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Questions and Answers - blood sugar


Use the chart below to help understand how different test results can indicate pre-diabetes or diabetes

  Fasting Blood Glucose Oral Glucose Tolerance Test Random Blood Sugar A1C
Description Test of sugar levels at least 8 hours without food Test of sugar 2 hours after a glucose drink Taken any time of day without fasting Average level of blood sugar over past 2-3 months
Ideal Result Less than 100mg/dl Less than 140 mg/dl Less than 140 (even after eating a large meal) Less than 5.7%
Pre-diabetes 100-125mg/dl 140-199mg/dl 140-200 5.7% to 6.4%
Diabetes 126mg/dl and greater 200 mg/dl and greater 200 or greater 6.5% or more


Q: Why is my fasting reading higher first thing in the morning?
A: This early morning rise in glucose, known as the “dawn phenomenon” is normal and happens when our bodies produce a surge of hormones to help us wake up. During the day, activity tends to keep sugars under control if following a healthy, active lifestyle. If using insulin, it may help to adjust your nighttime dosage.

Q: Why does my blood sugar level go up when I do yard work? I drink water all the time and eat my meals on time, but when I do yard work, like digging and planting and cutting the grass, my sugar levels rise. 
A:  The first 30-60 minutes of exercise, especially in warmer weather, can raise levels. They should come down after that. Try checking right after your yard work, then again in around 90 minutes and see if you have a drop.

Q: What is the normal range that your blood sugar should be if you test it at home?
A: For a basically healthy person, a good fasting is under 100, and 80-90 is even better for most people. If you test two hours after a meal, under 120 is ideal.

Q: Why does my blood sugar increase after exercise? I had a blood sugar reading of 135 first thing in the morning but after a 3 mile walk my reading was 155. I had nothing to eat or drink during this time. I repeated this test and got the same results a few days later.
A: Wait an hour after you exercise and see if you get the same results. Exercise is a stressor, so blood sugar will be higher immediately after your session. Also, blood sugars tend to be higher in the mornings because of hormonal activity during the night.

Q: I have been told that I have diabetes, or "", or that I am in the "" . My readings are all over the place: sometimes in the 120''s, sometimes, but rarely in the 150-170''t guarantee good control, even with diet improvement. You have started a good path with losing body fat, but you still carry enough to contribute to insulin resistance. Other medical conditions and medications you may be taking can also be a factor. In addition, foods eaten at earlier meals may not fully metabolize until later in day. If you are diligent with lifestyle changes, you should continue to see improvements over time.

Q: Why does my blood sugar jump from 115 to 165 after eating breakfast?
A: All food turns into sugar and carbs turn the fastest. It is normal for everyone''t go over 140 as a rule. If your blood sugars had been closer to 100 before your meal, you would have been closer to a normal range. Also, it may have been the types of foods you ate. A breakfast that includes protein, such as an egg, and whole grains, such as a higher fiber toast may help to keep your numbers down. Check your blood sugars 2 hours after eating for a while so that you see how you are the rest of the day. This will help your physician in adjusting any medications you might be on. Keeping a very healthy lifestyle is your best ally for keeping those numbers down.

Q: Every two hours after I eat, I take my blood sugar reading. I assume that if two hours post-meal my reading is 120 or below, I have good control of my sugar. However, if I have a small snack 30-60 minutes before I test, will that affect my blood sugar when I take it at two hours post-meal? 
A: It may, depending on what you eat. Simple carbs will react pretty immediately and certainly within the 30-minute timeframe. Protein and fats take longer in the digestive process. You may want to check just before your snack. The highest peak blood sugar levels generally occur 1 hour after a meal if carbs were eaten. At 2 hours, protein begins to break down into blood sugar so one may begin to see some food effect. Test both before and after your snack and see what differences in readings you may notice.

Q: My morning and afternoon blood sugar readings are fine but the reading before my evening meal is still really high, even though I have only been drinking black coffee and water during the afternoon. I try to walk between two and four miles a day, so I am sure I am getting enough exercise. I do seem to be stressed most of the time, and wondered if this could have something to do with it. 
A: Stress can play a part; you may want to have your cortisol levels checked to see if they stay elevated later in the day. Caffeine can also elevate levels in the short run. If you exercise right before you take your reading that can also be a factor. Try waiting 1/2-1 hour and see if that makes a difference.

