Glucose is the main sugar in the blood. It originates from ingested food and is the body’s main source of energy. The blood carries glucose to all cells in the body for their energy needs. In this article, we will give you a complete guide about normal blood sugar levels. Fasting blood glucose ( blood sugar ) levels are usually at their lowest in the morning, before breakfast, and rise after meals for a couple of hours. Alcohol intake causes an initial rise in blood sugar, followed by a drop in normal blood sugar levels, and some medications can also increase or decrease glucose levels.
Abnormal blood sugar levels can be indicative of disease. A persistently high value is called hyperglycemia, while the term hypoglycemia identifies levels that are too low (for example, we expect to find fasting blood glucose between 70 and 99 mg/dl). Diabetes mellitus is a condition characterized by persistent hyperglycemia for several reasons and is the most widespread problem with regulating blood sugar. Over time, constantly high glycemic levels manifest themselves in all their severity through complications that involve all systems.
In diabetes, it is essential to keep blood glucose levels within an adequate range, which can vary slightly from patient to patient. It may be necessary to check the values several times a day. To check, the doctor may also use a blood test called A1C ( glycated hemoglobin ), which is used to quantify the average level of glycemia over the last three months. If blood glucose is too high/low, it may be necessary to change therapy and/or diet.
Normal blood sugar levels: Values
Levels of glucose (“sugar,” measured in mg / dL) in the blood vary over the course of 24 hours. An individual’s levels depend on when, what, and how much they ate and whether they exercised.
Normal blood glucose levels
Normal fasting blood glucose (no nutrient intake for 8 hours) fluctuates between 70 and 99 mg/dl (note that the WHO still indicates normal blood glucose values up to 110 mg/dl). Blood glucose two hours after food intake is normal if below 140 mg/dl, although glucose values can follow large evening meals up to 180 mg/dl (source: Italian guidelines).
Diabetes is diagnosed after any of the following conditions:
- Two consecutive fasting blood glucose tests with results equal to or greater than 126 mg / dL.
- Any glycemic relief is greater than 200 mg/dl.
- An A1c test with a result equal to or greater than 6.5% (48 mmol/mol). The A1c test is a simple blood test that provides the quarterly average of your blood glucose.
- A 75 g oral glucose tolerance test (the “load curve”) with any two-hour relief above 200 mg/dl.
Sometimes, the person may experience tiredness, excessive urination or thirst, and unplanned weight loss. However, hyperglycemia is often asymptomatic, and the diagnosis of diabetes is incidental.
To make the diagnosis of diabetes are not useful measurements:
- postprandial blood glucose or glycemic profile,
- basal insulin or during OGTT (load curve),
- peptide C,
Carbohydrate intolerance (formerly pre-diabetes)
The doctor may speak of pre-diabetes, although the term should no longer be used as it is replaced by other terminology. What’s it about?
It means that the person has a high risk of developing diabetes. It is possible to prevent or delay the disease’s onset by increasing physical activity, following a healthy diet and maintaining or losing weight.
- fasting glucose 100-125 mg/dl (impaired fasting glucose, IFG);
- blood glucose 2 hours after oral glucose load between 140-199 mg/dl (impaired glucose tolerance, IGT);
- HbA1c 42-48 mmol / mol (6.00-6.49%).
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- When the disease is diagnosed during pregnancy, it is referred to as gestational diabetes; the expected values in the load curve proposed during gestation are:
- fasting, equal to or greater than 92 mg/dl,
- at 1 hour, equal to or greater than 180 mg/dl,
- at 2 hours, equal to or greater than 153 mg/dl.
- Glycemic Goals in People with Diabetes
The blood glucose limits to be pursued are customized based on:
- duration of diabetes,
- age / life expectancy,
- associated pathologies,
- known cardiovascular disease or advanced microvascular complications,
- inability to detect hypoglycemia,
- patient-specific considerations.
