How Can Continuous Glucose Monitoring Help You Maintain Optimal Glucose Levels
It is not uncommon for your glucose levels to increase after a meal: you just ate food that may contain glucose, and now your body is working on getting it out of the bloodstream and into the cells. We know that we want to prevent excessive spiking of glucose levels because studies show that high post-meal glucose spikes over 160 mg/dl are associated with higher cancer rates. Spikes are also associated with heart disease. Repeated high glucose spikes after meals contribute to inflammation, blood vessel damage, increased risk of diabetes, and weight gain. Additionally, the data shows that the big spikes and dips in glucose are more damaging to tissues than elevated but stable glucose levels. Therefore, you should strive to keep your glucose levels as steady as possible, at a low and healthy baseline level, with minimal variability after meals.
Keeping your glucose levels constant is more complicated than just following a list of eat this, avoid that foods. Each person has an individual response to food when it comes to their glucose levels studies have shown that two people can have different changes in their glucose levels after eating identical foods. The difference can be quite dramatic. One study found that some people had equal and opposite post-meal glucose spikes in response to the same food.
Do We Get Better At Using Ketones
Urine ketone strips are considered by many to be of limited use because before too long the body stops excreting ketones into the urine as it learns to use them rather than wasting them.
It seems that your body also adapts to use blood ketones more efficiently the longer you follow a lower carbohydrate diet. Most people move beyond the keto adaption phase as their bodies learn to use fat more efficiently, and their ketone levels reduce further.
You can think of BHB as the storage and transport form of ketones. Your body converts BHB back to acetoacetate to be used for energy.
The BHB ketones that you measure simply tells you how much energy you have stored as ketones in your bloodstream. Unfortunately, it doesnt tell you anything useful about your ability to burn fat for fuel. High blood ketones may mean that you have unused fuel backing up in your bloodstream .
Just like a fuel-efficient car doesnt need a massive fuel tank, you dont need high levels of ketones or glucose in your bloodstream if you have a healthy and efficient metabolism.
When To See A Healthcare Provider
Getting professional medical advice from a healthcare provider like an endocrinologist is the best way to learn more about whether your blood sugar levels are where they should be. Not getting proper treatment for low or high blood sugar levels can be serious and lead to health complications, especially for those with diabetes. Diabetes complications include nerve damage, kidney disease, heart disease, or heart attacks.
If you see a healthcare provider about your blood sugar levels, be prepared to answer questions about risk factors like what you eat, how much you exercise, and about your family history. Some healthcare providers may want to take a blood sample to test your blood sugar levels. They may also order an A1C test, which is a blood test that measures blood sugar levels over several months. You may have to fast eight hours beforehand to get accurate test results, so its always a good idea to check before your appointment.
If your blood sugar level goes above 250 mg/dL, you should go to the ER for immediate medical attention, says Dr. Tarugu. Emergency rooms are equipped to handle high blood sugar levels and can administer treatments like insulin therapy and fluid or electrolyte replacement.
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Random Plasma Glucose Test
A random blood glucose test is a blood test thats performed any time of day that you arent fasting. It measures the sugar level in your blood at that moment in time.
If your level is higher, your doctor will use one of the other tests listed to confirm the diagnosis.
Why Your A1c Matters
In a nutshell: your A1c is one of the clearest indicators of your risk for developing diabetes complications like neuropathy , retinopathy , nephropathy , and severe infection in any part of your body that requires healing.
For instance, a small cut on your toe could become infected due to high blood sugars, struggle to heal, and become severe enough that the infection could lead to an amputation.
The general guidelines from the American Diabetes Association recommend an A1c at or below 7.0 percent for the best prevention of diabetes complications. Your risk of developing a diabetes complication continues to drop as your A1c drops closer to 6 percent.
Some people with diabetes aim for A1c levels in the 5s and lower especially those who follow strict low-carb diets like the ketogenic diet and the Bernstein diet. However, this hasnt been proven in research as especially necessary, nor is it reasonably achievable for the larger population of people with diabetes.
Its also important to remember that your blood sugar levels and your A1c are just information that tells you whether your body needs more or less of factors like insulin, other diabetes medications, changes in your nutrition, and changes in your exercise.
If you dont like the number youre seeing on your glucose meter or your A1c results, use that number as motivation to make changes in how you safely manage your diabetes in order to get different results.
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Fasting Vs Nonfasting Blood Sugar
Fasting blood sugar is a test that measures blood sugar and is used to determine if an individual has diabetes. When a person takes this test, they are not to eat or drink for at least eight hours prior to the test. The results determine whether or not a person is prediabetic or diabetic.