Q:  I recently had a scary situation where my blood sugars dropped to a low number. An EMT was called and he measured my blood sugar with a meter at 46. He told me to eat some cookies. I ate four or five cookies and immediately had blood check again but it wasn’t going up yet, so was administered a tube of some type of glucose. Once again my blood sugars were measured within a minute or two and the level was now up to 125. The EMT left but within minutes I was experiencing extreme confusion, my legs were very shaky, and I finally fainted for a short time. I had nausea, and an extreme headache for hours. What could have been happening to me? 
A:  Your blood sugar levels rose too quickly. 46 is very low, and it sounds as though within the space of 10 minutes or so you were back into the diabetes range. The protocol to follow for low blood sugar when that low would be to administer 15 grams of carbs, then re-measure. Starting with the tube would have brought you into a better range more immediately, wait 15 minutes, then retest. You would probably have been in a range where the next "" would be a protein/carb combo: milk if you drink it, yogurt, nut butter on crackers, etc. Always stay well hydrated; this will help avoid some of those after-effects of low sugars. Better yet: be sure you are understanding how to eat for blood sugar control. This is even more important if also on medications. 

Q: I suffered what I believe was a low blood sugar attack with extreme dizziness and nausea. I take medication for type 2 diabetes. What should I do next time this happens?
A: It sounds like you did have a low blood sugar attack. It could be that you are not requiring as much medication, and/or you waited too long between meals. You should be checking your blood sugars and make sure that you know what ranges your physician wants you in. The idea is not to eat more to feed the medication, but to hopefully lower the medicine dose. Glucose tablets are good to carry with you in emergencies as the dose is then measured. Lifesaver candies can also work. The usual amount is 15 grams of carbs every 15 minutes until blood sugars come up.

Q: My friend''s office at your next visit and see if you can test it against one of theirs. I suggest you also call your meter company and discuss your concerns. They do calibration studies and should be able to give you some solid answers.

Q: Can the hot weather have an effect on a persons blood sugar readings? 
A: High heat, particularly warm weather, does not directly affect your glucose levels, but it can lead to changes in your daily habits: eating less and not adjusting medication, being less active, and possibly over exerting yourself. These situations can lead to either higher or lower levels. Dehydration can set in more readily; don''s stress levels is a ""; yoga, Tai Chi, dance are just a few examples of very positive supports. Find what works for you.

Q: I have type 1 diabetes and whenever my blood sugar is low I feel as if my thinking process is different and I tend to feel anxious. Then once my sugar gets back up I don''s society. The important thing here is that you know how to fix these symptoms. Better yet, keep yourself from getting to that point by always having something with you to elevate your blood sugar. Keeping a pack of glucose tabs with you at all times gives you a set dose of carbs to take when you first feel signs coming on. Dry roasted nuts also carry well to hold off hunger.

Q: I am an elementary school nurse. I have a 10 yr old student with type 1 diabetes. He typically comes in low before lunch (50-70), eats lunch, retakes his blood glucose 30 minutes later and it is up to 120-140. However, at that time the parent recommends the full compensation of insulin for carbs ingested at lunch. Invariably he comes back in less than an hour dropped back down to 50-70. My thought is they need to compensate for the low number that they are starting with before they give him a dose based on carb ingestion only. What are your thoughts? 
A: You are on the right track with seeing there is a deficit here in food/insulin. This is an active growing child. As with anyone with diabetes, it is important to have the right amount of protein/fat in place to create a more stable baseline for levels. Being around 110 pre-meal would be good unless his physician has established different numbers. The goal is not to keep feeding carbs to manage the insulin, but to reduce the insulin overall because the glucose levels are in better range. If he eats eggs for breakfast, they should provide a more stable morning. If the child begins to show fatigue and his performance is affected in school, this may be the documented route you need to have them revisit the protocol with their physician. Nobody wants him to suffer hypoglycemic episodes, which it sounds like he could be a candidate for. 

Q: I have had type 2 diabetes for 15 years. Although my fasting levels are generally higher in the morning, two weeks ago I noticed a few levels approaching 240 fasting before breakfast. For example, last week my morning level was 235. I ate a meal that had eggs and turkey sausage and coffee without sugar. My blood sugar dropped to 196 after one and a half hours. I took a walk for 20 minutes and my sugar level was 127. Then I had another coffee and an hour later my sugar was 190 again. Why would this happen?