Diabetes treatment must be adapted to each patient until HbA1c values are stably lower than 7% (HbA1C <53 mmol/mol), values that allow preventing the incidence and progression of the main complications. In newly diagnosed patients, more stringent glycemic targets can be set, up to obtaining values of HbA1C <= 6.5% – HbA1C <= 48 mmol/mol, while in patients with long-lasting diabetes (greater than 10 years) or frail due to age and/or presence of other diseases, the therapeutic approach must allow preventing hypoglycemia, and the glycemic compensation objectives are therefore less stringent (HbA1 7 – 8% – HbA1C between 53 and 64 mmol/mol).
The post-meal blood glucose measurement should be performed 2 hours after the start of lunch; postprandial values below 140 mg/dl are punishable in type 2 diabetes.
Interpretation of results
After your blood glucose check is complete, write down your results and review them with your doctor to understand how food, exercise, and stress affect your blood sugar. Look closely at your blood glucose data to see if your blood glucose levels are too low or too high, repeatedly around the same time of day. If the results are repetitive, it may be time to change plans. Ask your doctor or nurse if and when to report out-of-bounds results by telephone promptly.
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Keep in mind that blood glucose results often have a high emotional impact. These results can lead to annoyance, confusion, frustration, anger, or depression. It’s easy to use numbers to self-evaluate. Remember that your blood sugar level is a way to monitor your diabetes treatment program’s effectiveness, but it is not a judgment on the person.
When to check it?: Normal blood sugar levels
Check with your doctor about the need to check your blood sugar. Persons who:
- are using insulin,
- I’m pregnant,
- have trouble keeping their blood sugar stable,
- have low blood glucose levels,
- So have low blood glucose levels with no recognizable signs and symptoms,
- have elevated ketone levels resulting from hyperglycemia.
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How is it checked?: Normal Blood Sugar Levels
To check the amount of sugar in the blood, it is possible to rely on a laboratory specialized in the analysis (or in a pharmacy) or to proceed independently to check it at home with the appropriate self-measurement tools.
- Wash your hands, and then insert a test strip into the measuring device.
- Use a special lancet to take a drop of blood from the tip of a finger.
- Make contact and hold the test strip’s edge over the blood drop; wait for the results.
- The measuring device will show the blood glucose on its display.
- Note: each measuring device has specific characteristics; therefore, always refer to the instructions for using your instrument.
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Inconsistent high and low values
Sometimes, blood glucose values are occasionally measured higher or lower than usual without pinpointing the reason. Acute virosis or the flu will almost always cause normal blood sugar levels to rise, so you may need to contact your doctor. There are numerous other causes of changes in blood glucose levels. In particular:
- mealtime and type of food, type and amount of carbohydrates (for example, bread, pasta, cereals, vegetables, fruit, and dairy products),
- exercise or physical activity,
- disease and pain,
- diabetes medications,
- emotional stress,
- other drugs,
- measurement techniques.
Contact your doctor or diabetes healthcare professional if you notice that your blood glucose pattern varies or that your blood glucose is systematically higher or lower than usual.
In case of doubtful self-measurement results, here is a list of possible checks:
- the expiry date of the strips,
- compatibility of the test strip with the measuring device,
- sufficient amount of blood on the strip,
- correct insertion of the strip into the measuring device,
- conservation of the strips incorrect environmental conditions (heat, light, …),
- thorough hand washing and drying before testing (falsely high results may result from contamination from sweet foods, such as jams or fruit),
- cleaning the measuring device,
- the temperature of the measuring device (not too hot nor too cold),
- correct calibration code (newer devices no longer require it),
- low or dead battery.
Any device will give different results with a different drop of blood, and as long as the differences aren’t important, there’s no reason to worry. If you are concerned about the device’s good functioning, you can check it with a control solution. A pharmacist or specialist staff can carry out the check.
Glycated hemoglobin (A1c)
The glycated hemoglobin test measures the average glucose level over the past 10 to 12 weeks and should be recommended to the diabetic patient every 3 to 6 months. The A1c test is not a substitute for self-measurements. It does not show the high and low peaks detected by your own measurements. Therefore, it is a tool that provides additional information to get an overall picture of your glucose management.
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A1c target values: Normal Blood Sugar Levels
For many people with diabetes, the target will be around 6.5 – 7% (48 – 53 mmol/mol); however, it may need to be higher in some patients, particularly children and the elderly. The physician or appropriate staff can help establish a goal value that is appropriate and realistic in a specific individual.
