Glucose Level in the Blood and Diabetes - Essay Example

Blood Glucose Level Gannon J Undergraduate of science, of the Sunshine Coast Blood Glucose Level IThis paper encompasses a critique of the article Glycaemic glucose equivalent: combining carbohydrate content, quantity and glycaemic index of foods for precision in glycaemia management BY John A. Monroe. glucose level in the blood (BGL) after consuming 40g of carbohydrate food. Trying to interpret blood glucose level (BGL) results can often be a frustrating activity. In many cases there appears to be no rhyme or reason for the fluctuations in client's BGLs. When we find markedly raised BGL following capillary testing, how many of us immediately ask our patient what they ate It may be useful to go back one step. Why do we perform BG monitoring in the first place The first function of BG monitoring is to identify whether BGLs are unsafe. Second, we perform BG monitoring to identify trends in individual BG profiles. It is possible this concept is not highlighted enough to health professionals and patients. Acknowledgements Our thanks to the reviewers of this paper for their suggestions which have greatly assisted us in improving the presentation of the paper. Introduction It may be useful to go back one step. Why do we perform BG monitoring in the first place The first function of BG monitoring is to identify whether BGLs are unsafe. Hypoglycaemia, even if asymptomatic, which is common in those people with long standing diabetes, with multiple diabetes complications and in the elderly, is serious and underestimated consequence of diabetes medication. Hyperglycaemia, particularly if moderate to heavy ketonuria is present in clients with Type 1 diabetes (Insulin Dependent Diabetes Mellitus) requires immediate treatment. Second, we perform BG monitoring to identify trends in individual BG profiles. It is possible this concept is not highlighted enough to health professionals and patients. For example, if client's BGLs prior to breakfast and after lunch are within healthy diabetes range of 4 to 10mmol/L, and three times week after dinner their BGLs are raised to the mid teen level, modification of diet and/or medication may not necessarily be required. We need to look at all our clients' BGLs in the context of the larger picture rather than focus on just one reading or one part of day. biochemistry parameter that is very useful to assist capillary BG monitoring in interpreting the larger picture is glycosylated haemoglobin (HbA1c). This test will gives an average BGL for the past three months. Every client with diabetes should have HbA1c performed at least twice a year. BGLs usually rise during hospitalisation - why Yes, it could be the food the client has eaten but not necessarily for the reasons you may think. Current diabetes dietary recommendations focus on foods that have a low glycaemic index, that is, take longer to be broken down and digested by the body. (Miller, 2005, p.29) Such foods include multigrain bread, legumes and fresh stone fruit. Yet how many of us work in hospitals or residential facilities where such food is readily available on the menu More often, inpatients with diabetes can only obtain white bread, white dry biscuits and very limited choice of fresh fruit. Therefore, as consequence of high glycaemic index hospital diet, BGLs may rise in comparison with home BGLs because hospital food is more readily digested, and results in higher post prandial (two