A:  Food intake is a most powerful player here. It is common for blood sugar levels to be elevated in the early morning due to hormonal activity during the night, then begin to drop during the day with usual daytime activity. Then, assuming eating is well-controlled, daytime levels can be in normal ranges. You should clarify with your physician what the target glucose goals are for you for both fasting and 1-2 hours post meals. The morning protein meal you ate converted into glucose at a far slower rate than if you had eaten a carbohydrate based meal, so it is not surprising that you saw a drop in levels as you did after that meal. Coffee is often listed as a "" that does not affect blood sugar levels but you can see this may not be the case. It does stimulate the central nervous system and can cause some short term rise in levels. 

Q: I was diagnosed with type 2 diabetes five months ago. I have been testing and trying to determine what is working and what is not. I''m assuming you have made sure your old strips are up to date and calibrated if necessary? I suggest you call both companies for an explanation, then perhaps assume the newer meter is giving more accurate readings. You can verify this by bringing your meter to your physician''t eat a snack with sugar in it between meals. Please help, my doctor says Im fine. 
A: You clearly have blood sugar inbalances, going from some moderate highs to lows. The shakiness, etc. is hypoglycemia. Has your doctor done a glucose intolerance test on you yet? I suggest the one that shows your glucose levels at 4 intervals 2-3 hours apart. You may be higher in the morning and then going low daytime. Eating unrefined foods, lean protein, and more veggies than starches are really important for you right now. Eating 5-6 small meals/snacks should be your pattern. An apple and 1 oz. of cheese or 1 tbs. of nut butter is an idea for a snack. Learn where protein comes from and include it more. Beans have a good source of plant protein and fibers that stick with you longer and break down into sugar (as all food eventually does) in your blood stream more slowly. This is a good thing, as you won''t stick with you. Think of these simple sugars as very short term fuel. You may need a 2nd opinion. Eating correctly will help you straighten this out.

Q: My Dr. said my glucose number should be between 65-99. I am a 77 1/2 year old female who recently started experiencing low blood sugar episodes, especially at night. If my number when tested is 103 and lower, I shake, sweat and am generally miserable till I drink orange juice, etc. Is it possible that my count needs to be higher? 
A: I do think you need to revisit this with your physician, as clearly you seem to be requiring a higher blood sugar level. A textbook normal fasting glucose is closer to 80; 65 would be too low for many people. Keep close track of your intake, and be sure to eat protein at each meal.

Q: I was recently diagnosed with type 2 diabetes and manage with diet and medication. My primary care doctor told me when my blood sugar gets low and I get shaky I should take a pinch of table sugar. My question is, should I eat something like an orange or something other than table sugar to raise my blood sugar? It just seems counterproductive to watch what I eat all day, every day, then take some sugar to even out my blood.
A: Low blood sugars are better treated by drinking 4-6 ounces of milk if you are a dairy consumer, 4 ounces of juice, or some sugar equivalent to equal 15 grams. 3-5 Lifesaver candies often does the job. However, the goal is not to have to eat more, but to lower your medication requirements. As you continue to take charge of your lifestyle and how different foods affect your levels, episodes will be less frequent. When you are just beginning to show the signs of low blood sugar, milk is a good choice (this includes soy milk) because it has the right carbs to get into your bloodstream quickly, but also has some protein to digest at a slower rate. I suggest you try to find some diabetes classes in your area to learn all you can on how to manage, especially eating.

Q: I’m a type 1 diabetic and going though menopause. My blood sugars are consistently high whereas before they were on target. Does menopause cause my body to resist insulin? 
A: Hormonal changes can affect your glucose levels, as you are experiencing, which is not exactly insulin resistance. It is important during this time that you eat foods as unrefined as possible and stay active to reduce any potential symptoms like sweats and hot flashes. This will help to reduce glucose fluctuations as a result of less fluctuation at the nerve levels. You may want to eat the exact same diet every day to see what is due to hormones versus diet, etc. In addition, nutritional compounds for menopause may help with balance.

Q: I am on an 800-1000 calorie diet and my blood sugar readings are still 104-109. Shouldn''ve had different readings from two different fingers.
A:  It should not matter which finger you use as long as you test on the side of the finger.  Do not milk the finger; hold it upside down to let the blood flow to the tip.  Readings may vary slightly.  If the spread is wide, be sure you tested correctly in both situations.  If you still get discrepancies, I suggest you call the 800 number on your meter and ask their advice.

