High Blood Glucose Levels – Specific to Diabetes?

Diabetes is a disorder of carbohydrate metabolism caused by relative or complete deficiency of insulin leading to hyperglycemia and in long term may result in organ complications such as retinipathy, nephropathy, neuropathy and cardiovascular complications.

Type 1 diabetics are more prone to ketoacidosis with high blood glucose levels. They generally depend on insulin treatment as opposed to type 2 diabetics. Under stressful conditions insulin may not be adequately adjusted, causing susceptibility to diabetic ketoacidosis.

Type 2 diabetics on other hand are more prone to yyperosmolar nonketotic hyperglycemic coma (HHNKC) than ketoacidosis or hyperosmotic non-ketoic acidosis (HONK). This is severe hyperglycemia in the absense of significant ketosis. Precipitating factors are noncompliance with treatment and inability to drink sufficient water to keep up with urinary loss.

Gestational diabetes is glucose intolerance developed during pregnancy. Fortunately this condition usually resolves once the baby is born.

The most prevalent cause of high blood glucose levels (hyperglycemia) is Diabetes. But there are some other clinical conditions that cause hyperglycemia though they are not nearly as common.

All of these need special investigation, medical attention, and timely treatment. It is always advised to approach your physician anytime you have concern regarding your health.

1. Cushing’s Syndrome: Caused by persistent and inappropriate increase in glucocorticoid hormones. Patients are obese and symptoms include plethoric face, thin skin that bruises easily, and pathological fractures due to osteoporosis.
2. Pheochromocytoma: Excess production of catecholamines by tumors of sympathetic nervous system. Symptoms include headache, anxiety, palpitations, sweating, hypertention, hyperglycemia.
3. Glucagonoma: They are tumors of pancrease and produces lots of glucagon a hormore that counteracts the actions of insulin. Patients have hyperglemia with skin rash.
4. Pancreatic Conditions like pancreatitis, hemosiderosis etc also cause hyperglycemia due to damage of insulin producing cells in pancreas.
5. Liver Diseases like cirrhosis, hemochromatosis.
6. Medications such as diuretics, niacin, and phenytoin (taken in epilepsy) are also known to induce hyperglycemia. Discontinuing these drugs result in a return of normal glucose status.
7. Acute stress: In people with mild carbohydrate intolerance, stressful conditions like infections, myocardial infarction, and surgery may cause marked hyperglycemia. Some of these patients will not need therapy once the stressful condition has passed.

A physician can differentiate these conditions by running some tests beyond those identifying blood glucose levels. For example, there are tests that detect high levels of glucagon, cortisol in blood.

Investigations like abdominal CT scans and ultrasound can be used to screen for any tumors, pancreatic pathology, and liver pathology.

Diabetes – Diabetic Diet Facts (Part I)

Once a person is diagnosed with diabetes, he/she should contact a dietician to get a better idea of how to consume different food varieties while keeping an eye on their blood sugar.

To make it simple, the diabetic diet is no different than the regular food pyramid quantities and components except that the diabetic should watch their carbohydrate intake. The best is a low fat diet with complex carbohydrates.

Carbohydrates:

This is the most important component of the diet. It should consist of starchy foods like wheat, rice, pasta, potatoes, peas, corn etc. 6 – 8 servings per day

Try to eat complex carbohydrates. 45 – 65% of calories should come from your carbohydrates.

Vegetables:

Examples include carrots, green leafy vegetables, green string beans etc. Vegetables have less carbohydrates (except those falling withint the carbohydrate group such as potatoes, peas, beans, corn etc). They provide vitamins and minerals. You should remember vegetables that are high in fibre. Fibre is good for lowering cholesterol in blood. 3 – 5 servings per day

Half of the servings can be cooked and the other half as raw vegetables. Eat colored vegatables like carrots, broccoli, green leaves.

