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Frequently Asked Questions
What is Self-Monitoring of Blood Glucose(SMBG)?
What should I know about blood glucose measuring?
How often should I test my blood glucose level?
Pre-and Post meal blood glucose level - what’s the significance?
What is the significance of bed time blood glucose level?
Why do I wake up with high levels of blood glucose?
How can I determine if I am managing well by using my blood glucose data?
What are the dietary guidelines for diabetics?
What is “My Plate”?
How many calories a day does my body need? (Basal metabolic rate BMR)
What is “carbohydrate”?
What is the recommended daily carbohydrate intake? (Carbohydrate counting)
What is “glycemic index (GI)?
What to eat to lower blood sugar level?
What are the benefits of exercise?
What’s the best exercise activity for me?
How much physical activity do I need?
Determine the exercise intensity (strenuous, moderate or mild)?
Exercise tips for diabetics
How many calories am I burning when I exercise?
Is it necessary for diabetics to take medicine?
What do I need to know about diabetes medicines?
Does diabetes medicine have any side effects or adverse reactions?
Is it true that taking additional drugs or starting insulin shots means that condition has worsen?
If I use insulin treatment, do I have to take it forever?
How is insulin delivered to the body?
What should I pay attention to when I use insulin?
What is diabetes mellitus?
What is the cause of diabetes?
What is “blood glucose”?
What is HbA1c?
What is the general blood glucose target range for diabetics?
Am I diabetic? (Diagnosis of diabetes)
What are the symptoms of diabetes? 
Am I at risk for diabetes?
How does poor blood glucose control affect the body?
Could low blood glucose level occur?

Q: What is Self-Monitoring of Blood Glucose(SMBG)? 
SMBG, known as self-monitoring of blood glucose, is one of major components of blood glucose control at home. Values collected from regular daily measurements at many time points provide the healthcare professionals with precise information on the efficacy of glycemic control, and help healthcare professionals adjust therapy plans, including of dietary intake, physical activity, and medicine prescription, for individuals. 

• Keep your meter and strips clean, and store them at room temperature. 
• Check the functioning of your meter with matching test strips before measuring.  
• Apply blood to strips at the correct moment indicated by the meter. 
• The volume of blood drop used should not be too small.

• How often you should measure your blood glucose varies from individuals. The doctor may give you advice based on many factors, including the type of diabetes you have, the treatment plan, and the target of blood glucose control. 
• For type 1 diabetes, the frequency of measurement is associated with the timing of insulin shots. The doctor may recommend measurements be taken before and after certain meal, before and after exercise, and before going to bed. You should check your blood glucose more often when you feel ill and stressed, or when you change your life style. 
• For type 2 diabetes, the doctor may recommended testing times based on the type of drugs or the dose of insulin, which range from 1 to 3 times a day. You should check more often when you start your blood glucose management plan, and may check less often when your blood glucose level become more stable. 

➢ The blood glucose level before meal, also called pre-prandial blood glucose level, serves as reference for tweaking prescription, such as dose of insulin. Checking this reading helps track the efficacy of diabetes medicines, or diet and exercise control. Pre-prandial numbers that are within the normal range (80-120 mg/dl) suggest that the treatments are effective. 
➢ The blood glucose level after meal, also called postprandial blood glucose level, refers to the peak blood glucose level at 2 hours after a meal. Checking the level is important for diabetics, because it is often higher than standard due to impaired insulin response to dietary intake; insufficient dosing of medicine before or during meal also leads to higher than normal blood glucose levels. 

• For diabetics on medication, low blood glucose level could lead to hypoglycemia in the night. Blood glucose level should be checked before going to bed to ensure sufficient blood glucose level and prevent the development of hypoglycemia. High blood glucose level before going to bed indicates poor glycemic control which results from excess food intake in the evening or insufficient dosing of insulin. 

Morning blood glucose level before breakfast is not only a significant indicator of glycemic control, but also the first concern for prediabetes. The two primary causes of high blood glucose in the morning are "Dawn phenomenon" and "Somogyi effect". The blood glucose level increases gradually since midnight, even when no food is taken before going to bed. High blood glucose level in the morning would be observed. It is a result of the actions of counter-regulatory hormones which increase blood glucose level (e.g., cortisol, glucagon, and growth hormone). Dawn phenomenon occurs more often in type 1 diabetics. Somogyi Effect 

The blood glucose level is low in the midnight and high in the morning. Excessive intake of diabetic medicine in the preceding night would cause low blood glucose level, and subsequently triggers the release of counter-regulatory hormones for blood glucose regulation. 

or can use proper blood glucose management software to assist your glycemic control plan. Test records and practical graphs, such as log book, trend chart and pie chart, provide useful information to healthcare teams for treatment plan adjustments. 

