Checking Your Blood Glucose

People with diabetes work to keep their blood sugar (glucose) as near to normal as possible. Keeping your blood glucose in your target range can help prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage.

When you learned you had diabetes, you and your health care team worked out a diabetes care plan. The plan aims to balance the foods you eat with your exercise and, possibly, diabetes pills or insulin. You can do two types of checks to help keep track of how your plan is working. These are blood glucose checks and urine ketone checks.

Blood Glucose Monitoring Checks
Blood glucose monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. Keeping a log of your results is vital. When you bring this record to your health care provider, you have a good picture of your body's response to your diabetes care plan. Blood glucose checks let you see what works and what doesn't. This allows you and your doctor, dietitian, or nurse educator to make needed changes.
Here is a table that lists blood glucose ranges for adults with diabetes:
Glycemic control
A1C <7.0%
Preprandial plasma glucose (before a meal) 70–130 mg/dl (5.0–7.2 mmol/l)
Postprandial plasma glucose (after a meal) <180 mg/dl (<10.0 mmol/l)
Blood pressure <130/80 mmHg
Lipids LDL <100 mg/dl (<2.6 mmol/l)
Triglycerides <150 mg/dl (<1.7 mmol/l)
HDL >40 mg/dl (>1.1 mmol/l)

Who Should Check?
Experts feel that anyone with diabetes can benefit from checking their blood glucose. The American Diabetes Association recommends blood glucose checks if you have diabetes and are:
taking insulin or diabetes pills on intensive insulin therapy pregnant having a hard time ontrolling your blood glucose levels having severe low blood glucose levels or ketones from high blood glucose levels having low blood glucose levels without the usual warning signs.

Urine Checks
Urine checks for glucose are not as accurate as blood glucose checks. Urine testing for glucose should not be done unless blood testing is impossible. A urine check for ketones is another matter. This check is important when your diabetes is out of control or when you are sick. You can find moderate or large amounts of ketones in urine when your body is burning fat instead of glucose for fuel. This happens when there is too little insulin at work. Everyone with diabetes needs to know how to check their urine for ketones.

How Blood Checks Work
You stick your finger with a special needle, called a lancet, to get a drop of blood. With some meters, you can also use your forearm, thigh or fleshy part of your hand. There are spring-loaded lancing devices that make sticking yourself less painful. Before using the lancing device, wash your hands or site you chose with soap and water. If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.

Checking With a Blood Glucose Meter
Blood glucose meters are small computerized machines that "read" your blood glucose. In all types of meters, your blood glucose level shows up as a number on a screen (like that on your pocket calculator). Be sure your doctor or nurse educator shows you the correct way to use your meter. With all the advances in blood glucose meters, use of a meter is better than visual checking.

How to Pick a Meter
There are many meters to choose from. Some meters are made for those with poor eyesight. Others come with memory so you can store your results in the meter itself. The American Diabetes Association does not endorse any products or recommend one meter over another. If you plan to buy a meter, here are some questions to think about:
What meter does your doctor or diabetes educator suggest? They may have meters that they use often and know best.

What will it cost? Some insurance companies will only pay for a certain meter. Call your insurance company before you purchase a meter and ask how to get a meter and supplies. If your insurance company does not pay for blood glucose checking supplies, rebates are often available toward the purchase of your meter. You still have to consider the cost of the matching strips and lancets. Shop around.

How easy is the meter to use? Methods vary. Some have fewer steps than others.
How simple is the meter to maintain? Is it easy to clean? How is the meter calibrated (set correctly for the batch of strips you are using)?

Are meters accurate?
Experts testing meters in the lab setting found them accurate and precise. That's the good news. The bad: meter mistakes most often come from the person doing the blood checks. For good results you need to do each step correctly. Here are other things that can cause your meter to give a poor reading:
a dirty meter
a meter or strip that's not at room temperature
an outdated test strip
a meter not calibrated (set up for) the current box of test strips
a blood drop that is too small

Ask your health care team to check your skills at least once a year. Error can creep in over time.
Logging Your Results

When you finish the blood glucose check, write down your results and use them to see how food, activity and stress affect your blood glucose. Take a close look at your blood glucose record to see if your level is too high or too low several days in a row at about the same time. If the same thing keeps happening, it might be time to change your plan. Work with your doctor or diabetes educator to learn what your results mean for you. This takes time. Ask your doctor or nurse if you should report results out of a certain range at once by phone.

Keep in mind that blood glucose results often trigger strong feelings. Blood glucose numbers can leave you upset, confused, frustrated, angry, or down. It's easy to use the numbers to judge yourself. Remind yourself that your blood glucose level is a way to track how well your diabetes care plan is working. It is not a judgment of you as a person. The results may show you need a change in your diabetes plan.

