The American Diabetes Association published revised Standards of Care for diabetes, emphasizing that high-quality diabetes care must be individualized to reflect the needs, interests, and abilities of each person. The primary goal of care is to reduce blood glucose levels to as close to normal as is reasonable. To monitor success toward that goal, the diabetic should self-manage in a responsible manner using diet revision and exercise as the primary strategy and should self-monitor blood glucose levels at home.

The secondary goal is to monitor for and, if detected,  treat developing complications. This requires annual eye exams to detect retinopathy, annual urinalysis to search for early signs of nephropathy, periodic foot examinations, regular blood pressure and cholesterol and triglyceride testing to warn of impending heart disease. The official view is that patient education and motivation must be a central component of quality diabetes care because each person must provide daily self-care:

• managing food selection, meal planning

• staying in control  of  the diet

• getting daily exercise

• self-monitoring blood glucose

• taking medication, if required

• quitting smoking

Blood Sugar Monitoring

Home testing of blood glucose levels is a good idea for the self-managing diabetic. Several testing units are available and all are relatively easy to use. There are two blood sugar scales in use - the metric system mmol/l and the older mg/dl scale. The most important number is 7mmol/l = 120mg/dl - the upper limits of normal range for fasting blood sugar and 2 hours after-eating blood sugar.

Fasting blood sugar levels, taken in the morning before eating, should fall in a normal range. The goal is to keep this value under 7 mmol/L or 120 mg/dl. (finger test values 8.5mmol or 150 mg)

Two hours after eating; blood sugar rises and then falls to a baseline level. For year the glucose tolerance test was used, generating a blood sugar response profile over a 4 to 6 hour period. In the table below normal values are listed for a 75 gram glucose test. The sugar level peaks in 30-60 minutes and the falls back to a baseline level. The timing and height of the peak level will vary with the composition of the meal and activity levels. The glycemic index has been developed to show the peak sugar response after eating individual foods.

By sampling blood sugar levels two hours after eating, you find out if glucose is being removed from your blood in a reasonable period. The goal is to show values less than 7 mmol or 120 mg . (finger test values 8.5mmol or 150 mg) at two hours. Higher values tell you that you must do two things- change the food or meal that caused high sugar level and exercise after the meal to increase glucose utilization.

Checking symptomatic episodes: you measure blood sugar when you are not feeling well to find out how your symptoms correlate with the blood sugar level. High levels are associated with an intoxicated feeling - drowsy, hard to concentrate, judgment impaired. Levels above 17 mmol or 300 mg are dangerously high - you are likely to want to sleep at this level but the most effective way to reduce the sugar levels is to exercise as vigorously as you can.

Levels below 4.0 capillary (60 mg ) may be associated with hypoglycemic symptoms - you feel  strange, anxious, irritable; a tremor develops if the blood sugar value falls lower and you become desperate to eat something. If you can take a quick sugar hit - a glass of orange juice will do and measure your sugar immediately you can determine how low the value dropped; as you feel better do another blood sugar check to find the value that feels normal.

See the  Diabetes Rescue Pack 

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