Dr Araz Rawshani

Living with high blood sugar and diabetes


To control and balance your blood sugar every day

When talking about blood sugar, it refers to the concentration of glucose (glucose) in the blood. People with diabetes have high blood sugar and this is harmful. High blood sugar leads to diseases that we call diabetic complications. These complications include nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy) and others. High blood sugar also leads to awkward symptoms such as fatigue, blurred vision, urinating a lot, thirsty and so on. To reduce the risk of complications and to get rid of symptoms of diabetes, you need to keep your blood sugar in balance. This means that blood sugar should be kept as low as possible, without the risk of having a severe fall in blood pressure. So people with diabetes need to control their blood sugar every day. This can be exhausting and frustrating.

High blood sugar in type 1 diabetes

For people with type 1 diabetes, blood sugar is a challenge all day. Type 1 diabetes means that you do not have your own insulin and therefore have to inject insulin using syringes or insulin pump. Balancing your blood sugar by injecting insulin is difficult and requires constant thinking about what you eat, how much you eat and how much insulin to inject. Living with type 1 diabetes is a tough challenge because of the constant need to control your blood sugar. Fortunately, this has become much better in recent years through new aids such as insulin pump and continuous glucose measurement. In the future, it will be even easier when you start using artificial pancreas.

High blood sugar in type 2 diabetes

Most people with type 2 diabetes still have the ability to make their own pancreatic insulin. Then it’s easier to control your blood sugar, compared to having type 1 diabetes. But even people with type 2 diabetes need to constantly think about their blood sugar. In addition, over the years, pancreatic disease becomes worse at making insulin, so many people with type 2 diabetes may actually need insulin syringes.

If you have type 2 diabetes and do not use insulin — but only tablets, diet changes and exercise — you usually don’t have so high blood sugar and usually it’s easier to balance your blood sugar. As mentioned above, many people will have to use insulin after a few years of illness and this is due to the fact that blood sugar tends to rise over time. Then it will be more difficult to balance blood sugar in type 2 diabetes.

Other risk factors must be monitored and treated

Diabetes and high blood sugar lead to diabetic complications. Complications of type 1 diabetes and complications of type 2 diabetes are both serious and difficult to live with. Complications are due to the fact that high blood sugar damages the vessels of the eyes, kidneys, heart, nerves and other places. To reduce the risk of these complications, you need to treat other risk factors such as high blood pressure (hypertension), high blood lipidemia (hyperlipidemia), quit smoking and eat healthy food. According to guidelines today, the use of statins should be considered if you have diabetes and have reached the age of 40. Statins lower cholesterol (LDL cholesterol) and reduce the risk of heart attack and stroke. To treat hypertension and high blood lipids is quite simple today and you, as a rule, do not be bothered by the treatment. Quitting smoking is more difficult, but incredibly important. You who have diabetes can’t afford to smoke.

The positive news

An enormous amount has happened in diabetes care over the last few decades. Technological progress has been very fast and made life much more comfortable for people with diabetes. Medical knowledge has also developed and we have become very good at treating diabetes. As a result, people with diabetes today have a 30% lower risk of complications compared to 15 years earlier. These are sensational figures and it means that you can lead a healthy life with diabetes. To do this, it is crucial that you control your blood sugar and other risk factors.

Is it easy to balance blood sugar?

If the purpose of the treatment had been to reduce blood sugar as much as possible, it would have been easy. Namely, there are very many drugs that can lower blood sugar. Unfortunately, you cannot have that strategy because blood sugar can become too low and it can become dangerous. It is especially people treated with insulin who are at risk of getting low blood sugar (other antidiabetic medicines do not usually give low blood sugar). If you get low blood sugar when you are treated with insulin, you get so-called hypo sensations. Low blood sugar, which in medical language is called hypoglycemia, can become serious. Therefore, it is necessary to balance between low and high values. For people with type 1 diabetes, the goal is to have a blood sugar between 4 and 7 mmol/l but this can be difficult to achieve. For type 2 diabetes, the same level is sought, but it is usually easier to achieve in type 2 diabetes.