hours after eating) BGL peaks. Never underestimate the effects of stress on BGLs. Stress from illness, hospitalisation, even altered sleep patterns can raise BGLs. Pain, infection, immobility and medications such as corticosteroids can have an enormous effect on glycaemic control. In fact, when we identify the reasons why BGLs rise, is it really any surprise that nearly all our clients with diabetes experience hyperglycaemia whilst they are in hospital. Methodology We analysed the blood glucose level in the blood (BGL) after consuming 40g of carbohydrate food. One student out of selected groups ate a different type food such as coke, banana, mars bar, but were all equal to 40g of total carbohydrate. The foods had varying glycaemic Index (GI). The BGL was taken every 15 mins from the volunteers and the results are shown (see appendix). This showed the 3 different data of GI of low, med, and high measured against time. The graph is constructed to show the relationship between Blood Glucose Level and Time. (See figure 1) Results For to come to a conclusion with such type of data, it is necessary to include BGLs recordings at a variety of different times, information on food intake, weight loss or gain, febrile state, occurrence of vomiting or diarrhoea, chest pain, the volunteer's emotional state and the amount of physiotherapy or activity performed. Performing BG test twice a week and expecting client's general practitioner to alter diabetes medication is unrealistic. It is as though only torch was being shown into dark room. Producing BGL profile which records levels taken at different pre and post prandial times over period of time is like turning the electric light switch on. Informed, and often safer decision making can occur with respect to medication management. On the other side of the coin, if patient experiences trend of raised BGLs prior to bedtime, yet starts each day with lower readings that are within healthy range without any intervention, obtaining an order for quick acting bedtime insulin from covering medical officer may produce hypoglycaemia during the night and result in high rebounding pre breakfast BGLs, thereby creating more problems. Discussion The results indicate that neither the positive nor negative dimensions of perception of control had a direct effect on blood glucose levels. However, there was a general trend across five of the six factors when the interaction was considered. This would suggest that where a person indicated that a good outcome is due to him or herself but that a poor outcome is not to be attributed to him or herself, then blood glucose levels tend to be higher. This is only a trend, but it is consistent across the factors (with the exception of treatment) and hence suggestive of a possible psychological component in inter-individual differences in levels of blood glucose control. Conclusion In summary, think of performing BG monitoring as one part of jigsaw required to complete the diabetes puzzle. Certainly the more varied the times of monitoring, the more pieces of the puzzle can be solved. However, when looking at the larger picture, other information that you can observe and record, complemented by input from clients and their family, can be just as important. We would not overreact to one high or low blood pressure level, but instead instigate strategy of recording more levels to decipher whether the single result was an anomaly or pattern. The same thing applies to capillary BG