Glucose Tolerence Test (GTT)
Blood Sugar level is checked few times after a glucose containing drink.
*Normal - less than 140mg/dl
*Prediabetes- 140mg/dL-199mg/dL
*Diabetes -above 200mg/dL(confirm by retesting )

Glycosylated Heamoglobin Leve (HbA1C Test)

*Normal 4-6%
*Diabetic Control- less than 7%
*In Pregnancy- less than 6%


The End

NORMAL VALUES;-

These are in keeping with latest International Guidelines(2003)
Fasting Blood Sugar;-
This is testing blood sugar level after at least an 8 hour fast.
Normal- upto 100mg/dl
Prediabetes- 100-125mg/dl
Diabetes- above 126mg/dl (confirm by retesting)

Random Blood Sugar;-
Normal - up to 100mg/dl
Prediabetes - 100-200mg/dl
Diabetes- above 200 mg/dl (confirm by retesting)

WHAT TO DO IF YOU ARE ACUTELY UNWELL ???

* Keep taking your insulin or tablets. If the sickness is prolonged your insulin or tablet doses may have
to be changed.Hence consult your doctor.
* Drink water regularly.
* If you can't take food,try taking fruit juice or some drink containing ,etc.
* You need medical attention if you feel sleepier than usual, unable to think clearly, have diarrhoea or
persistant vomiting.
* Try to monitor your blood sugar regularly if you have Glucometer at home. During acute illnesses,
the diabetic control could be more difficult and hence closer monitoring is needed.
* Keep your own record book as follows

Date Fasting Glucose Level Comments*

* comments- Indicate results like Glycosylated Heamoglobin level, kidney functions, other test results like cholesterol etc or hypo attacks and changes to medications.

ARE THERE ANY PROBLEMS IN PREGNANCY ???

If diabetes is not controlled during pregnancy your baby can have increased risk of congenital
abmormalities or baby can get too big causing major problems with delivery.

Hence strict blood sugar control is vital during pregnancy.

The pregnancy has to be well planned in advance and discussed with your doctor before the
conception. In general all diabetic tablets need stopping and a good control should be achieved with
diet and insulin.

If you get to know that you are pregnant while on tablets, make an early appointment to see your doctor.

Some women who are not known diabetics could show evidence of mild diabetes for the first time
during pregnancy ( gestational diabetes ) which resolves after delivery. They too need strict
monitoring during pregnancy.They may develop true diabetes later in life.

WHAT TO DO IF I GET "HYPO" SYMPTOMS

As it is due to low sugar, when you get these symptoms you should take something containing sugar-
either glucose,sweets,sugar drink immediately and later eat a carbohydrate like bread or sandwich etc.
It is recommended that diabetics who tend to get these attacks carry a sweet with them regularly.

If this happens on a regular basis you may need to speak to your doctor to alter the doses of medications. Also if these happens when you are driving, please stop driving till your symptoms improve with above measures.

WHAT IS A 'HYPO' ATTACK???

For our body & brain functioning we need a certain amount of sugar in blood.If our
blood sugar drops below the normal level you could get many symptoms and could even lead to loss of consciousness. Hence all diabetic patients should be aware of these warning symptoms.
These hypo attacks could be due to excess of insulin ortablets, too little food or taking
food later than normal,unusual alcohol intake or due to unusual exercise.
Common warning signs of hypos are ;-
* Sweating or feeling 'hot'
*Trembling
*Weakness/tiredness
*Faintish feelings
*Hunger
*Anger
*Blurred or double vision
*Palpitations( feeling of heart beating)
*Tingling around the lips and toungue.
*At night, may wake with nightmares bathed in sweat.
If you ignore these you may end up being unconscious or even having brain damage
if prolonged.

THE MAIN FEATURES OF MANAGEMENT OF DIABETES ARE;-

Type 1 - Healthy life style +balance diet +Insulin+/tablets

Type 2- Healthy life style +balance diet OR
Healthy life style +balance diet +tablets OR
Healthy life style +balance diet +insulin +/tablets

Usually the medications need to be gradually increased over the years asthe insulin levels tend to diminis gradually.
As mention above additional measures are needed to reduce your overall risks.

HOW DO INSULINS WORK & HOW IT IS GIVEN ???

Insulin works by lowering blood sugar.If you take too much it could lower your blood sugar too much causing a`Hypo` attack. (see below)

Insulins have to be injected by the patient or a family member.Though it is an injection
patients generally get used to it.It is commonly injected to the thigh, around your bellybutton or shoulders. It should not be injected in to the same site all the time.
Insulin should be stored in the refrigerator.(not in the freezer compartment) or in a cool
room.It is sensible always to havean extra bottle of insulin in case of breakage.The
number of injections could usually vary from one to three injections a day depending on the type of insulin prescribed.

WHAT ARE THE INDICATIONS FOR INSULIN???

Daily insulin injections are absolutely essential for Type 1 diabetic patients.
Type 2 patients may need insulin when diet, drugs etc do not work adequately any longer.Also if they suddenly become ill due to any other reason or if they go for surgery, diets or during pregnancy they may need Insulin till they get better.

There are many different types of Insulin as they could be made from cows (beef insulin), pigs (porcine insulin) or human insulin.Action of these types of insulin is
basically the same.

Also they are categorized as short,intermediate,long acting insulin and mixed types according to the duration they act.Hence different combinations of these insulin types could be very confusing!!!. Therefore do not change the type of insulin unless
specifically advices by your doctor.
Insulin as an inhalation could be available in the very near future

WHAT ARE THE MEDICATIONS FOR TYPE 2 DIABETES ???

For some dietry control,exercise and maintaining ideal body weight alone may be enough.Medication is in addition to above measures and
not "instead of " diet and exercise.Those who need tablets may need
one or more drugs to control sugar levels.Commonly used drug groups are;-
* Metformin-Controls of blood sugar by reducing the amount of sugar released to theblood stream bythe liver and increase the sensitivity
of body tissues to insulin.It is particularly useful for overweight
patients.
*Sulphonylurea-They work by increasing the insulin secretion by your
pancreas.Excess dose could cause low blood-sugar.( hypoglycemia )
Examples are - Chlorpropamide, Tolbutamide,Glibenclemide,Gliciazide,
Glipizide etc.
*Glitazones-Newer class of drugs which improvesthe action of insulin.
*Others- Acarbose- Reduces sugar absorption from your gut

WHAT ABOUT EXERCISE ?

Exercise helps the muscles to burn off extra energy.Regular exercise not only helps diabetics bu also
reduces the risks of the having heart-attacks ans stroke which are closely associated with diabetes.
If you are able, you should aim to do 30 minutes ofbrisk walking at least 5 times a week. Try to make
it a part of your daily routine like walking to your work place orshop etc.