Can you get perfectly normal blood sugar with diabetes?

Type 2 diabetes: Yes, you can actually get rid of type 2 diabetes. Most often it requires losing a lot of weight and becoming physically active. People who eat a low-carbohydrate diet can also get normal blood sugar. However, most people do not succeed in this. Over the years, blood sugar tends to rise if you have type 2 diabetes. On average, blood sugar rises by 1 mmol/l every 4 years. That’s why people often need insulin after a number of years of illness.

Type 1 diabetes: It is extremely difficult to get normal blood sugar if you have type 1 diabetes. But today the treatment is very good and you can get a very good blood sugar. In addition, the technique is developing very quickly. With the help of insulin pump and continuous glucose measurement (CGM), you can now get very good blood sugar and also easier to balance the sugar. Within a few years, it is likely that people will start using so-called artificial pancreas, which will further improve treatment. There is a lot of hope for anyone who has type 1 diabetes.

How do you manage your blood sugar?

  • You use a blood glucose meter to measure blood sugar. Today, many patients have more sophisticated blood glucose meters. Insulin pumps can have built-in blood glucose meter. You may also have a continuous blood glucose meter (CGM).
  • If you are using insulin (all with type 1 diabetes, some with type 2 diabetes), you will need to make many regular blood sugar measurements every day.
  • If you are only being treated with a change of diet, physical activity and other lifestyle changes, the risk of swinging blood sugar low, and therefore you do not need to do the same number of blood sugars.
  • You take the drugs that the doctor or nurse has prescribed.
  • You evaluate how blood sugar varies during the day and try to set it in relation to the following: 1. How much you have eaten and what you have eated. 2. How much physical activity you have had during the day. 3. If there are other factors that may affect blood sugar (stress, other illness, lack of sleep, etc.).
  • You make sure you have good communication with your doctor and nurse: 1. What target values should you have? Target values are the blood glucose values you should aspect. 2. What should you do if your blood sugar becomes too high or too low?

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Measurement of ketones

If the blood sugar becomes very high then you can get high levels of ketones in the blood. Very high level of ketones is toxic and leads to the condition called ketoacidosis. You can measure ketones at home using special needles (urine sticks). Always start by controlling your blood sugar. Please read about Ketoacidosis here at diabeteson.com.

What measurements of blood sugar should I use?

You should use common blood sugar (P-glucose) and long-term blood sugar (HbA1c).

Blood sugar, P-glucose: in the blood there is glucose (glucose). The concentration of glucose is called blood sugar, or blood glucose. During the day, blood sugar varies greatly; blood sugar rises after meals and drops between meals. When you measure blood sugar, you measure the level at the moment the measurement is made.

Long-term sugar, HbA1c: Long-term sugar is also called HbA1c, which stands for Hemoglobin A1C. HbA1c is actually a type of hemoglobin (which is a protein in our red blood cells). Glucose can attach to hemoglobin. The higher the blood sugar you have, the more glucose attaches to the haemoglobin. When you measure HbA1c, you measure the amount of hemoglobin that is “sugared”. The higher the blood sugar, the higher the amount of HbA1c is sugared. High HbA1c means that blood sugar is high. Long HbA1c means that blood sugar is low. The big difference between HbA1c and blood glucose is that HbA1c reflects the average blood sugar levels in the last 6 weeks. This is because it proceeds slowly when glucose attaches to hemoglobin. It also means that short-term fluctuations in blood sugar have no effect on HbA1c.

The risk of diabetic complications has a very strong relationship with HbA1c, which in turn is a reflection of blood sugar over a longer period of time. Swedish guidelines for diabetes care indicate that HbA1c should be less than 52 mmol/mol. This means that the target value is 52 mmol/mol and this is considered to be “good control”.

The diagram below shows how the risk of complications increases with higher HbA1c.

HbA1c is set in a new scale since 2010

Since 1 September 2010, HbA1c has been specified in a different way than before. Previously, the answers were given as a percentage (%), now the answers are given in mmol/mol. The change is part of international cooperation, which means that HbA1C results are directly comparable worldwide.

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