HbA1c values between 42 and 48 mmol/mol (6.0-6.49%) are not linked to a diagnosis of diabetes. Still, they are considered worthy of attention as they are associated with a high risk of developing the disease. In the presence of these conditions, careful monitoring is recommended, the evaluation of the coexistence of other risk factors for diabetes or cardiovascular diseases such as
- high cholesterol,
- arterial hypertension,
- that is the factors that are part of the metabolic syndrome.
In any case, we remind you that at the moment, there is no uniformity of views on this point by medical societies. In fact, the WHO considers the available evidence not sufficient to give any recommendation on the interpretation of glycated hemoglobin levels below 48 mmol/mol ( 6.49%), while on the contrary, the ADA (American Diabetes Association) extends the high-risk category to glycated hemoglobin values between 39 and 42 mmol/mol (e.g., 5.7-6%).
Control of glucose in the urine
Urinary glucose checks are less accurate than blood (i.e., blood) checks and should only be used if a blood test is not possible. However, urinary ketone checks become important when diabetes is out of control or in case of illness. A person with diabetes will need to learn how to search for ketones in the urine.
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Normal blood sugar levels: Hypoglycemia
Hypoglycemia, or low levels of glucose, or blood sugar, is a condition in which glucose drops below normal levels. The drugs used for diabetes therapy (insulin, sulfonylureas, and biguanides) are the most frequent hypoglycemia causes. The risk is greater in people with diabetes who have eaten less, exercised more, or consumed more alcohol than usual. Other causes of hypoglycemia include kidney failure, certain cancers, liver disease, hypothyroidism, starvation (severe malnutrition), inborn errors of metabolism, severe infections, reactive hypoglycemia, and various drugs, including alcohol.
Hypoglycemia can arise in otherwise healthy infants who have not been fed for a few hours.
- The glucose level that defines hypoglycemia is variable. So in diabetic subjects, levels below 70 mg / dL are diagnostic.
- In non-diabetic adults, the diagnostic elements are hypoglycemia symptoms, low sugar levels at the time of symptoms, and improvement following normalization of the values.
In people with diabetes, prevention consists of coordinating food intake, physical activity, and drug intake. Some patients have few warning symptoms of hypoglycemia; in these subjects, it is advisable to habitually take frequent measurements. Treatment of hypoglycemia consists of eating foods rich in simple sugars or dextrose. In people unable to take food by mouth, a glucagon injection may help. Treatment of non-diabetes-related hypoglycemia involves treating the underlying cause as well as a healthy diet.
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Signs and symptoms: Normal Blood Sugar Levels
Symptoms and manifestations of hypoglycemia can be divided into:
- effects dependent on counter-regulatory hormones (epinephrine/adrenaline and glucagon) activated by the fall in glucose,
- neuroglycopenic effects on the reduction of cerebral glucose.
In general, the following may occur:
- tremors, anxiety, and nervousness,
- palpitations, tachycardia,
- sweating, feeling hot (sympathetic rather than adrenergic, muscarinic effect),
- paleness, cold sweats,
- dilated pupils (mydriasis),
- sense of hunger and borborygmi,
- nausea, vomiting, abdominal discomfort,
- inconsistency, impaired judgment,
- nonspecific dysphoria, moodiness, depression, crying, exaggerated worries,
- the feeling of numbness and pinpricks (paraesthesia, tingling, ..),
- pessimism, irritability, aggression, anger,
- personality changes, emotional lability,
- fatigue, weakness, apathy, lethargy, daydreams, sleep,
- confusion, memory loss, lightheadedness or dizziness, delirium,
- fixed eye, vitreous, blurred or double vision,
- flashes of light in the field of view,
- mechanical behaviours, also known as automatisms,
- difficulty speaking, muddy words,
- ataxia, lack of coordination, sometimes, drunkenness- like signs,
- focal or general motor deficits, paralysis, hemiparesis,
- stupor, coma, abnormal breathing,
- generalized or focal seizures.