many more than the few types currently recognized (see section on types). When you read advice, realize that what works (or doesn't work) for someone else may not work (or may work) for you. When you give advice, try to remember that most advice is relative to the individual, not absolute. Recognize that you can't treat your own diabetes by a set of rules, but only by knowing how your own individual body and physiology work and by adjusting to your own mechanisms.
Subject: Abuse of the newsgroup As mentioned above, a few participants believe that name-calling and abusive language are more effective than polite discussion, support and interchange of information. They are wrong, and the vast majority of participants support a more civilized and polite view of humanity. Since misc.health.diabetes is unmoderated, we all have to live together. A few m.h.d. participants have received abusive email. Some are afraid to expose such abuse, having been told that email must always be private. However, abusive email is no more deserving of privacy than obscene phone calls or threatening letters. There is no authority to which you can report abusive email (unless it contains an actual threat, in which can you may be justified in contacting a law enforcement agency). Steve Kirchoefer <swkirch(AT)chrisco.nrl.navy.mil> is willing to try to mediate problems with email. Though Steve has no official authority, he has experience in dealing with problems on the net and may be able to help clear up such problems. Send him complete copies of any abusive email.
Subject: The newsgroup charter The actual charter which led to the creation of the newsgroup in May 1993 follows. This charter was proposed by Steve Kirchoefer <swkirch(AT)chrisco.nrl.navy.mil> and approved by a public vote of the Usenet readership, and is the official statement of the scope and purpose of this newsgroup. 1. The purpose of misc.health.diabetes is to provide a forum for the discussion of issues pertaining to diabetes management, i.e.: diet, activities, medicine schedules, blood glucose control, exercise, medical breakthroughs, etc. This group addresses the issues of management of both Type I (insulin dependent) and Type II (non-insulin dependent) diabetes. Both technical discussions and general support discussions relevant to diabetes are welcome. 2. Postings to misc.health.diabetes are intended to be for discussion purposes only, and are in no way to be construed as medical advice. Diabetes is a serious medical condition requiring direct supervision by a primary health care physician.
Subject: Newsgroup posting guidelines The following posting guidelines were adopted by a vote of m.h.d participants in September 1994. Posting guidelines for misc.health.diabetes: Postings to misc.health.diabetes should be compliant with the standards for all material posted to Usenet. The following articles may be found in news.announce.newusers, and should be reviewed by all posters: -Emily Postnews Answers Your Questions on Netiquette -Answers to Frequently Asked Questions about Usenet -A Primer on How to Work With the Usenet Community -Rules for posting to Usenet -What is Usenet? Posting to misc.health.diabetes should be compliant with the group charter, [which is in the previous section]. In addition to the above, the following guidelines are emphasized as particularly relevant for contributions to misc.health.diabetes: -No personal attacks or insults. Avoid argumentative debates. Responses should concentrate on the issues presented. -No private discussions. Take private discussions to email. When in doubt, use email. -Edit responses to avoid unnecessary inclusions of earlier postings. -Edit subject lines as necessary to remain consistent with the topic. -Support factual statements with your sources. If you can not recall the source, then say so. Do not imply authority which you can not actually support. Additional information can be found in the general FAQ posted periodically to this group.
Subject: What is glucose? What does "bG" mean? Glucose is a specific form of sugar, one of the simplest. It is the form found in the bloodstream. "Blood sugar" always refers to blood glucose, and is abbreviated bG. All bG meters are specific for glucose and will not respond to other sugars, such as fructose, sucrose, maltose and lactose. Although sucrose (table sugar) is the most common sugar in food, glucose is also common. Most fruits, fruit juices, and soft drinks contain large amounts of glucose, and many foods contain small amounts. This means that you must be very careful to clean any food residue from your fingers before drawing blood for a bG check. Since the normal level of bG is only 1g/L (=100mg/dl), it only takes a tiny speck of glucose on your finger to contaminate the sample and give you a falsely high reading. 10 *micrograms* of glucose could raise the reading enough to cause you to overreact dangerously.
