Blood sugar level

Concentration of glucose present in the blood (Glycaemia)

The glycaemia, also known as blood sugar level, blood sugar concentration, or blood glucose level is the
measure of glucose concentrated in the blood of humans or other animals. Approximately 4 grams of
glucose, a simple sugar, is present in the blood of a 70 kg (154 lb) human at all times. The body tightly
regulates blood glucose levels as a part of metabolic homeostasis. Glucose is stored in skeletal muscle
and liver cells in the form of glycogen; in fasting individuals, blood glucose is maintained at a constant
level at the expense of glycogen stores in the liver and skeletal muscle.

The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the
course of a day with three meal. One of the effects of a sugar-rich vs a starch-rich meal is highlighted.

In humans, a blood glucose level of 4 grams, or about a teaspoon, is critical for normal function in a
number of tissues, and the human brain consumes approximately 60% of blood glucose in fasting,
sedentary individuals. A persistent elevation in blood glucose leads to glucose toxicity, which contributes
to cell dysfunction and the pathology grouped together as complications of diabetes. Glucose can be
transported from the intestines or liver to other tissues in the body via the bloodstream. Cellular glucose
uptake is primarily regulated by insulin, a hormone produced in the pancreas.

Glucose levels are usually lowest in the morning, before the first meal of the day, and rise after meals
for an hour or two by a few millimoles. Blood sugar levels outside the normal range may be an indicator
of a medical condition. A persistently high level is referred to as hyperglycemia; low levels are referred
to as hypoglycemia. Diabetes mellitus is characterized by persistent hyperglycemia from any of several
causes, and it is the most prominent disease related to the failure of blood sugar regulation. There are
different methods of testing and measuring blood sugar levels.

The intake of alcohol causes an initial surge in blood sugar and later tends to cause levels to fall. Also,
certain drugs can increase or decrease glucose levels.

Units

The international standard way of measuring blood glucose levels is in terms of a molar concentration,
measured in mmol/L (millimoles per litre, or millimolar, abbreviated mM). In the United States, the
western parts of Germany, and other countries mass concentration is measured in mg/dL (milligrams
per decilitre).
Since the molecular weight of glucose C6H12O6 is 180, the difference between the two units is a factor
of 18, so 1 mmol/L of glucose is equivalent to 18 mg/dL.

Normal value range

Humans

Normal value ranges may vary slightly between laboratories. Many factors affect a person’s blood sugar
level. The body’s homeostatic mechanism of blood sugar regulation (known as glucose homeostasis),
when operating normally, restores the blood sugar level to a narrow range of about 4.4 to 6.1 mmol/L
(79 to 110 mg/dL) (as measured by a fasting blood glucose test).

Normal blood glucose level (tested while fasting) for non-diabetics is between 3.9 and 7.1 mmol/L (70
and 130 mg/dL). The global mean fasting plasma blood glucose level in humans is about 5.5 mmol/L (100
mg/dL); however, this level fluctuates throughout the day. Blood sugar levels for those without diabetes
and who are not fasting should be below 6.9 mmol/L (125 mg/dL). The blood glucose target range for
diabetics, according to the American Diabetes Association, should be 5.0–7.2 mmol/l (90–130 mg/dL)
before meals and less than 10 mmol/L (180 mg/dL) two hours after meals (as measured by a blood
glucose monitor).

Despite widely variable intervals between meals or the occasional consumption of meals with a
substantial carbohydrate load, human blood glucose levels tend to remain within the normal range.
However, shortly after eating, the blood glucose level may rise, in non-diabetics, temporarily up to 7.8
mmol/L (140 mg/dL) or slightly more. For people with diabetes maintaining “tight diabetes control”, the
American Diabetes Association recommends a post-meal glucose level of less than 10 mmol/L (180
mg/dL) and a fasting plasma glucose of 3.9 to 7.2 mmol/L (70–130 mg/dL).

The actual amount of glucose in the blood and body fluids is very small. In a healthy adult male of 75 kg
(165 lb) with a blood volume of 5 L, a blood glucose level of 5.5 mmol/L (100 mg/dL) amounts to 5 g,
equivalent to about a teaspoonful of sugar. Part of the reason why this amount is so small is that, to
maintain an influx of glucose into cells, enzymes modify glucose by adding phosphate or other groups to
it.

Other animals

In general, ranges of blood sugar in common domestic ruminants are lower than in many monogastric
mammals. However this generalization does not extend to wild ruminants or camelids. For serum
glucose in mg/dL, reference ranges of 42 to 75 for cows, 44 to 81 for sheep, and 48 to 76 for goats, but
61 to 124 for cats; 62 to 108 for dogs, 62 to 114 for horses, 66 to 116 for pigs, 75 to 155 for rabbits, and
90 to 140 for llamas have been reported. A 90 percent reference interval for serum glucose of 26 to 181
mg/dL has been reported for captured mountain goats (Oreamnos americanus), where no effects of the
pursuit and capture on measured levels were evident. For beluga whales, the 25–75 percent range for
serum glucose has been estimated to be 94 to 115 mg/dL. For the white rhinoceros, one study has
indicated that the 95 percent range is 28 to 140 mg/dL. For harp seals, a serum glucose range of 4.9 to
12.1 mmol/L [i.e. 88 to 218 mg/dL] has been reported; for hooded seals, a range of 7.5 to 15.7 mmol/L
[i.e. about 135 to 283 mg/dL] has been reported.