• Eat from a wide category of nutrition, and choose nutrient-dense foods and beverages. 
• Maintain a calorie balance by healthy intake and be physically active. 
• Reduce daily lipid and sodium intake. 
• Avoid foods high in sugars, and try estimate the amount of carbohydrate in your daily diet to your best. 
• Choose low GI (glycemic index) diets which produce smaller fluctuation in blood glucose. 

More information about Glycemic index. 

My Plate is a new guideline of daily diet control advocated since 2010 by U.S. Department of Agriculture (USDA). The plate icon helps us to easily work out appropriate portions of food to take through filling the plate by categories. It's easy to know what amount of foods from each category we need daily. 

The "My Plate" method is a general guideline to diet control, and may not be suitable for all diabetics. Please consult your physician or dietitian for professional recommendation. 

The calories consumed varies for different individuals. Age, sex, height, weight and life style would be factors for concern. Basal metabolic rate (BMR) is the total number of calories required for daily normal body functions (excluding activity factors). Calculating the calories input (dietary intake) and output (physical activity) you need daily based on BMR would be an effective method for body weight control. 

Carbohydrate in foods raises blood glucose level directly so that the amount should be restricted for achieving the goal of glycemic control. 

The three main types are: 
• Starches: starchy vegetables: include peas, corn, lima beans, and potatoes and grains: include whole grain (recommended for healthy diet) and refined grain: such as oats, wheat, barley, bran, and rice 
• Sugar: naturally occurring sugars: such as those in milk or fruit and added sugars: those added during processing such as cakes, cookies, donuts, and beverages, etc. 
• Fibers: It's the indigestible part of plant foods so that it can almost be subtracted for carbohydrate counting. Recent study indicated that fiber contributes to blood glucose control. Vegetables, fruits, whole grains, nuts, and legumes are rich in fibers which prevent stomach irritation and constipation. More information about Carbohydrate counting. 

The appropriate amount of carbohydrate in foods which directly raises blood glucose should be concerned by diabetics. Suggested amount of carb may be determined by factors like age, sex, activity level and goal of blood glucose control. About 45-60 grams per meal is suggested generally for adults. The first step to learning precise carbohydrate counting is to read food labels, or you can estimate according to the following reference. For example, there is about 15 grams of carbohydrate in: 

1 small piece of fresh fruit (4 oz.) 
1/2 cup of canned or frozen fruit 
1 slice of bread (1 oz.) or 1 (6 inch) tortilla 
1/2 cup of oatmeal 
1/3 cup of pasta or rice 4-6 crackers 
1/2 English muffin or hamburger bun 
1/2 cup of black beans or starchy vegetable 
1/4 of a large baked potato (3 oz.) 
2/3 cup of plain fat-free yogurt or sweetened with sugar substitutes 
2 small cookies 
2-inch square brownie or cake without frosting 
1/2 cup ice cream or sherbet 
1 Tbsp. syrup, jam, jelly, sugar or honey 
2 Tbsp. light syrup 
6 chicken nuggets 
1/2 cup of casserole 
1 cup of soup 
1/4 serving of a medium French fry 
* source from American Diabetes Association More information about What is carbohydrate. 