Subject: What are mg/dl and mmol/l? How to convert? Glucose? Cholesterol? There are two main methods of describing concentrations: by weight, and by molecular count. Weights are in grams, molecular counts in moles. (If you really want to know, a mole is 6.022*10^23 molecules.) In both cases, the unit is usually modified by milli- or micro- or other prefix, and is always "per" some volume, often a liter. This means that the conversion factor depends on the molecular weight of the substance in question. mmol/l is millimoles/liter, and is the world standard unit for measuring glucose in blood. Specifically, it is the designated SI (Systeme International) unit. "World standard"is not universal; not only the US but a number of other countries use mg/dl. A mole is about 6*10^23 molecules; if you want more detail, take a chemistry course. mg/dl (milligrams/deciliter) is the traditional unit for measuring bG (blood glucose). All scientific journals are moving quickly toward using mmol/L exclusively. mg/dl won't disappear soon, and some journals now use mmol/L as the primary unit but quote mg/dl in parentheses, reflecting the large base of health care providers and researchers (not to mention patients) who are already familiar with mg/dl. Since m.h.d is an international newsgroup, it's polite to quote both figures when you can. Most discussions take place using mg/dl, and no one really expects you to pull out your calculator to compose your article. However, if you don't quote both units, it's inevitable that many readers will have to pull out their calculators to read it. Many meters now have a switch that allows you to change between units. Sometimes it's a physical switch, and sometimes it's an option that you can set. To convert mmol/l of glucose to mg/dl, multiply by 18. To convert mg/dl of glucose to mmol/l, divide by 18 or multiply by 0.055. These factors are specific for glucose, because they depend on the mass of one molecule (the molecular weight). The conversion factors are different for other substances (see below). And remember that reflectance meters have a some error margin due to both intrinsic limitations and environmental factors, and that plasma readings are 15% higher than whole blood (as of 2002 most meters are calibrated to give plasma readings, thus matching lab readings, but this is a recent development), and that capillary blood is different from venous blood when it's changing, as after a meal. So round off to make values easier to comprehend and don't sweat the hundredths place. For example, 4.3 mmol/l converts to 77.4 mg/dl but should probably be quoted as 75 or 80. Similarly, 150 mg/dl converts to 8.3333... mmol/l but 8.3 is a reasonable quote, and even just 8 would usually convey the meaning. Actually, a table might be more useful than the raw conversion factor, since we usually talk in approximations anyway. mmol/l mg/dl interpretation ------ ----- -------------- 2.0 35 extremely low, danger of unconciousness 3.0 55 low, marginal insulin reaction 4.0 75 slightly low, first symptoms of lethargy etc. 5.5 100 mecca 5 - 6 90-110 normal preprandial in nondiabetics 8.0 150 normal postprandial in nondiabetics 10.0 180 maximum postprandial in nondiabetics 11.0 200 15.0 270 a little high to very high depending on patient 16.5 300 20.0 360 getting up there 22 400 max mg/dl for some meters and strips 33 600 high danger of severe electrolyte imbalance Preprandial = before meal Postprandial = after meal More conversions: To convert mmol/l of HDL or LDL cholesterol to mg/dl, multiply by 39. To convert mg/dl of HDL or LDL cholesterol to mmol/l, divide by 39. To convert mmol/l of triglycerides to mg/dl, multiply by 89. To convert mg/dl of triglycerides to mmol/l, divide by 89. To convert umol (micromoles) /l of creatinine to mg/dl, divide by 88. To convert mg/dl of creatinine to umol/l, multiply by 88.
Subject: What is c-peptide? What do c-peptide levels mean? Thanks to Andrew Torres <andym(AT)ku.edu> for this section. C-peptide blood levels can indicate whether or not a person is producing insulin and roughly how much. Insulin is initially synthesized in the form of proinsulin. In this form the alpha and beta chains of active insulin are linked by a third polypeptide chain called the connecting peptide, or c-peptide, for short. Because both insulin and c-peptide molecules are secreted, for every molecule of insulin in the blood, there is one of c-peptide. Therefore, levels of c-peptide in the blood can be measured and used as an indicator of insulin production in those cases where exogenous insulin (from injection) is present and mixed with endogenous insulin (that produced by the body) a situation that would make meaningless a measurement of insulin itself. The c-peptide test can also be used to help assess if high blood glucose is due to reduced insulin production or to reduced glucose intake by the cells. There is little or no c-peptide in blood of type 1 diabetics, and c-peptide levels in type 2 diabetics can be reduced or normal. The concentrations of c-peptide in non-diabetics are on the order of 0.5-3.0 ng/ml.