The results are measured in milligrams per deciliter or mg/dL. The following results indicate whether or not a person is prediabetic or diabetic:
- Normal: Less than 100 mg/dL
- Prediabetes: 100 mg/dL to 125 mg/dL
- Diabetes: 126 mg/dL or higher
To test nonfasting blood sugar, an A1C test is administered to determine the average blood sugar level of an individual over a period of two to three months. There is no need to fast prior to taking this test. The following results indicate whether or not a person is prediabetic or diabetic:
- Normal: 5.7%
- Diabetes: 6.5%
A1c Goals Should Be Individualized
A1c goals should be individualized based on the individual capabilities, risks, and prior experiences, explains Gary Scheiner, MS, CDE, founder of Integrated Diabetes, and author of Think Like a Pancreas.
For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly.
However, Scheiner highlights important factors that could justify aiming for a higher A1c, like hypoglycemia unawareness, which is described as when a person with diabetes no longer feels the oncoming warning signs of low blood sugar. This can put you at significant risk for severe low blood sugars resulting seizures or death. To reduce that risk, you would aim for higher target blood sugar ranges.
Someone with significant hypoglycemia unawareness and a history of severe lows should target higher blood glucose levels than someone who can detect and manage their lows more effectively, adds Scheiner. And certainly, someone who has been running A1cs in double digits for quite some time should not be targeting an A1c of 6% better to set modest, realistic, achievable goals.
Learn how to lower your A1c in DiabetesStrongsA1C Guide.
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Know Your Body Mass Index
Being overweight or obese puts you at risk for developing type 2 diabetes. BMI is an easy way to estimate excess fat. Even a small change in body weight can reduce your risk of diabetes.
If your score is:
25.029.9 = Overweight/Pre-obese 30.0 and over = Obese
To calculate your BMI, you can use the BMI chart or the formulas at the bottom of this page or complete the Canadian diabetes risk questionnaire.
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 sugarNormal for person without diabetes: 7099 mg/dl Official ADA recommendation for someone with diabetes: 80130 mg/dl
Normal blood sugar 2 hours after mealsNormal for person without diabetes: Less than 140 mg/dl Official ADA recommendation for someone with diabetes: Less than 180 mg/dl
Normal for person without diabetes: Less than 5.7%Official ADA recommendation for someone with diabetes: Less than 7.0%
Source: American Diabetes Association
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Know Your Blood Sugar
Blood sugar is the amount of sugar in your blood at a given time. It’s important to check your blood sugar level, because it will:
- determine if you have a high or low blood sugar level at a given time
- show you how your lifestyle and medication affect your blood sugar levels
- help you and your diabetes health-care team make lifestyle and medication changes to improve your blood sugar levels
What Causes Low Blood Sugar
Low blood sugar has many causes, including missing a meal, taking too much insulin, taking other diabetes medicines, exercising more than normal, and drinking alcohol. Blood sugar below 70 mg/dL is considered low.
Signs of low blood sugar are different for everyone. Common symptoms include:
Know what your individual symptoms are so you can catch low blood sugar early and treat it. If you think you may have low blood sugar, check it even if you dont have symptoms. Low blood sugar can be dangerous and should be treated as soon as possible.
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Diagnosing Prediabetes Type 2 And Type 1 Diabetes
Depending on which country or medical organization you ask, the qualifying numbers for normal versus prediabetes versus diagnosed type 1 or type 2 diabetes can vary slightly. The following blood sugar and A1c the general results are used to diagnosed prediabetes and diabetes according to sources including the American Diabetes Association and Diabetes UK:
- HbA1c: 5.7 to 6.4 percent
- Fasting: 100 to 125 mg/dL
- 2 hours after a meal: 140 mg/dL to 199 mg/dL
Type 1 or 2 diabetes
- HbA1c: 6.5 percent or higher
- Fasting: 126 mg/dL or higher
- 2 hours after a meal: 200 mg/dL or higher
Please note: Type 1 diabetes tends to develop very quickly which means that by the time symptoms are felt, blood sugar levels are generally well above 200 mg/dL all the time. For many, symptoms come on so quickly they are dismissed as the lingering flu or another seemingly ordinary virus.
By the time blood sugar levels are tested, many newly diagnosed type 1 patients will see levels above 400 mg/dL or higher. If you do suspect that you or a loved-one has type 1 diabetes, visit your primary care or urgent care immediately and ask for a urine test to measure ketones in addition to testing blood sugar levels and A1c.
Read more about ketones at diagnosis in Diabetes StrongsDiabetic Ketoacidosis Guide.
