In part 1 of this series, we gave an overview of diabetes, including the types, how the body uses glucose to generate energy for the body, the incidence in the population, and what to look out for in terms of signs and symptoms. We also briefly touched on two common diabetic emergencies: low blood sugar-related (hypoglycemia) and very high blood sugar-related (diabetic ketoacidosis or DKA).

To be able to treat high blood glucose, the family medic must first know what the normal values should be. There is some slight variation of what’s normal, depending on the source. A urine glucose test involves dipping a special test strip in a urine sample. The kidney eliminates excess glucose from the body, so elevated urine levels mean there’s an elevated blood level.

Unfortunately, urine glucose tests can be very inaccurate. The test reflects what the glucose level was a few hours earlier, not at the time of testing. Also, various things cause false readings, such as certain medicines and even vitamin C. Therefore, whenever possible, blood is used for a much more accurate reading. Levels can be checked while fasting (not eating for about eight hours), one to two hours after eating, or randomly.

Some tests are “oral glucose tolerance tests” (OGTT). In an OGTT, a glucose is taken after fasting and, then, the patient is given a glucose-rich drink. Repeat blood glucose levels are performed either 2 hours afterwards or  1, 2, and 3 hours afterwards to see the body’s response to a “sugar load.”

Blood glucose readings differ depending on whether a person is normal, diabetic, or “prediabetic.” Prediabetes is when your blood sugar level is impaired (higher than normal), but not high enough to meet the criteria for diabetes. Almost all type 2 diabetes were prediabetic earlier in life; the CDC estimates that 1 in 3 Americans may be prediabetic.

The chart below shows common glucose levels for normal, prediabetics, and diabetics.

Another useful blood test is the “Hemoglobin A1C” or “glycohemoglobin.” Hemoglobin is a protein in blood cells that gives them their red color. In diabetics, sugar binds to a higher percentage of red blood cells than normal.

If the percentage of “sugared” cells is excessive, it is a result of poor control over the past 3 months, the average life span of a red blood cell. Anyone can have a bad random glucose test, so it’s useful to have one that gives you an idea of a patient’s control over a longer period.

Tests are usually done 2-4 times a year. Of course, Hemoglobin A1C studies won’t be available in survival scenarios, but it’s important to know about them. A chart with typical control ranges is below.

DIABETIC COMPLICATIONS

Having a higher level of sugar than normal in your blood causes damage to various organs. Many of the complications below were experienced by my son, a brittle diabetic who was poorly controlled. They include:

CARDIOVASCULAR DISEASE: Diabetes greatly increases the risk of heart, blood vessel, and circulation problems. It doubles the risk of coronary artery disease, which leads to chest pain, heart attack, stroke, and more.

Impaired blood flow to the lower extremities causes minor cuts and scrapes to heal more slowly and be more prone to infection. Diabetics are much more likely to require amputation of a toe, foot, or leg than non-diabetics.

KIDNEY DAMAGE: Kidney damage is also known as “nephropathy.” Diabetes damages the ability of the kidney to filter waste toxins from the body. If bad enough, the kidneys fail, leading to the need for dialysis to stay alive.

EYE DAMAGE: The tiny blood vessels of the retina are disrupted by elevated glucose levels, a condition referred to as “retinopathy,” In severe cases, retinopathy leads to blindness. Diabetes also increases the risk of other eye problems, such as cataracts and glaucoma.

NERVE DAMAGE: Also called “neuropathy,” high glucose levels damage the nerves. This is most evident in the lower extremities. Impaired nerves cause tingling, burning, pain, and numbness. The symptoms usually begin at the ends of the toes and spreads up. In some cases, complete loss of feeling may occur. For men, it can lead to troubles in the bedroom.

SKIN CONDITIONS: Those with high glucose levels are more likely to have bacterial and, especially, fungal infections.

HEARING IMPAIRMENT: Loss of hearing is not uncommon in those with diabetes.

Diabetes during pregnancy can lead to overly large babies, causing complications with delivery. Stillbirths are occasionally seen. Mothers will have a higher tendency to develop high blood pressure and other serious medical issues, as well.

Some also believe that diabetics are more likely to develop mental issues such as depression, and possibly even Alzheimer’s disease (also known as “senile dementia”).

Although most of the complications above manifest later in life, poor control led to my son experiencing kidney, eye, foot, and heart disease in his late twenties.

Next time, we’ll discuss treatment options for diabetes, both on and off the grid.

Joe Alton MD

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