Subject: What's type 1 and type 2 diabetes, and gestational diabetes? The term diabetes mellitus comes from Greek words for "flow" and "honey", referring to the excess urinary flow that occurs when diabetes is untreated, and to the sugar in that urine. Diabetes mellitus (DM) comes in the following classifications (which some will argue don't really represent the actual types very well): type 1 -- characterized by total destruction of the insulin-producing beta cells, probably by an autoimmune reaction. Onset is most common in childhood, thus the common (but now deprecated) term "juvenile-onset", but the onset up to age 40 is not uncommon and can even occur later. Patients are susceptible to DKA (diabetic ketoacidosis). There seems to be some genetic tendency, but the genetic situation is unclear. Most patients are lean. Always requires treatment by insulin. Not sex-linked. Also referred to as IDDM (insulin dependent diabetes mellitus). type 2 -- characterized by insulin resistance despite adequate insulin production. A large majority of patients are overweight at onset, and a majority are female. Most are over 40, hence the common (but now deprecated) terms "adult-onset" or "maturity-onset", but onset can occur at any age. Patients are not susceptible to DKA (diabetic ketoacidosis). There is a strong genetic tendency, but not simple inheritance. Depending on the individual, treatment may be by diet, exercise, weight loss, oral drugs which stimulate the release of insulin, or insulin injections -- and usually a combination of several of these. Also referred to as NIDDM (non insulin dependent diabetes mellitus) *even when treated with insulin* -- a confusing terminology which, unfortunately, is supported by the ADA. gestational -- occurs in about 3% of all pregnancies as a result of insulin antagonists secreted by the placenta. It is recommended that all pregnant women receive a screening glucose tolerance test (GTT) between the 24th and 28th weeks of pregnancy to detect gestational diabetes early if it occurs, as diabetes can cause serious difficulties in pregnancy. Sometimes requires insulin treatment. Not susceptible to DKA (diabetic ketoacidosis). Usually disappears after childbirth, but about 40% of patients develop type 2 diabetes within five years. Most authorities state that the typical patient is female ... malnutrition-related -- severe malnutrition sometimes causes diabetes -- hyperglycemia and all the usual symptoms. The reason is unknown, and since this syndrome occurs almost entirely in third world countries, research on this form of diabetes is nearly nonexistent. other types -- sometimes called secondary. A catchall for forms not covered by the types described above. Causes include loss of the entire pancreas (to trauma, cancer, alcohol abuse, or exposure to chemicals), diseases that destroy the beta cells, certain hormonal syndromes, drugs that interfere with insulin secretion or action, and some rare genetic conditions. These terms are not used entirely consistently. Some doctors will refer to any diabetic using insulin as type 1, and will refer to the early onset of type 1 diabetes as type 2 until insulin therapy is required. This usage does not fit with most modern usage as described above (type 1 is beta cell destruction, type 2 is insulin resistance). The situation is complicated by the fact that early in the course of the disease it can be difficult to determine which type is occuring, especially for patients in their 30's, the age when the onset of both types is common. Different patients respond very differently to what is categorized above as the same disease. The root causes of all forms of diabetes are not understood, and are likely more complex and varied than the simple categories show. Type 1 diabetes likely has a few root causes, and type 2 diabetes probably has a larger number of root causes. There are also well documented reports of cases of diabetes with unexplained combinations of syndromes from types 1 and 2. These are sometimes referred to as "type 1-1/2", and the reasons are not understood. The classification above is not completely standard, and other classifications exist. About 90% of diabetes patients are type 2 (some 12 million in the US), and about 10% are type 1 (some 1 million in the US). Discussion on m.h.d tends to run about 2/3 type 1, I'd guess. This probably reflects the fact that type 1 diabetes is harder to ignore, and that type 2 seldom strikes the younger people who are more likely to have net access. Type 2 is *not* less serious. "1" and "2" are often written in Roman numerals: type I, type II. Because typography is often unclear on computer terminals, I've stuck with the Arabic numeral version. Diabetes accounts for about 5% of all health care costs in the US, some US$90 billion per year.