The Nuances Of Low Glucose
In a recent study, researchers reviewed the published literature to see if low fasting glucose levels affected healthy peoples long term risks of health problems, like strokes and heart attacks. They found that healthy non-diabetic people who had baseline fasting glucose levels of less than 72 mg/dl had a 56% increase in all-cause mortality compared to people with normal fasting blood glucose levels. Also, the risks for heart attacks and strokes were higher in people with baseline fasting glucose levels less than 72 mg/dl. This result is likely due to the body releasing more epinephrine to counteract the low glucose levels too much epinephrine for too long leads to heart problems. Interestingly, people with low fasting glucose levels of less than 83 mg/dl but higher than 72 mg/dl did not have an increased risk of future heart attacks and strokes.
While there has been an association between low fasting plasma glucose levels and worse health outcomes, it is not clear whether transient dips in glucose levels during a continuous 24-hour period are unhealthy for nondiabetic individuals. Part of the reason that this is unknown is that continuous glucose monitoring is a relatively new technology and has been studied more extensively in diabetic individuals than in healthy individuals.
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How Do You Know What Your Blood Glucose Level Is
For the most part, you cant feel what your blood glucose level is unless its fairly high or its low. You may not even always have symptoms of either high or low blood glucose in fact, many people with type 2 diabetes dont have the usual symptoms of high blood glucose, and for this reason, its not uncommon for people to go undiagnosed for many years.
The best way to know your blood glucose level is to check it with a glucose meter. This means doing a fingerstick with a lancet and getting a drop of blood onto a test strip, then inserting the strip into the meter for a reading. Your doctor may be able to give you a meter free of charge, but youll likely need to pay for test strips and lancets. But check with your health plan, as there are likely one or two preferred meters that they want you to use.
Another way to know what your glucose levels are up to is to use a continuous glucose monitor, or CGM, which reads glucose in the interstitial fluid about every 5 minutes. Continuous glucose monitoring is expensive and may or may not be covered by your health plan.
Fasting & Elevated Blood Glucose
Type 2 diabetes for 20+ years. Started keto with intermittent fasting in January 2019. Why would my fasting blood glucose numbers during my 18-24-hour fast be elevated, then come down to normal ranges after eating?
Fasting can definitely raise blood glucose. This is due to the effect of insulin falling and the rising counter-regulatory hormones including increased sympathetic tone, noradrenaline, cortisol and growth hormone, in addition to glucagon. These all have the effect of pushing glucose from liver storage into the blood. This is normal. If you are not eating, you want to use some stored glucose. The question is this if you are not eating, and your blood glucose went up, where did that glucose come from? It can only have come from your own body . So, its a natural phenomenon, and the fasting now allows your body to use some of the glucose for energy.
Dr. Jason Fung
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Veggies Or Fat Or Protein
I was taught to eat my salad first, then the meal but I read that you advised to break a longer fast with ¼ cup of Macadamia nuts, and an hour later a salad. Ivor Cummins talked about the veggies doing their thing in the upper intestine, and the fat and protein in the lower. My question is which should I eat first to receive the best benefit. I eat once a day while fasting at least 24 hours. When 24 hours comes past 8 pm, I wait until the next day around lunch, then move ahead one hour each day and repeat.
I think you should eat the salad first. There is some data to suggest that eating the veggies first reduces insulin.
Dr. Jason Fung
Navratri : Fasting With Diabetes Here Are Tips You Should Follow
- Navratri 2021: People with diabetes are advised to follow a proper diet plan and stay hydrated while Navratri fasting. Here are tips by a dietician.
People with uncontrolled diabetes and those who are on insulin especially need to exercise caution to avoid risk of hypoglycemia . Intake of 2-3 litres of water per day is advised for diabetes while fasting and foods with low glycemic index like buckwheat flour, green vegetables, buttermilk, are ideal to have in lunch and dinner.
Shruti Bharadwaj, Senior Clinical Dietician, Narayana Hrudalayala Multi Speciality Hospital Ahmedabad, in a telephonic conversation with HT Digital gives more tips for diabetics who are fasting this Navratri.
Manage sugar levels:Don’t starve and keep long gap between meals. As healthy vrat-friendly snacks one can have buttermilk, curd or a handful of almonds, walnuts and makhana. People who are on insulin must plan their diet in consultation with a dietician to ensure they do not get hypoglycemia. If your sugar level fluctuates too much, your doctor may advise you not to fast.
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Oral Glucose Tolerance Test
Doctors generally only perform this prediabetes blood test during pregnancy. Like the fasting blood sugar test, the doctor will take a blood sample after the patient has been fasting for at least eight hours. Then, the patient will consume a sugary liquid and have their blood sugar levels tested again in two hours.
In this test, a blood sugar level from 140 to 199 mg/dL is considered prediabetes. Any higher indicates diabetes.