Control of Blood Glucose Level

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A first and very basic goal of diabetes care is to eliminate the symptoms of hyperglycemia. Treatment is inadequate if the person remains polyuric, thirsty, or continues to lose weight from hypergly-cemia. To cause symptoms, however, hyperglycemia usually must average more than 11 mM (200mg/dl). Since blood glucose in the 7-11 mM (125-200 mg/ dl) range is distinctly abnormal and does cause long-term diabetic complications, freedom from symptoms is only the beginning of adequate therapy.

Irrefutable evidence exists that better control of blood glucose concentration reduces the risk of developing long-term complications from diabetes. This is especially true of microvascular complications such as retinopathy (eye disease), nephropathy (kidney disease), and nerve damage in both type 1 and type 2 diabetes. Control of blood glucose also reduces the risk of macrovascular disease (heart disease, stroke, and peripheral vascular disease), although the contribution of blood glucose to these complications is less strong.

Carbohydrate ingestion (rather than fat or protein) is the main determinant of postmeal blood glucose level.

Dietary intake, oral medications, insulin, exercise, and stress all contribute to blood glucose levels in the person with diabetes and must be understood when establishing and implementing medical nutrition therapy.

To determine the efficacy of treating glycemia, blood glucose must be monitored. There are two ways to assess diabetic control: self-monitoring of blood glucose (SMBG) laboratory monitoring of hemoglobin A1c (HbAlc). SMBG, done by obtaining a drop of blood and using a small, handheld meter, measures the blood glucose at the time the measurement is taken. It may be done as often as six to eight times per day or as infrequently as several times per week. The HbAlc is a laboratory test that reflects glycemic control during the previous 60-90 days and should be done every 3-6 months. Target HbAlc is generally considered to be <6.5-7% when the upper limit of normal is <6%.

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