Subject: Is it OK to discuss diabetes insipidus here? What is it? Diabetes insipidus (DI) results from abnormalities in the production or use (two main types) of the hormone arginine vasopressin. The main symptoms are excessive thirst and massive urination. The excess urine flow is devoid of sugar. There are no blood glucose abnormalities, and in fact there is nothing in common with diabetes mellitus except the excess urination when untreated. Diabetes insipidus caused by failure to produce vasopressin. This is known as neurogenic DI (or central DI, or pituitary DI). It can be treated with hormone replacement (by nasal spray or other routes). DI caused by failure to use vasopressin (nephrogenic DI) is more difficult to treat, but several drugs are available which help. DI is much less common than diabetes mellitus, though a few people have discussed it on misc.health.diabetes and are reading m.h.d. Such participation is certainly welcome, but because the number of DI patients is only 1 or 2 per 10,000 population (25,000-50,000 in the US), there probably isn't a critical mass for discussion on Usenet. I'm aware of two organizations which offer support specifically related to DI. DIARD publishes a support newsletter, maintains a support network, distributes information on DI, and promotes education and research related to DI, and has a web page with information and links: Diabetes Insipidus and Related Diseases Network 535 Echo Court Saline, MI 48176-1270 USA +1 734 944 0078 email: GSMAYES(AT)aol.com web: http://members.aol.com/ruudh/dipage1.htm The DI Foundation publishes a quarterly newsletter, Endless Water, promotes public awareness and understanding of DI, and provides informational material to patients, medical practitioners and researchers: The Diabetes Insipidus Foundation, Inc. 4533 Ridge Drive Baltimore, MD 21229 USA +1 410 247 3953 email: diabetesinsipidus(AT)maxInter.net web: http://diabetesinsipidus.maxInter.net
Subject: How about discussing hypoglycemia? Sure ... To clarify: the term "hypoglycemia" is used to refer to two distinct conditions. The word just means "low blood glucose". This can occur as an insulin reaction, the result of too much injected insulin (taken to treat diabetes) compared to food intake and exercise. But low blood glucose can also be a chronic condition resulting from abnormalities of insulin secretion, and this chronic condition is also called hypoglycemia. Chronic hypoglycemia may be caused by beta cells which overreact to an increase in blood glucose (bg) by releasing too much insulin, which then causes a too-rapid drop in bG. Such a condition, called reactive hypoglycemia, is usually handled by dietary adjustments, in particular avoiding refined sugars and large meals which stimulate the overreaction. This often requires an effort in calculating the diet and monitoring bG levels that is equal to what anyone with diabetes needs. Tumors (insulinomas) can cause a steady overproduction of insulin. These generally require surgical removal. There are other causes as well. Mayer Davidson discusses some in his book _Diabetes Mellitus: Diagnosis and Treatment_. But you'll have to find the Second Edition, because he dropped this chapter from the Third Edition. I don't believe anyone claims to understand all the causes of hypoglycemia. The US NIDDK has a booklet online which discusses some of the less common causes: http://www.niddk.nih.gov/health/diabetes/pubs/hypo/hypo.htm So chronic hypoglycemia is closely related to diabetes mellitus in being a disorder of insulin production and use, and requires many of the same techniques for its treatment. The two are a natural for discussion in the same newsgroup. Which is good, since there really isn't anywhere else in Usenet at present to discuss chronic hypoglycemia. Welcome. A hypoglycemia mailing list, HYPO-L, is available and sees moderate traffic. See the section on mailing lists in part 4 of this FAQ for subscription information. Lars Idema maintains a hypoglycemia FAQ and information on a variety of hypoglycemia resources on the Internet. See his web page at http://hypoglykemie.nl
Subject: Helping with the diagnosis (DM or hypoglycemia) and waiting Diagnosis of marginal type 2 diabetes, and even more so of hypoglycemia, can be an iffy task. Single-point blood glucose measurements often miss significant readings, especially for hypoglycemia. While I don't recommend self-diagnosis, you can take some steps on your own to aid your health care team in your diagnosis and treatment. These are safe and useful steps. The first is purely monitoring and not treatment or diagnosis on your part. The others are good advice for anyone who does not have some other medical condition to contraindicate the action, and are particularly good for those with type 2 diabetes. 