monitoring. Try to look outside the circle, rather than giving into some of the 'knee-jerk' responses that have been instilled in to nursing management over the years. One can only conclude that the variables used in this study do not as yet provide sufficient explanatory power for the inter-individual differences found in the management of diabetes. Likewise, the regular attendance at clinics, for the purpose of monitoring and advising on glycaemic control, needs to be further evaluated and a more effective means found for lowering blood glucose levels. Figure 1: BGL Chart References Miller, B., Foster-Powell, K. and Colagiuri, S. The G.I. factor, Hodder Headline, Australia Pty Ltd, Sydney, 2005, pp.29-37. Dunning, T., Care of people with diabetes: a manual of nursing practice, Blackwell Scientific Publications, Oxford, 2004, pp.26-33. Jerreat, L., Diabetes for nurses, Whurr Publishers Ltd, London, 2004, pp.10-19. Pickup, J. and Williams, G. (Editors) Textbook of diabetes, (2nd edition), Blackwell Science Ltd, Oxford, 2005, pp.30-48. Monro , John A D Glycaemic glucose equivalent: combining carbohydrate content, quantity and glycaemic index of foods for precision in glycaemia management Appendix LFS112 GI prac week 4 * Food wt is amount of food that provides 40g of carbohydrate Team Sex (M/F) Time since last ate (h) Food GI food category D1 F 6hrs dates high P4 M 3 Dates high O6 M 3 dates high Q3 M 3 Dates high Q2 M 3.25 Dates high B5 M 7 Hrs Gatorade high A5 F 3hrs Gatorade high O5 M 3.5 Gatorade high M5 M 3 Gatorade high t2 m 3 Gatorade high r1 m 3 Gatorade high D6 F 3.5 hrs Jelly Beans high C3 M 3 hrs jelly beans high E5 M 3 jelly beans high N1 F 3.15 jelly beans high O4 M 3 jelly beans high R5 M 18 jelly beans high C5 M 6hrs White bread high 3pm Tues T6 M 4.5 White bread high R4 M 18 white bread high Q6 m 19 white bread high q4 f 3.5 White bread high S3 M 2 white bread high C2 F 17hrs apples low D4 F 5hrs apples low G2 F 3 apples low E1 F 3.25 Apples low G2 F 4 apples low P3 F 3 apples low N3 F 7 apples low S4 F 3.75 Apples low B3 F 3hrs Banana low H2 F 3 Banana low F3 F 4.5 Banana low G3, G5, G6 M 3 Banana low N4 M 3.5 Banana low T1 m 2.45 Choc milk low 1pm class D3 F 3.5 hrs Choc milk low A3 F 3hrs Choc milk low F5 F 5 Choc Milk low P1 F 3 Choc milk low o1 F 5.5 choc milk low s1 M 4 Choc Milk low R3 F 3.25 choc milk low B1 F 3.5hrs fruit loaf low A2 F 3Hrs fruit loaf low F4 F 3 fruit loaf low N2 F 5 fruit loaf low M6 M 3 fruit loaf low P2 F 3 fruit loaf low C4 M 6hrs ice cream low G4 F 7 ice cream low H1 M 4.5 ice cream low H5 F 4 ice cream low P5 F 3 ice cream low P6 F 4.5 ice cream low O3 F 3 ice cream low A1 F 6Hrs Milk Chocolate low A4 M 30hrs Milk Chocolate low C6 M 5 hrs Milk Chocolate low F1 F 4hrs Milk Chocolate low E2 F 4.5 Milk Chocolate low T4 M 7.5 Milk Chocolate low B6 F 4hrs yoghurt low C1 F 5.5hrs yoghurt low 1pm Tues M1 M 3 Yoghurt low T5 F 3 yoghurt low R6 F 3.5 yoghurt low M2 F 4 Yoghurt low M3 F 3.5 yoguhrt low E4 F 3.5hrs coke med O2 M 3 Coke med N6 m 3.5 coke med M4 M 3.5 Coke med Q5 M 20 coke med R2 M 3.5 Coke med T3 F 3.0 Coke med D2 F 3hrs Mars Bar med D5 F 4hrs Mars Bar med A6 F 2.5hrs Mars Bar med 3pm class F2 F 3 Mars Bar med H4 F 3 Mars Bar med H3 F 3 Mars Bar med F6 M 7.5 Mars Bar med H6 F 3 Mars Bar med E3 M 3 Mars Bar med s2 F 5 mars bar med BGL (mmol.L-1) or mM Carb in food (g) Food wt ( g)* fasting 15min 30min 45min 60min 75min 90min 40 60 4.2 5.1 5.4 6.8 7.5 7.1 40 60 5.5 6.1 7.2 7.7 6.2 