Glycemic index, simplified as GI, is a numerical index that reveals the effects of carbohydrate on blood glucose level on scale of 0 to 100. Choosing lower GI foods that produce smaller fluctuation in blood glucose is useful for long-term blood glucose control. Foods with low GI include all non-starchy vegetables and some starchy vegetables, most fruit, beans and legumes (e.g., kidney beans and lentils) and many whole grain breads and cereals (e.g., whole wheat bread and all-bran cereal). Meats and fats have GI score of 0 because they do not contain carbohydrates.
• Avocado: avocadoes are rich in monounsaturated fats and soluble fibers that improve insulin sensitivity and reverse insulin resistance. 
• Cherry: Cherries contain red-pigmented antioxidants, low in calories and rich in soluble fibers that can improve body's insulin output 
• Cinnamon: Cinnamons contain magnesium, fibers, and polyphenols, which possibly mimic the effect of insulin so that significantly lower blood glucose level. 
• Flaxseed: flaxseeds are rich in fibers and Omega-3 fatty acids, low in carbohydrates and fat, which help lower blood glucose and cholesterol levels. They are also strongly anti-inflammatory. 
• Garlic: Garlics contain high levels of anti-oxidants. It was proved that garlics can raise insulin production and lower blood glucose. 
• Lemon: Lemons are rich in vitamin C, rutin and limonene, low on the glycemic index scale, which help prevent high blood glucose. 
• Nut: Nuts are rich in good fats and proteins, and are proven that has a positive effect on insulin resistance decrease so that lower the risk of developing type 2 diabetes. Examples of healthy nuts are almonds, cashews, peanuts, pecans and walnuts, etc. 
• Onion: Onions contain high level of sulfur and flavonoid which significantly help lower blood glucose level and raise good cholesterol (HDL) level. They are also strongly anti-inflammatory as well as diuretic to help lower blood pressure. 
• Sweet potato: Sweet Potatoes contain rich soluble fibers that have excellent effects on regulating insulin and lowering cholesterol. They have medium GI which prevent high blood glucose fluctuation, and they are also rich in anti-oxidants, beta carotene, vitamin A and B6. High level of Vitamin B6 found in sweet potatoes is believed to help reduce the risk of diabetic heart disease. 
• Vinegar: Vinegar is indicated to help lower both fasting and after-meal glucose levels by studies. Either by addition to meal or drinking, two to three tablespoons per day is recommended for blood glucose control.  

Being active is important for blood glucose management. Proper physical activities not only enhance the uptake of glucose from bloodstream by cells, but also make cells more sensitive to insulin. Exercise also produces other significant effects that prevent chronic diseases such as high blood pressure and body weight loss. Be active and you'll get to enjoy the benefits the decreased dose of pills or insulin, improved cardiopulmonary function, or better strength and flexibility of muscle and bone.
More information about Proper physical activities for me. 

Proper physical activities vary for individuals. For the elder and the overweighed, swimming and biking would be better choices instead of weight-bearing activities such as hiking and running, which could cause lower limb joint injury. For people with high blood pressure combined diabetes or cardiovascular diseases, light-intensity aerobic activities are preferred. If you are taking any medicine, talk to your doctor before you begin to exercise. Try to find activities you would enjoy, and ask for your doctor if any concern before you take part in these activities. 

One week Activity plan for children & adolescents:
------------------------------
Monday - Bicycle riding 40 minutes (aerobics) 
Tuesday - Jumping rope 10 min + jogging 20 minutes (aerobics) 
Wednesday - Boxing aerobics 30 minutes (aerobic, stretching) 
Thursday - Basketball 60 minutes 
Friday - Football 40 minutes 
Saturday - Swimming 40 minutes 
Sunday - Off 

One week Activity plan for elders:
------------------------------
Monday - Swimming 30 minutes (aerobics, weight training) 
Wednesday - Yoga 40 minutes (aerobics, stretching) 
Thursday - Bicycle riding 30 minutes 
Friday - Swimming 30 minutes (aerobics, weight training) 
Saturday - Bicycle riding 30 minutes

The intensity, frequency and duration of physical activities do not necessarily fit everyone. Please ask your doctor for advice on the right exercise for you. 

To reduce the risk of heart disease, adults need only do about 30 minutes of moderate activity on most, and preferably all, days of the week. This level of activity can also lower the chances of having a stroke, colon cancer, high blood pressure, diabetes, and other medical problem. 

** Source from "Your Guide to Physical Activity and Your Heart (2006)" by National Heart, Lung, and Blood Institute (NHLBI). More information about Intensity of exercise. 
To begin the exercise program, you can set the intensity by 55/65 to 90 percent of "maximum heart rate" for cardiopulmonary function improvement recommended by American College of Sports Medicine (ACSM). 

The commonly used formula of "maximum heart rate" is "220 - age". For example, a 30 years-old man has a maximum heart rate of 190 beats per minute (bpm). To improve his cardiopulmonary performance, he can set 80 percent of "maximum heart rate" as the goal of exercise intensity, that is, (220－30) * 80% = 152 beats per minute. People with cardiovascular disease should start with low-intensity activities, and try to reach the goal with close monitoring. 

