Monitoring & Diagnosis

Your goal: Do your level best

One of the main goals of treating diabetes is to control the blood sugar level by maintaining it as close to normal as possible. Follow the blood sugar goals recommended by your doctor.

Below are the recommendations of the associations (ADA,AACE,IDF) for the blood sugar goals of HbA1c, fasting sugar and postprandial sugar for people with diabetes:

ParameterADAAACEIDF
HbA1c (%)<7<6.5<6.5
Fasting (mg/dl)70-130<110<115
Postprandial (mg/dl)<180<140<160

Note: These guidelines apply to many people, but not to everyone. Your best "level" may be higher or lower than these guidelines. Your doctor will help you set the blood sugar target range that is right for you.

How to compare the results of your daily blood sugar test to HbA1c test:

This chart shows the average blood sugar that corresponds to the HbA1c test result. Note that an HbA1c of 6.5% results when blood sugar averages about 135 mg/dL.

Always consult your doctor to gain the right information on your HbA1c. The chart below only depicts the averages.

Blood Sugar ( mg / dL )HbA1c ( % )
1356%
1707%
2058%
2409%
27510%
31011%
34512%
When to test the blood sugar?

Testing patterns are individualized and depend on the type of diabetes and treatment plan of the patient. Your doctor sets these patterns for you.

Some of the standard times to test include:

  • First thing in the morning (Fasting)
  • Before meals
  • 2 hours after meals (Post Prandial)
  • At bed time
  • During the night (2-3 a.m.)

Low Blood Sugar (What is Hypoglycemia?)

When your blood sugar falls below 70mg/dL (3-9mmol/L), you may have low blood sugar (hypoglycemia). When this happens, most people experience unpleasant symptoms that can be both physical and emotional. These symptoms can come on quite suddenly. Hypoglycemia is usually easy to treat. However, if it is not dealt with quickly, serious reactions may result, including passing out or having convulsions. Talk with your doctor about what steps to take in case of a low blood sugar emergency, and most importantly, how to avoid one.

What causes Hypoglycemia?

The most common causes of hypoglycemia are:

  • Eating at the wrong time for the medicine you take
  • Skipping or not finishing meals or snacks
  • Drinking alcoholic beverages
  • Doing more exercise than usual
  • Taking too much diabetes medication

Skipping or delaying meals can cause low blood sugar in people who take sulfonlyureas, meglitinide or insulin. These drugs increase the body's insulin level which results in the blood sugar levels to fall too low.

Before you drink alcoholic beverages, discuss with your doctor whether moderate use of alcohol may be included in our meal plan.

Symptoms of Hypoglycemia

When blood sugar gets too low you may

  • Feel shaky
  • Be sweaty
  • Feel tired
  • Be hungry
  • Have a fast heartbeat
  • Become confused
  • Have blurred vision or a headache
  • Have no symptoms at all
Having no symptoms at all can be a dangerous situation!

First treat the low blood sugar level. If you ever have a blood sugar reading below 60 mg / dL, ( 3.3 mmol /L ) without experiencing symptoms, then call your doctor. A blood sugar level this low needs treatment, even if you are feeling fine.

Low blood sugar feels different to different people. Learn to recognize your own particular symptoms.

How to prevent hypoglycemia?

Low blood sugar can be prevented if you:

  • Eat your meals on time.
  • Don't skip meals.
  • Learn to adjust your food and diabetes medicine.
  • Test your blood sugar on schedule.
  • Do extra tests when you feel different from normal and write down the results in your log book.

References:

Standards of Medical Care in Diabetes2015. DIABETES Care 2015;3 (Suppl. 1)
Harrison’s Principles of Internal Medicine, edition 18, chapters 35, 94, 218, 21, 344
ISPAD Clinical Practice Consensus Guidelines 2014
Uptodate: Overview of medical care in adults with diabetes mellitus Author David K McCulloch, MD, Mar 18-2015
Uptodate: Glycemic control and vascular complication in type 2 diabetes mellitus, Author David K McCulloch, MD, Jun 2015  

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