Self-Monitoring of Blood Glucose in Diabetes

A tree in Maui. (Dr. Noorali Bharwani)
A tree in Maui. (Dr. Noorali Bharwani)

Diabetes mellitus or simply called diabetes is a chronic, lifelong condition that affects our body’s ability to use the energy found in food. This happens when our body’s capacity to produce insulin is diminished.

There are two types of diabetes – not counting gestational diabetes that occurs during pregnancy.

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. Only five per cent of people with diabetes have this form of the disease. The body is not capable of producing insulin.

Type 2 diabetes is the most common form of diabetes. In this situation the body produces insulin but the body does not use insulin properly. Eventually, the pancreas that normally produces insulin fails.

Individuals with diabetes have to check the blood sugar levels regularly to make sure it is within normal range. If the levels are too high then it can cause many complications. Instead of going to a lab for blood tests diabetic patients can now do their own blood tests and adjust their own insulin dosage.

Consumer Report (Blood Glucose Meter Buying Guide) says today’s blood glucose meters are smaller, faster, and come with more features than ever before. They’re also more accurate than blood glucose meters of years past. That’s good news for approximately 30 million North Americans with diabetes.

Why is it so important for diabetics to monitor their blood sugar levels?

Controlling blood glucose is key to managing diabetes and preventing complications. Test results help patients make adjustments to their diet, exercise routine, and diabetes treatment plan, which can help lower the risk of seizures, blindness, kidney disease, and nerve damage. There are dozens of models available priced between $10 and $75.

The Consumer Report warns don’t just look at the retail price of the meters alone. What makes blood glucose monitoring expensive is the test strips that you might use many times a day. At $18 to $184 per 100 test strips, the cost can add up to about $265 to $2,685 a year for people who test four times a day. Also there is a learning curve to make sure you get a full value for your health and investment.

Does regular monitoring of your blood sugar make your health better?

Xiang and colleagues (Journal of Diabetes Science and Technology, July 2014) says the blood glucose meter is the most successful and widely used portable device for point-of-care tests. The device has more than 50 years of technology development. So the device has stood the test of time. Regular self-monitoring of blood glucose levels in diabetics play a key role in preventing complications in the short, medium and long term.

How do you decide which meter to buy?

One way is to ask your friends who have similar health issues. Ask your doctor, nurse, dietician or individuals who work in diabetic clinics. See what the Consumer Reports has to say. Experts at their National Testing and Research Center tested 25 models to see which ones perform best.

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Medications That Put Our Seniors in the Hospital

Summer Flowers (Dr. Noorali Bharwani)
Summer Flowers (Dr. Noorali Bharwani)

I covered this topic about three years ago. It is never too early or too late to review the subject again.

A study published in the New England Journal of Medicine says 40 percent of people over 65 take five to nine medications every day. What this means is that hospitalizations for accidental overdoses and adverse side effects are likely to increase among this group.

The study found that every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. Most of the patients are there because of accidental overdoses. Sometimes the amount of medication prescribed for them had a more powerful effect than intended.

The four most common groups of medications putting seniors in hospitals are: warfarin (a blood thinner), insulin injections for diabetes, antiplatelet drugs to thin the blood and oral diabetes drugs.

Warfarin accounts for the most visits due to adverse drug reaction. It accounted for 33 percent of emergency hospital visits. Warfarin (Coumadin) is an anticoagulant – popularly referred to as a “blood thinner.” In reality, it does not make the viscosity of the blood thin. What it does is that it acts on the liver to decrease the quantity of a few key proteins in blood that allow blood to clot.

It was initially marketed as a pesticide against rats and mice. Later it was found to be effective and relatively safe for preventing blood clots in humans. It was approved for use as a medication in the early 1950s and now it is the most widely prescribed oral “blood thinner” drug in North America.

Insulin injections were next on the list, accounting for 14 percent of emergency visits. Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body.

Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetes mellitus will result. Patients with type 1 diabetes depend on insulin injections.

Antiplatelet drugs like aspirin, clopidogrel (Plavix) and others that help prevent blood clotting were involved in 13 percent of emergency visits. An antiplatelet drug is a member of a class of pharmaceuticals that decrease platelet aggregations and inhibit clot formation. They are effective in the arterial circulation, where “blood thinners” have little effect.

Lastly, diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

The authors of the article say that in order to reduce the number of emergency hospitalizations in older adults we should focus on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group. And patients should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.

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Sugar… Sugar… You Are Not My Honey Anymore

Ice cream and fried bananas. (Dr. Bharwani)
Ice cream and fried bananas. (Dr. Bharwani)

Many experts believe sugar is a poison. So does the Mayor of New York city, Michael R. Bloomberg. The mayor has been trying to improve the health habits of New Yorkers for some time, with actions like bans on smoking in bars and city parks and the posting of calorie counts on menus in chain restaurants.

Bloomberg’s recent project was to reduce the obesity rates of his citizens by restricting the amount of sugary drinks they can buy. So, last week, the New York City Board of Health approved a ban on the sale of large sodas and other sugary drinks at restaurants, street carts and movie theaters, the first restriction of its kind in the U.S. Now sugary drinks cannot be sold in containers larger than 16 ounces – some exceptions apply.

Dietary sugar is not good for your health. There are nine reasons why you should quit on sweetie sugar. It may cause hyperactivity, raise blood sugar level, suppress immune system, lead to obesity and diabetes, cause cardiovascular disease, Alzheimer’s disease, dental decay and macular degeneration.

Like many things in science, you can dig out statistics which have contradictory conclusions. This leads to confusion. The World Health Organization and others have said there are contrasting impacts of sugar in refined and unrefined forms. So there are at time no comparable studies to draw conclusions from.

Some experts believe hyperactivity is due to sugar consumption. Others have refuted the idea. Until we get a final word on it, you can stop feeding sugar to kids and adults – especially if they get sugar-high. Your blood sugar level goes up as soon as you eat sugary stuff. Consuming too much sugar suppresses the immune system. The white blood cells that attack bacteria are less effective. Immune system is also suppressed if a person is obese.

Consuming large amount of dietary sugar does not cause diabetes but it does cause obesity which is a risk factor in diabetics. A meta-analysis of several studies found sugar-sweetened beverages may increase the risk of metabolic syndrome and type 2 diabetes not only through obesity but also by increasing dietary glycemic load, leading to insulin resistance, β-cell dysfunction, and inflammation. Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes. It is estimated the syndrome is present in 25 per cent of the the U.S. population.

There is indirect evidence to suggest consuming a diet with a high glycemic load is strongly associated with an increased risk of developing coronary heart disease. The glycemic index ranks foods on how they affect our blood glucose levels.

It is suggested that Alzheimer’s disease is linked with the western diet. Animal studies suggest controlling the consumption of sugar-sweetened beverages may be an effective way to curtail the risk of developing the disease. There are links between free sugar consumption and macular degeneration in older age. There is convincing evidence from human studies to show an association between the amount and frequency of free sugars intake and dental decay.

Bloomberg’s next project should be to do what Japan did in 2008. A law in Japan requires overweight individuals or individuals who show signs of weight – related illnesses to go to dieting classes. If they fail to attend the classes then the company and/or the local government would be fined.

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