• Wear your diabetes ID, and keep snacks (e.g., cookies or juice) on the side in case of hypoglycemia event occurs. 
• Do not exercise when fasting, especially after taking diabetes medicine. 
• Wear socks and proper fitting shoes to protect your feet. 
• Check your blood glucose level before exercise. 
• Eat a little if too low. 
• People with extremely poor blood glucose control should be cautious when being physically active, because exercise may lead to body fats break down and accelerate ketones production. Ketoacidosis, most seen in type 1 diabetics with extremely high blood glucose, is an acute diabetic complication which could result in coma. 
• Warm up properly and start with low-intensity activity. End with cool-down activity. If feeling uncomfortable, immediately stop exercising and get help. 
• Check your blood glucose level after exercise. Low blood glucose level may result from intense activity or reaction of medication. 
• Please check with your doctor about any concern 

Metabolic equivalent, simplified as MET and may be heard in gyms, is a unit used to estimate the amount of oxygen the body uses during physically exercise. The concept of MET is popular due to its practical purpose on calorie consumption calculation. 

1 MET is equivalent to 3.5 ml/kg/minute of oxygen consumption, and is approximately equivalent to 1 kcal/kg/hour of calorie consumption

Light-Intensity | MET< 3 
0.9 - Sleeping
1.0 - Watching TV  
1.8 - Writing, desk work, typing 
2.3 - Walking 1.7mph(2.7KM/h), level ground, strolling, very slow 
2.9 - Walking 2.5 mph(4KM/h) 

Medium-Intensity MET 3 to 6 
3.0 - bicycling, stationary, 50 watts, very light effort  
3.6 - walking 3.0 mph (4.8 km/h) 
3.5 - calisthenics, home exercise, light or moderate effort, general  
3.6 - walking 3.4 mph (5.5 km/h)  
4.0 - bicycling, <10 mph (16 km/h), leisure, to work or for pleasure  
5.5 - bicycling, stationary, 100 watts, light effort  

High-intensity MET> 6 
7.0 - Jogging  
8.0 - calisthenics (e.g., push - ups, sit - ups, pull -ups, jumping jacks), heavy, vigorous effort  
10.0 -Running, jogging 8.0 Rope jumping  

At present, it is true that insulin treatment is needed all lifelong for type 1 diabetics because their bodies cannot produce sufficient insulin for blood glucose control, but drugs or insulin shots are not necessary for other types diabetics. Medication with regular self-blood glucose monitoring, healthy diet and physical activity is the key to good blood glucose control. Usage of either oral drugs or insulin should be discussed with your doctor. 

Diabetes medicine consists of oral drugs and insulin. Diabetes pills work only for type 2 diabetes, but pills are not necessary for all type 2 diabetics. The doctor may prescribe type 2 diabetics with one type of pill, combination of pills, or pills plus insulin for blood glucose management. 

Common pills prescribed include Amaryl, Actos, Glucophage, Novonorm, Glucobay and Januvia, which improve blood glucose with different pharmaceutical mechanism. Common insulin shots include NovoRapid, NovoMix, Levemir, Lantus, Humulin, and Actrapid, which work on the body with different onset, peak times and duration. More information about Side effects or adverse reactions of medicine. 

Oral drugs bring side effects such as low blood glucose, dizziness, headache, drowsiness, and nausea, etc. Low blood glucose is also seen in people who use insulin. Hypoglycemia, which results from blood glucose dips, should be avoided because it may lead to coma. Carry cookies or sugars to prevent from development of hypoglycemia. If these symptoms occur, please consult with your doctor. 

Not exactly. Sometimes, combination of pills or pills plus insulin can help you overcome the barrier of blood glucose management. Achieving the goal of blood glucose control would be the major concern for prescription adjustment. Stick to healthy diet and regular exercise, then you may be amazed when your intake of pills or insulin decreases! 

It's true that blood glucose control is needed all life long for people with type 1 diabetes, but the same is not true for people with type 2 diabetes. The doctor prescribes you with insulin based on your overall health status, including of blood glucose management, other medicine you take, how long you have diabetes, and pregnancy, etc. 

Syringe and pen are the most common forms of insulin delivery. There are other types such as pump and jet injector available. Each of them meets a different practical demand. Consult with your doctor for advice. 

• Pay attention to hypoglycemia. 
• Carry your diabetes ID and have snacks on the side. 
• Store the bottle of insulin you are using at room temperature. It will last approximately 1 month. Keep others in the refrigerator for longer storage life. 
• Find the injection areas of your insulin shots that produce the best results. 
• In addition, each mealtime injection of insulin should be given in the same general area (but not the same site) for best results. 
• Inject into the depth where insulin is best absorbed - the fat under your skin. 
• Inject insulin timely with meals for effective reaction to increase the breakdown of blood glucose from the meal. 

