A: For Normal Patient Fasting should be less than 100 and 140 about two hours after meal.

A: For Diabetic Patient- The American Diabetes Association recommends a blood glucose range of 80-
130 before meals and less than 180 about 2 hours after a meal. This range should place your A1c under 7.

A Hemoglobin A1c is a 2-3 month average of your blood sugars. This result gives you a good idea of
how well your diabetes is being managed/controlled. The American Diabetes Association recommends an
A1c of less than 7 to keep the risk of complications low.

A: It is very important to keep your blood sugar level under control. When your blood sugar level is high,
it can cause damage in your veins and arteries. This damage could lead to complications later such as
heart attacks, strokes, kidney disease, neuropathies, vision problems, etc.

Fruits, starchy vegetables, milk, yogurt, rice, cereals, bread and other grains all have carbs and give
you important nutrients. Many snack foods, such as chips and popcorn, have carbs. Sweets, including
regular soda, cakes, candy and cookies, also contain carbohydrates. Be sure to check the nutrition label on
each food item to determine carbohyrdate content.

Sugar free foods can be part of a healthy meal plan in small amounts. Keep in mind though that some
of these foods still have carbs (in the form of other sweeteners such as sorbitol, isomalt, and mannitol)
and may affect your blood glucose levels. Many sugar free foods have calories and carbohydrates and lots
of fat. Mak e sure you read the nutrition labels.

Currently no cure exists for diabetes. Type 1 diabetes is a deficiency of the pancreas to produce
insulin, so insulin injections are necessary to sustain life. Type 2 diabetes is more common; the pancreas
can produce some insulin, but not enough for the diet and size of the body, and/or the insulin functions
poorly due to insulin resistance.

Research has shown that healthy lifestyle changes such as weight loss and exercise can decrease the need
for medication for type 2 diabetes. Even if symptoms diminish and blood glucose measures normal, the
disease is still present.
Your risk of complications of diabetes is lower if your blood glucose control is improved.

Many people with diabetes experience one or more symptoms, including extreme thirst or hunger, a
frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores
that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people
with diabetes, however, have no symptoms at all.

People with type 1 diabetes must take insulin to sustain life. People with type 2 diabetes either produce
inadequate insulin or have insulin resistance (which means the cells have difficulty responding to insulin)
or both. Treatment for type 2 usually begins with a change in diet and exercise. However, very
overweight, inactive newly diagnosed people with diabetes may have such a high blood glucose level that
they may initially need insulin to bring blood glucose under control. Many people with type 2 diabetes
can manage their diabetes with lifestyle changes and oral medications. Diabetes is a progressive disease,
and in spite of a person’s best efforts, he may need insulin to control blood glucose at some time.

If blood sugar is not kept in check, diabetes can lead to a number of serious complications, including
heart attacks, strokes, kidney disease, blindness, blood vessel disease that can require amputations, nerve
damage and impotence in men. However, a recent study conducted over a 10-year period showed that
patients can reduce the risk of complications by 50% or more when their blood sugar measures as close to
normal as possible.
The best way to protect yourself from the serious complications of diabetes is to manage your blood
glucose, blood pressure, and cholesterol and avoid smoking. It is not always easy, but people who make
an ongoing effort to manage their diabetes can greatly improve their overall health.

The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or
prevent type 1 diabetes. However, research has shown that making modest lifestyle changes can prevent
or delay type 2 diabetes in people at risk for the disease.
In the Diabetes Prevention Program (DPP), a landmark study by the National Institute of Diabetes and
Digestive and Kidney Diseases, researchers found that adults at high risk for type 2 diabetes were able to
cut their risk in half by losing a modest amount of weight and being active almost every day. This means
losing 5 to 7 percent of body weight (that's 10 pounds if you weigh 200 pounds) and getting 150 minutes
of physical activity a week.
The DPP study also showed that modest weight loss (achieved by following a low calorie, low-fat diet)
and moderate physical activity were especially effective in preventing or delaying the development of
diabetes in older people. In fact, people over the age of 60 were able to reduce their risk for developing
type 2 diabetes by 71 percent.

To be sure, ask your doctor how often you should check your blood glucose. If you are treating your
diabetes through diet and exercise or oral medication, diet and exercise, you should probably check your
blood glucose level at least twice daily. If you take insulin, check your blood glucose four times daily.
This will help you assess how well your meal and exercise plan and medication are working to stabilize
blood sugar. Blood sugar levels of 180 two hours after eating or above 140 before eating are considered
high.

People with diabetes should do aerobic activities, such as brisk walking, which use the body’s large
muscles to make the heart beat faster. The large muscles are those of the upper and lower arms and legs
and those that control head, shoulder, and hip movements.
Do activities to strengthen muscles and bone, such as sit-ups or lifting weights. Aim for two times a week.
stretch to increase flexibility, lower stress, and help prevent muscle soreness after physical activity.
Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin
slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.
(Tip: you don’t need to get your exercise in all at one time.)