5.2 40 60 4.6 5.7 6.6 6.5 7 6.7 40 60 5.4 6.7 6.9 6.9 8.3 40 60 5.1 5.7 8 6.9 6.6 6.9 40 670 4.2 7.7 6.9 6.4 5.2 4.1 40 670 4.2 7.8 6.3 5.9 4.6 3.8 40 666 5.2 7.8 8.2 5.2 5.3 5 40 670 4.4 5.6 5.8 4.8 4.2 4 40 670 4.9 8 7.5 5.2 4.4 5.6 40 670 4.9 8.2 9.1 7.3 6 5.3 40 43 4.2 6.5 6.4 6.9 7.3 7.8 40 42.86 4.8 5.7 8.3 7.6 7 6.5 40 43 4.5 8.8 7.1 6.1 6.5 6.3 40 43 4.2 7.5 8 8.3 5.6 40 43 5.2 7.2 5.9 6.2 6.3 5.8 40 43 4.1 5.4 7.6 6.1 5.8 6.3 40 86 4.7 5.9 5.7 4.8 4.9 5.4 40 86 4.7 5.2 6.4 7.3 6.4 5.7 40 86 4.9 4.7 6.7 6.7 6.7 6.7 40 86 4.8 5.8 6.3 7.4 8.1 8.7 40 86 4.5 5.4 5 5.9 7 8 40 86 5.2 6.3 6.5 6.5 6.4 7.3 40 369.23 4.3 5.5 7.6 7.8 6.7 5.6 40 369.23 4.7 7.6 8.1 7.5 6.9 40 300 4.9 6.7 6.5 40 369 4.4 6.2 6.3 5.7 5.2 5.1 40 300 4.9 6.7 6.5 6.5 5.4 5.6 40 320 4.4 8 8.1 7.5 6.9 5.9 40 320 4.4 8.5 7.2 6.8 5.5 5.1 40 320 4.4 6.4 7.9 6.8 6.4 6 40 192 4.6 7.2 7.8 7.7 7.2 6.2 40 200 3.7 4.9 6.5 6.1 5.5 5.3 40 200 3.8 11 7.5 7.2 6.3 6.4 40 192 4.5 5.1 8.1 6.3 6.1 5.5 40 200 4.8 5.8 6.6 6.8 6.6 6.1 40 384 4.7 6.8 5.7 4.8 5 40 385 4.9 5.2 5.1 6.3 5.6 4 40 385 5.2 5.9 6.3 5.2 4.9 5.1 40 385 4.7 8.7 7.3 5.8 5.8 6 40 385 5.3 9.6 6.8 6.2 5.1 4.8 40 400 4.4 4.9 6.1 8.7 7.9 6.3 40 400 4.3 5.8 7.3 8.6 8.3 7.9 40 385 4.5 5.4 5.6 5.7 5.1 4.8 40 92 4.9 5.8 6.1 7.5 7.7 7.2 40 92.31 3.9 5.3 6.4 5.2 5.3 5.1 40 92 4 11 5.8 6.6 6.5 6.8 40 92.2 4.8 6.4 5.3 6.4 7.6 9.7 40 92.3 5 5.2 6.4 8.3 7.5 5.9 40 92.5 4.8 4.7 5.4 6.9 6.7 6.5 40 222.22 4.5 4.6 6.1 5.9 5.6 5.6 40 222 4.3 4.7 4.6 4.8 4.4 4.2 40 222.2 4.3 5.3 5.4 5.8 5.9 40 222.2 4.1 3.9 4.3 5 4.8 5.1 40 222 5.4 5.3 5.8 7 7.9 7.9 40 222 4.8 5.9 8.9 8.9 9.1 40 222 4.7 4.9 5.4 6 2.4 40 66.6 4.2 4.9 5.8 5.8 6.4 6.3 40 67.99 5.2 5.8 6.8 8.2 8.1 8.7 40 66.3 4.1 6.3 6.7 6.4 5.7 5.3 40 67 4.6 5.3 5.8 5 6.4 5.8 40 67 3.1 4.1 3.9 5.7 5.7 5.7 40 66.7 4.4 3.7 5.5 5.8 6.1 5.7 40 258 4.6 4.6 5.4 5.4 4.9 5.7 40 258 4.8 6.7 5.3 5.4 5 5.1 40 258 5.1 6 6.4 5.7 4.8 4.9 40 258 4.7 5.2 5.7 5.4 4.7 5.4 40 258 4.1 5.5 5.2 5.2 4.8 5.3 40 260 5.8 6.8 5.6 4.9 5.8 5.3 40 260 4.5 5.6 5.6 5.3 5.3 4.8 40 385 4.8 7.9 6.1 5.1 5.4 6.2 40 377 5.3 6.8 6.4 5.6 4.8 40 385 7.2 8.4 7.3 6.3 5.4 4.9 40 385 4.5 6.5 5.7 4.2 4.5 4.9 40 385 4.9 5.8 6.2 5.9 5.6 5.6 40 385 6.3 6.7 8.1 7.3 5.9 5.7 40 385 4.1 3.1 5.2 5.5 6.2 4.8 40 60 4.4 4.4 8.1 7.8 8 7.4 40 66.6 4.1 5.2 7.1 8.3 6.9 3.4 40 60 6.4 5.3 7.6 5.6 5.6 40 60 5.5 6.7 7.6 7.4 8.3 7 40 60 4.7 6.1 6.6 9.2 6.7 6.1 40 60 4.4 5.4 5.8 5.7 5.8 6.3 40 60 4.8 5.3 8.4 10.4 8.8 7.8 40 60 4.7 7.2 5.9 5.7 5.7 7.1 40 60 3.6 4.7 6.9 5.2 4.6 5.3 40 60 4.7 6.1 5.9 6.2 5.8 5.7 STEPS 1 Look at data - any points that should not be included: too few values at 9 &105 mins so all should be excluded Subject B2 consumed double required amount so remove from data set Subject Q1, S5, B4 & E6 had extraneous data points at 45, 75, 30 & 45 min, respectively, so should remove from data set 2 Categorise the food types into high med or low GI and sort into categories (this is best done by first sorting on column F then on column E) 3 Calculate the mean and SD for all categories at each time 4 Construct a table of data including Mean and SD values (best to put all means in rows then all SDs below that 5 Construct the graph of all mean values and add SDs to data points. What type of graph will you use 6 Tidy up the graph appropriately 7 Import the graph into a Word file and add appropriate title 8 Address the questions asked on p138 of the course manual 9 Hand in to your tutor at the beginning of next week's tutorial Read More