"Diabetes mellitus", often simply referred to as "diabetes", is a metabolic disease in high blood glucose level which is regulated by insulin. Either when the pancreas does not produce enough insulin, or body cells do not respond to insulin, cause the three typical symptoms of diabetes: polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). More information about Classification of diabetes. 

The classification of diabetes includes four clinical classes: 
➢ Type 1 diabetes (insulin-dependent, immune-mediated or juvenile-onset diabetes). It results from β-cell (insulin-producing cell) destruction, which leads to insulin deficiency so that one needs insulin shots every day. 
➢ Type 2 diabetes (non-insulin dependent or adult-onset diabetes). It results from insulin resistance and relative insulin deficiency, and accounts for at least 90% of all cases of diabetes. 
➢ Gestational diabetes mellitus (GDM). It results from poor performance of insulin during pregnancy, and usually disappears after pregnancy. Women with GDM and their offspring are at an increased risk of developing type 2 diabetes later in life. 
➢ Other specific types of diabetes. For example, genetic defects in cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drugor chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation). 

More information about Diagnosis of diabetes. 

Glucose, one of products of food metabolism, is released to blood to be used for cell activity, called blood glucose. If the blood glucose level is over high (approximately > 180 mg/dl) so that glucose is excreted to urine through kidney, thenurine glucose produces. More information about Recommended blood glucose target. 

Art of glucose in blood may permanently attaches on hemoglobin, and HbA1c (simplified as A1c) is one type of glycated hemoglobin. The higher percentage of A1c reveals higher blood glucose level. The A1c test is a critical measurement for average blood glucose control for the past 2 to 3 months. More information about Diagnosis of diabetes. 

Here is glycemic recommendation for many no pregnant adults with diabetes published by American Diabetes Association (ADA). 

Glycemic control                      Value 
HbA1c                                         4.0% 
pre-prandial plasma glucose      70–130 mg/dl (3.9–7.2 mmol/l) 
postprandial plasma glucose      < 180 mg/dl (< 10.0 mmol/l) 

More information about HbA1c. 

Here is criteria for the diagnosis of diabetes published by American Diabetes Association (ADA). 
* Clinically, physicians often perform repeatable or multiple tests to confirm whether the subject got diabetes. More information about Recommended blood glucose target. 

Three typical symptoms of diabetes are: polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). 

Other symptoms include unusual weight loss, extreme fatigue and irritability, blurred vision, cuts / bruises that are slow to heal, tingling / numbness in the hands / feet, and frequent skin, gum, bladder infections. The early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes. 

More information about Complications of diabetes. 

Let's check if you have any risk factor for diabetes. 

1. Risk factors known associated with type 1 
• Genetic factors 
• Increased height and weight development 
• Increased maternal age at delivery 
• Exposure to some viral infections 

2. Risk factors known associated with type 2 
• Over age 45 • Family history of diabetes 
• Obesity 
• Diet and physical inactivity 
• Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth 
• Certain racial and ethnic groups (e.g. Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, American Indians, and Alaska Natives). 

3. Risk factors known associated with GDM Pregnant women who are overweight, have been diagnosed with Impaired Glucose Tolerance (IGT), or have a family history of diabetes More risk factors you have means you're in higher danger of developing diabetes. 
* Source: International Diabetes Federation(IDF) and American Diabetes Association (ADA) More information about Classification of diabetes. 


Complications of diabetes) Poor blood glucose control may lead to: 
1) Acute complications 
(a) Hyperglycemia (high blood glucose). Result in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic coma (HHNK) 
(b) Hypoglycemia (low blood glucose). Light signs such as palpitations, pallor, cold sweats, headache, dizziness, irritability, weakness, and fatigue; poor treatment would result in coma. 

2) Chronic complications 
(a) Cardiovascular diseases. Result in heart attack and stroke, which are the major causes of death in diabetes 
(b) Eye diseases (diabetic retinopathy). Damage to the retina of the eye, which can lead to vision loss 
(c) Kidney diseases (diabetic nephropathy). Lead to uremia and total kidney failure, result in life-long need for dialysis or kidney transplant 
(d) Nerve diseases (diabetic neuropathy). Autonomic neuropathy affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, etc. Peripheral neuropathy results in abnormal sensitivity on toes, feet and legs so that wounds and infection occur easily. Poor foot care may lead to ulceration and amputation of the toes or feet, even whole lower limbs. 

Yes, sudden blood glucose decreasing should be alert for diabetics with oral drugs taken or insulin injection. Hand-carried juices or sugars are necessary to relieve discomfort. More information about Complications of diabetes.
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