As a diabetic, you risk eye and foot problems, so check both regularly. In particular, it is critical that
you get a yearly eye exam that includes dilating your pupils to detect signs of eye disease. Diabetics face
a higher risk of eye complications, such as retinopathy, macular edema, and cataracts.
Your doctor should check your feet at least once a year. Symptoms of foot problems can include
decreased feeling in the feet, cramps when walking, cuts and scratches that heal slowly, redness in the feet
when sitting and whiteness when propped up, lack of hair growth on legs and feet and leg or feet pain.
Doctors advise daily checks for cuts or injuries in order to prevent infection or other problems.

Ideally, your A1c should measure below seven. If it measures above seven and closer to eight or
above, you may need to make changes in your treatment plan. To track your progress, you should get
your hemoglobin A1c tested two to four times per year. (Hemoglobin A1c measures blood glucose

Blood sugar test are performed to check the level of sugar (glucose) present in the blood at that the
time of sample collection. Blood sugar levels keep fluctuating throughout the day and for diabetic people,
the fluctuation takes place more often. Blood sugar test gives an idea about the instantaneous value of
blood sugar level persistent in the body at the time of sample collection.
Fasting Blood Sugar - Fasting means after not having anything to eat or drink (except water) for at least
8-10 hours before the test.
PP stands for  Postprandial. Blood sample is collected after consumption of a meal. It helps in assessing
the quantity of glucose present in blood after eating. It is done after 2 hours of starting meal. 
Random Blood sample is collected at any time during the day, to check for instantaneous value of blood
glucose level. Fasting or eating is not a requirement for this test.

There are several reasons why postprandial blood sugar (PP blood sugar) might be lower than fasting
blood sugar in an otherwise healthy adult. Some possible causes include:
 Insulin resistance: If the body's cells are not responding properly to insulin, glucose may not be
taken up from the bloodstream as efficiently after a meal. This can lead to lower PP blood sugar
levels.
 Increased insulin secretion: The pancreas may secrete more insulin after a meal to help lower
blood sugar levels. This can lead to lower PP blood sugar levels.
 Low-carb diet: Consuming a diet low in carbohydrates can lead to lower PP blood sugar levels.
 Exercising before or after eating: Physical activity can lower blood sugar levels, which can result
in lower PP blood sugar levels.
 Rise in fasting as compared to pp is a part of 'Dawn's phenomenon'. This is a natural
phenomenon.
Dawn Phenomenon also known as 'Liver Dump'. It is the term given to an increase in blood sugar in the
morning caused by the body's release of certain hormones.
For diabetics, they don't have normal insulin responses to adjust thing, and they may see their fasting
glucose on high.
Reason behind rising sugars in morning:

The rise in glucose is mostly because your body is making less insulin and more glucagon (a hormone
that increases blood glucose) than it needs. The less insulin made by the pancreas, the more glucagon the
pancreas makes as a result.
Glucagon signals the liver to break down glycogen into glucose. This is why high fasting blood glucose
levels are common in people with type 2.
Sugars in blood are not just an output of immediate food but cumulatively stored food/ glucose over the
past 2-3 months in your body.
Early morning at Dawn, this stored glucose gets released in the blood in anticipation of requirement of
more energy by the body through hormones opposite to insulin. This happens naturally in both diabetics
and non diabetics.
Just that in DIABETICS the rise is exaggerated than non diabetics hence the confusion gets created.
It may take 3 months to 1 year for this exaggerated response which has got built up over years to
reverse...
So,
Smile as long as it is below 140 during reversal of diabetes period with IF ( intermittent fasting)
Following tips can be tried. Success not guaranteed with any one of them alone or in combination because
the phenomenon is more because of hormonal changes in the morning:
1. Do more exercise in evening than in morning.
2. Take dinner before 7:30
3. Reduce grains in dinner
4. Have minimum 50% green in dinner includes cooked vegetables and raw
5. Antigravity i.e. climbing stairs after dinner
6. Sleep before 10 pm for 7 hours in night
7. Consume green smoothie without fruit
8. Avoid TV/ SCREENS OF MOBILE/ LAPTOP... after 9 pm
Always REMEMBER...
Even after doing all the above, fasting sugar may still not come down immediately as it is more hormonal
in nature.
In general, lower PP blood sugar levels are not typically a concern for an otherwise healthy adult.
However, if you have been diagnosed with diabetes or prediabetes, it is important to monitor your blood
sugar levels and work with your healthcare provider to manage them appropriately.It is always important

to consult with a healthcare professional if you have any specific concerns about your health. They can
help you determine the cause of your low PP blood sugar and develop an appropriate plan of action.

Oral Glucose Tolerance Test

• For non pregnant patient:
  • Collect fasting blood specimen in fluoride tube and urine specimen
  • Administer 75 gm glucose orally
  • Collect two additional blood specimen in fluoride tube and urine samples as follows:
    • 60 min. after glucose
    • 120 min. after glucose
• For pregnant patient:
  • Collect fasting blood specimen in fluoride tube and urine specimen
  • Administer 75 gm glucose orally
  • Collect blood sample in fluoride tube and urine samples as follows:
    • 2 hour after glucose

Cortisol

• Morning sample:
  • Collect plain sample at 8 am
  • Specify time and the date on the tube
  • Overnight fasting is preferred
• Evening sample:
  • Collect plain sample at 4 pm
  • Specify time and the date on the tube
  • Four hours of fasting is recommended for evening specimen