Fruits:

Examples are apples, berries, citrus etc. Fruits have significant quantities of carbohydrates. So care must be taken when consuming them. 2 – 4 servings per day

You will get vitamins, minerals and fibre from fruits.

Protein:

Examples are chicken, fish, eggs, cheese, tofu etc. These are foods that are high in protein content and very low in carbohydrates. Protein is necessary for the bodies building and repair. It is the main component of cells as cell proteins. 2 – 3 servings per day

15 – 20% of total calories should be from protein.

Milk:

Examples are milk, condensed milk, yogurt etc. Milk is an excellent source for protein and calcium. Most of the milk products are fortified with Vitamin A, D. So milk is also good source for these two fat soluble vitamins as well. 2 – 3 servings per day

Fats and Oils:

These should be the least consumed portion of the diet. They should make up 5% of the total diet. Examples are butter, snacks, candy, sweets etc. Avoid them as much as possible. No more than 20 – 30% of total calories should be from fats.

You don’t have to give up your favorite foods; Instead follow these tips:

• Change the ingredients. Example instead of high fat butter, use zero fat butter or another substitute.
• Limit the quantity of your favorite foods.
• Use artifical sweeteners instead of simple sugar.
• Substitute complex carbohydrates for simple carbohydrates.

Another question diabetics frequently ask:

"Can I eat what I want and and in any quantity and just take an extra tablet or insulin?"

Simply, no. Don’t let your blood sugar levels become erratic. It is always best to maintain consistent levels.

Plan well before, what to eat the next day. Take responsibility for your health. Be prepared for next day’s events and stress induced work etc. For example if you have to travel to different place for few days, carry your sugar substitute, prescription medications etc.

How Insulin Works

Insulin is produced by beta cells of the pancreas. It is called anabolic because it promotes synthesis – synthesis of glycogen, protein and triglycerides.

Regulation of insulin secretion in the body :

Glucose – After ingestion of carbohydrate rich diet, there will be increased levels of glucose in the blood. Beta cells sense this increase and release insulin.

Amino acids – Ingestion of protein leads to an increase in aminoacids in the blood. This is also a stimulus for insulin release.

Hormones produced in the intestines (like secretin) – These hormones are released into our blood when we eat food. And these raise the levels of insulin well before the actual glucose increases in the blood.

These factors all increase insulin secretion after eating, while during fasting insulin secretion is inhibited. We need fuel in fasting states, so epinephrine (a stress induced hormone) inhibits insulin secretion and mobilizes glucose from liver and fatty acids from fat stores. These glucose and fatty acids are used as fuel in a starving state.

How insulin acts in the body :

• In muscle and fat, insulin increases glucose uptake by increasing the number of transporters in the cell membrane.
• In the liver, insulin decreases the breakdown of glycogen (glucose storage form) to glucose.
• In the liver, insulin inhibits glucose synthesis.
• In fat stores, insulin inhibits release of fatty acids in to the blood.
• Insulin increases uptake of amino acids by cells leading to protein synthesis.

Types of insulin preparations :

Rapid-acting insulin – Action will be within 20 minutes. Convenient for taking before meals as you don’t have to wait 60 minutes as with regular insulin. But the diabetic patient is instructed to eat carbohydrates first.

Short-acting insulin – Effect occurs with in 30 minutes after subcutaneous injection and lasts for around 6 hours. Used after hyperglycemic episodes and emergencies and insulin changing needs like after a surgery.

Intermediate-acting insulin – Example is Lente insulin. Action starts within 2 hours and extends up to 18 – 24 hours. Two doses per day are needed for this reason. Used for regular daily maintanence of blood sugar.

Long-acting insulin – These actions are prolonged more than 24 hours. Daily dose is used in two divided doses.

Most important thing to follow when using insulins is the careful monitoring of blood glucose at home and recording it in a dairy. Follow your doctor’s instructions carefully regarding when and how much to take. Any deviation from your original healthy state should be shared with your doctor for further checking.

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