Q: What are the risks when blood sugar is 400 to 500?
A: The intensity of the symptoms will vary between individuals. If these high blood sugars persist, some symptoms that may be experienced include dizziness, nausea, headaches, frequent urination, and hunger. In some cases, one may even experience Diabetic Ketoacidosis, a condition that if left unchecked, can lead to coma. This is generally more associated with type one diabetes. High blood sugars over the long-term precipitate complications such as organ and nerve damage.

Q: I had a blood test but did not realize that I was supposed to fast beforehand. I had two cups of the coffee in the morning, and a sandwich and chips for lunch. My results came back at 293. Is this an accurate test? Do I have diabetes? My doctor wants to put me on medication.
A: 293 would still constitute a diagnosis of diabetes, since it is over 200 - the limit for a random blood sugar, even without fasting. In my experience working with endocrinologists, the next step after “discovering” the high blood sugar would be to order an A1C test to measure an average over the last 3 months. An Oral Glucose Tolerance test may also be order to see how the blood sugars go over the course of 3 hours after a high carb load. If you have no other symptoms or uncontrolled conditions, a course of 3 months of focused diet/lifestyle changes may be put in place to see how far your numbers come down before starting medications. It is most important for you to get educated on eating for diabetes management. Exercising and working towards reduced body fat is usually also at the top of the list.

Q: What is the normal blood sugar levels for a pregnant person fasting, immediately following a meal and 2 hours after? How many carbs can I eat?
A: The guidelines for gestational diabetes have gotten tighter. Those practitioners who manage their patients more tightly prefer a fasting glucose of less than 90 and 110 one-two hours post meal. The best rule of thumb for carbs is NOT to eat them in the morning if you do experience elevated blood sugars. This often means saving your fruit for lunch or later. How many carbs is dependent on your nutritional needs and caloric needs for your pregnancy. It would be helpful for you to have a consult with a nutritionist who understands gestational diabetes patterns. Once you and your physician have determined your blood sugar guidelines, a management plan should follow. Meanwhile, eat unrefined foods as much as possible, lean “flesh”, and minimize sweets and juices.

Q: Can having diabetes cause your blood alcohol levels to go up? 
A: Yes, though generally this is more pronounced for those with insulin dependent diabetes. When the cells can’t suck in the blood sugar due to insufficient insulin, the body breaks down fat for fuel and produces ketones, which can cross-react with both blood and alcohol tests to produce a positive result, even without a drink. Lots of ketones can cause a fruity breath, mistaken for alcohol, and cause a person to have symptoms of being intoxicates such as slurred words and dizziness. ALWAYS HAVE ID ON YOU THAT IDENTIFIES YOU ARE DIABETIC TO AVOID UNNECESSARY HASSLE AND GET TREATMENT YOU MAY NEED IN A TIMELY FASHION!

Q: Is a 132 glucose level, after a ten hour fast, high enough to be concerned about? 
A: Two fasting levels of 126 or greater is a diagnosis of diabetes. If this was a lab test, your physician should order another fasting glucose to confirm, and an A1C to get your average level over a 3 month period. Meanwhile, start practicing a very healthy lifestyle, understanding what food choices to focus on. In a nutshell, focus on eating lots of veggies, some fruit, legumes, lower starch, and fish or smaller amounts lean meat. BE ACTIVE! That is the best key to control.

Q: My fasting blood glucose is normal, but the A1c was 6.5. What would you recommend?
A: I suggest to closely review what you eat the entire day, and increase your activity level if necessary. If your fasting is between 80-90, great! If higher, then lifestyle habits certainly are what need to be addressed first. You may also request an Oral Glucose Tolerance Test to see what your blood sugar response is post-meal.

Q: Why does my blood sugar get highest 3 hours after eating? One hour after eating my blood sugar is around 160-180, after 2 hours it is around 100-125. What''t give up; keep up with your good work. Insulin resistance can be just that: resistive! For some people, if they don''m strict about my diet, is there any way of keeping the sugar levels down without having to take insulin? Will they return to "" levels without medication, or will I still require insulin shots?
A: In general, illness and stress do elevate blood sugar, and if you are already requiring insulin when you are otherwise healthy/unstressed, you may need more at these times. If your blood sugars fall into normal levels without needing medications, then triggers such as an illness may or may not raise them, and if so, may not raise them high enough or long enough to warrant medication. Be sure you understand the nature of the disease, and monitor yourself in all situations as closely as you can. No one will be able to manage this better than yourself.