1) Get a blood glucose meter and start checking your blood glucose before meals and at bedtime. Keep records. Also note what you ate, any exercise, any unusual stress. If you suspect type 2 diabetes, also try to check an hour after eating. If you suspect hypoglycemia, check any time you have suspicious symptoms; you may also want to set up a few runs where you check every 15-30 minutes for up to five hours after eating. Don't try to make any adjustments based on the readings until you review them with your doctor -- just keep the record and show it to the doctor. This will give the doctor more information than any examination or lab test can give. Furthermore, if you are waiting for an appointment, this record will put you ahead of the game when you actually see the doctor. (If during this monitoring you see a dramatic rise in blood glucose, to preprandial levels of 250 mg/dl [15 mmol/L] and above, call the doctors and say you need an appointment *now*, not in a month, not next week, and quote your bg levels.) As an additional advantage, doing this monitoring on your own will demonstrate to the doctor that you are willing to put in this kind of effort. Often doctors are reluctant to ask patients to put in serious time to monitor their health because so many patients don't follow up. Blood glucose meters and all the supplies are OTC items. (True in the USA, and I haven't heard of any country with a different policy.) However, depending on where you live and what type of insurance or national medical coverage you have, you may have to pay from your own pocket if you do not have a prescription or proper pre-authorization. For a month or so of monitoring, this is probably worth the cost. 2) Increase your exercise level, within levels that are safe in light of any other medical conditions. In other words, if you are not already in an exercise program, consult your doctor. Exercise will also help with other stresses you are under. This is primarily applicable if you suspect type 2 diabetes, but may help with hypoglycemia also. 3) Improve your diet if you are not already watching it carefully. A standard diet with moderate calories and fat is good at this stage, until you see the specialist. If you suspect hypoglycemia, you may want to be especially careful of eating large amounts at one time, and avoid concentrated sugars.
Subject: Exercise and insulin Charles Coughran <ccoughran(AT)ucsd.edu> contributed this section. The best way to deal with problems associated with diabetes and exercise begins with understanding of what goes on in the metabolic system of normal people and what the differences are for diabetics. Only with such understanding can you make intelligent choices about pharmacological tactics. Relying on rules of thumb can cause more problems it solves because of the wide variability of individual responses and the wide variety of diseases that fall under the rubric of diabetes. Not to mention, I have seen postings where the rules of thumb were clearly misunderstood. While the following is intended for those who take insulin, it may assist those on oral medications as well. Exercise in this context means extended aerobic activity, say a minimum of 20 minutes of jogging. This is a somewhat simplified account but I think it captures the most important aspects for exercise related bg control. Comments encouraged. When a normal person starts to exercise, the insulin output of his pancreas goes down. At first blush, this seems backward since the muscles are working hard and therefore require more glucose to be transported from the blood into the cells. There are two reasons more glucose can be transported with less available insulin. The first is that during exercise insulin becomes much more efficient. The mechanism of this effect is not fully understood, but it helps overcomes the reduction in circulating insulin. Second, exercise activates non-insulin mediated glucose transport pathways. These pathways are not sufficient to handle the load in the absence of insulin, but do increase the effective insulin efficiency. When insulin levels decline relative to the counterregulatory hormones -- glucagon, epinephrine, norepinephrine, growth hormone, and cortisol -- the liver is stimulated to release stored glucose. The blood glucose that is being transported into the cells is replaced by that from hepatic stores. It is this hormonal balance system that keeps the levels of blood glucose in the normal narrow range during exercise. For those of us who inject insulin, the first problem is obvious. Our circulating levels of insulin do not react to exercise. Absent any correction, when the muscles demand glucose and insulin becomes more efficient our blood glucose plummets and we become hypoglycemic. This is the reason for a commonly encountered prohibition to not schedule exercise when your insulin is peaking. The higher the level of circulating insulin, the more pronounced the effect. One solution is to reduce our circulating insulin levels by reducing insulin intake. Here specific advice starts to be difficult due to the wide variety of insulins, regimens, and individual variability. The spectrum spans from a Type II who takes a little NPH to help his beta cells out to a c-peptide free pumper. I have spoken to diabetic runners whose tactics would put me in an ambulance, even though our situations seem to be very similar. You see a lot of advice of the form, "reduce your insulin 2 units for every hour of strenuous exercise". This kind of advice ignores real world variability and is sometimes much worse than useless. Clearly, someone who takes one shot/day has a much more limited ability to adjust circulating insulin levels than someone using multiple injections or a pump. The other approach is to increase blood glucose levels by eating carbohydrates timed to arrive at the blood stream in the