Checking for Ketones
You may need to check your urine for ketones once in a while. Ketones in the urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy. Ketones in the urine is more common in type 1 diabetes.
Urine tests are simple, but to get good results, you have to follow directions carefully. Check to be sure that the strip is not outdated. Read the insert that comes with your strips. Go over the correct way to check with your doctor or nurse.

Here's how most urine tests go:
Get a sample of your urine in a clean container.
Place the strip in the sample (you can also pass the strip through the urine stream).
Gently shake excess urine off the strip.
Wait for the strip pad to change color. The directions will tell you how long to wait.
Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.

Record your results.
What do your results mean? Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours. Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucoser is high. These are signs that your diabetes is out of control. Talk to your doctor at once if your urine results show moderate or large amounts of ketones.

Keeping track of your results and related events is important. Your log gives you the data you and your doctor and diabetes educator need to adjust your diabetes care plan.
When to Test
Ask your doctor or nurse when to check for ketones. You may be advised to check for ketones when:
your blood glucose is more than 300 mg/dl
you feel nauseated, are vomiting, or have abdominal pain
you are sick (for example, with a cold or flu)
you feel tired all the time
you are thirsty or have a very dry mouth
your skin is flushed
you have a hard time breathing your breath smells "fruity"
you feel confused or "in a fog"

These can be signs of high ketone levels that need your doctor's help.

Diagnosing Diabetes

The two primary tests and their results which combine to make the diagnosis of diabetes
In diagnosing diabetes, physicians primarily depend upon the results of specific glucose tests. However, test results are just part of the information that goes into the diagnosis of diabetes. Doctors also take into account your physical exam, presence or absence of symptoms, and medical history. Some people who are significantly ill will have transient problems with elevated blood sugars which will then return to normal after the illness has resolved. Also, some medications may alter your blood glucose levels (most commonly steroids and certain diuretics (water pills)). The two main tests used to measure the presence of blood sugar problems are [1] the direct measurement of glucose levels in the blood during an overnight fast, and [2] measurement of the body's ability to appropriately handle the excess sugar presented after drinking a high glucose drink.

[1] Fasting Blood Glucose (Blood Sugar) Level:
The "gold standard" for diagnosing diabetes is an elevated blood sugar level after an overnight fast (not eating anything after midnight). A value above 140 mg/dl on at least two occasions typically means a person has diabetes. Normal people have fasting sugar levels that generally run between 70-110 mg/dl.

[2] The Oral Glucose Tolerance Test
An oral glucose tolerance test is one that can be performed in a doctor's office or a lab. The person being tested starts the test in a fasting state (having no food or drink except water for at least 10 hours but not greater than 16 hours). An initial blood sugar is drawn and then the person is given a "glucola" bottle with a high amount of sugar in it (75 grams of glucose), (or 100 grams for pregnant women). The person then has their blood tested again 30 minutes, 1 hour, 2 hours and 3 hours after drinking the high glucose drink.

For the test to give reliable results, you must be in good health (not have any other illnesses, not even a cold). Also, you should be normally active (for example, not lying down or confined to a bed like a patient in a hospital) and taking no medicines that could affect your blood glucose. The morning of the test, you should not smoke or drink coffee. During the test, you need to lie or sit quietly.

The oral glucose tolerance test is conducted by measuring blood glucose levels five times over a period of 3 hours. In a person without diabetes, the glucose levels in the blood rise following drinking the glucose drink, but then then fall quickly back to normal (because insulin is produced in response to the glucose, and the insulin has a normal effect of lowing blood glucose.) In a diabetic, glucose levels rise higher than normal after drinking the glucose drink and come down to normal levels much slower (insulin is either not produced, or it is produced but the cells of the body do not respond to it) (see details on type 1 and type 2 diabetes for more information on this topic).

As with fasting or random blood glucose tests, a markedly abnormal oral glucose tolerance test is diagnostic of diabetes. However, blood glucose measurements during the oral glucose tolerance test can vary somewhat. For this reason, if the test shows that you have mildly elevated blood glucose levels, the doctor may run the test again to make sure the diagnosis is correct.
Glucose tolerance tests may lead to one of the following diagnoses:
Normal Response A person is said to have a normal response when the 2-hour glucose level is less than or equal to 110 mg/dl.

Impaired Fasting Glucose
When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dl, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes, and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes.

Impaired Glucose Tolerance
A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dl. This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.

Diabetes
A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dl. This must be confirmed by a second test (any of the three) on another day. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.

Gestational Diabetes
A woman has gestational diabetes when she is pregnant and has any two of the following: a fasting plasma glucose of more than 105 mg/dl, a 1-hour glucose level of more than 190 mg/dl, a 2-hour glucose level of more than 165 mg/dl, or a 3-hour glucose level of more than 145 mg/dl.