Q: What is a good blood sugar reading after eating a meal?
A: In an entire day, we generally say your blood sugar should not go over 140 even after eating a large meal. Ideally it would not go over 120 two hours after eating. With diabetes, one''t fit these criteria unless you search for a type with higher fiber. I suggest an overabundance of plant foods now, to clean out your system a bit, giving your liver a work break. This should help to fine tune your metabolism. Make sure you have essential fatty acids in your intake: fish/plant foods are main sources.

Q: My husband is on an insulin pump but after a severe low blood sugar, he will struggle for several weeks to get his blood sugars under control again. The blood sugars go low and then high for no reason, regardless of diet, exercise, insulin.
A: I suggest you work a bit more closely with the pump trainer on how to cut back on insulin depending on time of day, activity level, etc. With the abilities of today''m sure you are "". Hopefully, you will adjust with time. And is it possible to shift your desk?

Q: How often should pen needles be used before discarding?
A: Pen needles technically are to be used once. In reality, most people who do more than one injection per day immediately cap their needles after use, discarding at the end of the day. Most pens are prefilled, so when finished, discard and start another pen.

Q: My wife is having problems with her blood sugar levels. She has been watching her carbohydrate intake but when she sleeps for at least 8 hours, her sugar levels are higher. Why?
A: It is good she is monitoring her carbs closely, but it is also about the total intake of food and her activity level. Glucose is generally higher in the early morning due to hormonal activity during the night. If she is also elevated during the day, it again may be the types and quantities of foods. Perhaps her medication needs reevaluating. I would suggest she pose these questions to her physician.

Q: I have had type 1 diabetes for about 16 years now. My A1C was 8.6 for a while but now I have it down to 7.6 and lower now. The problem is that now I feel like I am having low blood sugar even when I am in the good range.
A: For many who have adapted to functioning on higher sugars for many years, then in a reasonably short period drop into more normal ranges, low blood sugar symptoms may persist for a time. This means that your insulin is functioning far more efficiently in removing sugar from your bloodstream. At 7.6, you are still in a higher range, but certainly closer to numbers that are more protective for complications. If you are on other medications, particularly for CAD, these may also contribute to symptoms. Make sure you know from your physician what range you should be in. If the symptoms persist, perhaps something else would be the cause not directly related to glucose lowering in the bloodstream. Hormonal changes as part of the life cycle can also play a role.

Q: Do I use the first or the second drop of blood when testing my blood sugar?
A: With most strips now, you can touch them with the first drop. It takes far less blood than it used to to get a good sample. One drop is all that is needed.

Q: I''t go any higher, you should do well.

Q: My blood glucose runs about 106 fasting every morning. The rest of the day it is fine. I run and lift weights regularly, and my diet is good while watching my carbs. I do not drink. I am also careful with snacks at night. Is this morning level a reason for concern and why is it high in the morning?
A: It is good that you are normal during the daytime. The biggest wear and tear on the body seems to come from fluctuating daytime levels rather than a stable but slightly high fasting level. Yes, it would be good to get under 100, ideally between 80-90, but if you truly are most diligent in your lifestyle, you should be able to maintain good health. Certain hormones elevate nighttime levels, contributing to morning highs. Research is out there on many nutraceuticals that may lowering fasting blood sugar levels. Cinnulin PF, from cinnamon, is one of the most recent that is showing good results. It can be found in capsule form.

Q: I have been overweight for years and have been having my blood sugar checked at bi-annual doctor’s appointments, always to be told it was “fine” or “normal”. Five months ago the A1c was 6.3. Now it has gone to 10.1 with a fasting blood sugar of 329. While at my first diabetic management appointment, the nurse showing me how to test my blood sugar got a 428, stuck a needle of insulin in me, and sent me home with vials and needles. Is it normal for someone to go from fine to insulin diabetic so rapidly?
A: I would hope you had a bit more instruction than what you are conveying. With blood sugars over 300, it is now the thought of many endocrinologists to start a person on insulin to detox the beta cells of the pancreas. This may only be for a short period if lifestyle changes are diligently made. Sometimes, it is a shift to oral medication, or none at all. Over the years, one may need a return to insulin and/or other medications. Take charge of you lifestyle habits and get all the education you can on managing this disease.


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