form of glucose when it is needed. The easiest way to do that is usually to eat fast acting carbohydrates during or immediately preceding exercise. Again, there are rules of thumb around about so many grams of carbohydrates for a particular length of exercise at some defined level. Again, they seem to be swamped by individual and circumstantial variability. Some of us do a combination of both and pump up our bg levels somewhat before exercise and reduce insulin levels to keep things on an even keel. The bottom line is to make careful adjustments and test, and test, and test, to find out how things work for your particular body. So much for too much insulin. What happens when the circulating insulin level is too low? When levels are so low that even the increase in insulin efficiency doesn't overcome the defect, glucose isn't transported into the cells. Worse, since insulin levels are low the liver continues to pump glucose into the blood. The result is bg levels rise with exercise. The muscles get stressed due to lack of fuel and the metabolism of fats kicks in, ketones start being produced and the danger of ketosis or ketoacidosis looms. This is the basis for another rule of thumb which is often misunderstood. The rule is usually stated "don't exercise when your bg is above 240 mg/dl (13.3 mmol/l) and ketones are present in the urine". This makes sense because those are signs that you have inadequate insulin supplies -- that's how many of us got diagnosed. Exercise in those circumstances will make things worse, not better. On the other hand, if you are 300 mg/dl (16.7 mmol/l) because you just drank a large regular cola by mistake with lunch, exercise is a great way to bring that bg down in a hurry. Why your bg is elevated is just as important as the fact of the elevated level when deciding whether or not exercise is contraindicated. The 240 is also a somewhat arbitrary number. Some people start throwing ketones at significantly lower levels. In short: avoid exercise if your insulin level is too low. Do exercise if you are sure your insulin level is adequate but your blood glucose is too high. Exercise also produces effects at longer time scales. Sometime after exercise, there is often a take up of blood glucose by the muscles to replenish depleted stores. This most often occurs an hour or two after exercise, but has been reported in the range of 1/2 hour to 48 hours. Again, as is the case during exercise, artificially high insulin levels will lead to hypoglycemia. The last rule of thumb is to watch for hypoglycemia after exercise. *SPECULATION BEGINS HERE* A problem some of us encounter from time to time is a post exercise bg spike. Blood glucose readings will be reasonable after exercise but sharply elevated a few hours later. It is my speculation that this represents circulating insulin levels that were adequate to deal with exercise induced blood glucose demand with its attendant insulin efficiency increase, but too low to deal with the post exercise demand when insulin efficiency has lowered somewhat. It has been my experience that post exercise elevated bg levels respond to much less insulin than would be required in a more normal situation. It appears that insulin efficiency falls off after exercise at some rate and you can be on the correct side of the curve during exercise and the wrong side after. This hypothesis is the best of a couple I have come up with. *SPECULATION ENDS HERE* Regular exercise over time scales of weeks or months can reduce overall insulin requirements. In addition, as muscles become trained and improve their internal storage, it feeds back into the amount of glucose demand present during exercise, and thus into the entire control cycle. Diabetes makes exercise, and almost everything else, harder. But, hey, if it was easy it wouldn't be any fun :-) There are two very good, readable books from which you can get more information. The better is Campaigne and Lampman, _Exercise in the Clinical Management of Diabetes_. Almost as good is _The Health Professional's Guide to Diabetes and Exercise_ edited by Ruderman and Devlin and published by the American Diabetes Association.
Subject: Who did this? -- Edward Reid <edward@paleo.org> Tallahassee FL -- Art works by Melynda Reid: http://paleo.org org> Tallahassee FL -- Art works by Melynda Reid: http://paleo.org d this? -- Edward Reid <edward@paleo.org> Tallahassee FL -- Art works by Melynda Reid: http://paleo.org -------- Subject: Who did this? -- Edward Reid <edward@paleo.org.SPAMNOT> Tallahassee FL -- Art works by Melynda Reid: http://paleo.org

User Contributions:

Raqiba Shihab
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May 10, 2012 @ 2:14 pm
Many thanks. My husband has Type 2 diabetes and we were a bit concerned about his blood sugar/glucose levels because he was experiencing symptoms of hyperglyceamia. We used a glucometer which displays the reading mg/dl so in my need to know what the difference
between and mg/dl and mmol/l is, i came across your article and was so pleased to aquire a lot more info regarding blood glucose, how to read and convert it.
Bhavani
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Aug 11, 2012 @ 9:09 am
It was really informative and useful for people who don't know conversion. Thanks to you

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