Nutrition for Diabetics

If you are one of the millions who suffer from diabetes, you’ll notice that a couple of things in your life will have to change to accommodate your condition. What you eat plays a key role in how your body copes with being diabetic. When you do right by maintaining the proper daily diet, you can directly benefit your health and how your body reacts to being diabetic in the future. And all it takes is a little know-how when it comes to food.

Recent medical studies have found that including more fiber in your diet can help lower your blood sugar as much as using diabetes medication. How is this possible? By consuming more soluble fiber, this causes the human body to form a thick gel that prevents carbohydrates and glucose from absorbing into the intestine. This directly results in lower blood sugar and insulin levels. Doctors now suggest that diabetics consume 13 daily servings of fruits, vegetables and grains. So the next time you go grocery shopping, be sure to buy a helping of prunes, oranges, grapefruits, raisins, lima beans, oatmeal, oat bran, papayas, cantaloupes, granola, strawberries, barley, peas, apple, and zucchini.

As far as beverages go, including glasses of tomato juice and milk can also help you naturally tame your diabetes, making it much easier to manage and allowing you to do without all the prescription meds. Tomato juice has been found to naturally thin the blood. This is important for those who suffer from type 2 diabetes because these individuals are more at risk for heart attacks and strokes. Type 2 diabetes sufferers have blood cells that tend to stick to each other easily, which can lead to clogged arteries. Healthy blood cells should lack any type of tendency to cling and should instead slip and slide freely through the arteries. By drinking one cup of tomato juice a day, you can effectively reduce the stickiness of your blood platelets, which can reduce your risk for blood clots by as much as 27%. For dairy lovers, add a glass of 1% milk or try a smoothie made with low-fat yogurt. The lactose, fat and protein in milk has the ability to improve blood sugar naturally. The lactose works to convert blood sugar at a slow rate, which helps improve blood sugar control and reduce insulin levels. The proteins and fat help fill you up so you have a natural appetite suppressor that can prevent you from overeating.

In addition to these helpful foods and beverages, diabetics should also aim to include these four supplements into their daily diets as well: magnesium, chromium, alpha-lipoic acid and vitamin E. When you consume more magnesium, the risk of type 2 diabetes goes down. Magnesium improves insulin resistance and blood sugar control. You can take a pill supplement for magnesium or you can chow down on nuts, wheat germ, whole grains, legumes, and green leafy veggies. Having chromium present in the body prevents sugar from building up in the blood. Alpha-lipoic acid is a potent antioxidant that has been medically used to treat diabetic neuropathy, which happens when high blood sugar levels damage the nerve endings in the legs, feet and hands. Spinach and meat are good sources of alpha-lipoic acid but for greater doses, supplements are best. Eating nuts, vegetable oils and avocadoes can give you the daily dose of vitamin E that has been shown to reduce free radical damage in diabetics that is responsible for heart disease and nerve damage.

All About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.
In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

Recently Diagnosed?This area of our Web site can help ease your fears and teach you more about living with diabetes or caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.
Visit the Recently Diagnosed area of diabetes.org
Major Types of Diabetes

Type 1 diabetes:- Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.

Type 2 diabetes - Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

Gestational diabetes - Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.
Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.
Additional Information

Recently Diagnosed You or someone you love has just been diagnosed with diabetes -- chances are you have a million questions running through your head. This area of our Web site can help ease your fears and teach you more about living with diabetes or caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.

Diabetes Learning Center Take the first steps toward better diabetes care by visiting the Diabetes Learning Center -- an area for people who have been recently diagnosed with diabetes, or those needing basic information.

Diabetes SymptomsOften diabetes goes undiagnosed because many of its symptoms seem so harmless. Learn what they are in this section.

Further Reading . . . The Complete Guide to Diabetes has been completely revised to bring you all the information you need to live an active, healthy life with diabetes. Now in its fourth edition, this guide gives you information on the best self-care techniques and the latest medical advances. If you have diabetes, this guide will answer all your questions. For more books on healthy living.

Diabetes Risk Test - 23.6 million Americans have diabetes -- nearly one in four does not know it! Take our diabetes risk test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders.
Diabetes Myths Find the truth about some of the most common myths about diabetes.
Diabetes Statistics - With so many people affected by diabetes, the American Diabetes Association has compiled statistics on the impact of diabetes and its complications. We have statistics listed by population, complication, and economic impact.

The Genetics of Diabetes - You've probably wondered how you got diabetes. You may worry that your children will get it too. Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.

Who's on your health care team? -No matter what kind of diabetes you have, it affects many parts of your life. You can get help from health professionals trained to focus on different areas, from head to toe. A health care team helps you use the health care system to its fullest. So whom do you need on your team? Find out here.

Books & MagazinesVisit - our bookstore for a variety of cookbooks, meal planners, self-care guides and other educational materials to assist you in managing diabetes.