Regulation

Main article: Blood sugar regulation

The body’s homeostatic mechanism keeps blood glucose levels within a narrow range. It is composed of
several interacting systems, of which hormone regulation is the most important.[citation needed]

There are two types of mutually antagonistic metabolic hormones affecting blood glucose levels:

Catabolic hormones (such as glucagon, cortisol and catecholamines) which increase blood glucose;

And one anabolic hormone (insulin), which decreases blood glucose.

These hormones are secreted from pancreatic islets (bundles of endocrine tissues), of which there are
four types: alpha (A) cells, beta (B) cells, Delta (D) cells and F cells. Glucagon is secreted from alpha cells,
while insulin is secreted by beta cells. Together they regulate the blood-glucose levels through negative
feedback, a process where the end product of one reaction stimulates the beginning of another
reaction. In blood-glucose levels, insulin lowers the concentration of glucose in the blood. The lower
blood-glucose level (a product of the insulin secretion) triggers glucagon to be secreted, and repeats the
cycle.

In order for blood glucose to be kept stable, modifications to insulin, glucagon, epinephrine and cortisol
are made. Each of these hormones has a different responsibility to keep blood glucose regulated; when
blood sugar is too high, insulin tells muscles to take up excess glucose for storage. Glucagon responds to
too low of a blood glucose level; it informs the tissue to produce more glucose. Epinephrine prepares
the muscles and respiratory system for activity in the case of a “fight and flight” response. Lastly, cortisol
supplies the body with fuel in times of heavy stress.

Abnormalities

Hyperglycemia
If blood sugar levels remain too high the body suppresses appetite over the short term. Long-term
hyperglycemia causes many health problems including heart disease, cancer, eye, kidney, and nerve
damage.

Blood sugar levels above 16.7 mmol/L (300 mg/dL) can cause fatal reactions. Ketones will be very high (a
magnitude higher than when eating a very low carbohydrate diet) initiating ketoacidosis. The Mayo
Clinic recommends emergency room treatment above 16.7 mmol/L (300 mg/dL) blood glucose.[citation
needed] The most common cause of hyperglycemia is diabetes. When diabetes is the cause, physicians
typically recommend an anti-diabetic medication as treatment. From the perspective of the majority of
patients, treatment with an old, well-understood diabetes drug such as metformin will be the safest,
most effective, least expensive, and most comfortable route to managing the condition. Diet changes
and exercise implementation may also be part of a treatment plan for diabetes.

Some medications may cause a rise in blood sugars of diabetics, such as steroid medications, including
cortisone, hydrocortisone, prednisolone, prednisone and dexamethasone.

Hypoglycemia

If blood sugar levels drop too low, a potentially fatal condition called hypoglycemia develops. Symptoms
may include lethargy, impaired mental functioning; irritability; shaking, twitching, weakness in arm and
leg muscles; pale complexion; sweating; loss of consciousness.

Mechanisms that restore satisfactory blood glucose levels after extreme hypoglycemia (below 2.2
mmol/L or 40 mg/dL) must be quick and effective to prevent extremely serious consequences of
insufficient glucose: confusion or unsteadiness and, in the extreme (below 0.8 mmol/L or 15 mg/dL) loss
of consciousness and seizures. Without discounting the potentially quite serious conditions and risks
due to or oftentimes accompanying hyperglycemia, especially in the long-term (diabetes or pre-
diabetes, obesity or overweight, hyperlipidemia, hypertension, etc.), it is still generally more dangerous
to have too little glucose – especially if levels are very low – in the blood than too much, at least
temporarily, because glucose is so important for metabolism and nutrition and the proper functioning of
the body’s organs. This is especially the case for those organs that are metabolically active or that
require a constant, regulated supply of blood sugar (the liver and brain are examples). In healthy
individuals, blood glucose-regulating mechanisms are generally quite effective, and symptomatic
hypoglycemia is generally found only in diabetics using insulin or other pharmacological treatment, and
in starvation or severe malnutrition or malabsorption (of various causes), and conditions such as
anorexia.[dubious – discuss] Hypoglycemic episodes can vary greatly between persons and from time to
time, both in severity and swiftness of onset. For severe cases, prompt medical assistance is essential, as
damage to brain and other tissues and even death will result from sufficiently low blood-glucose levels.
Glycosuria

Glycosuria happens when you have glucose, or other sugars like lactose, fructose, or galactose,
in your urine. This is sometimes also called glucosuria.

Normally, your body eliminates glucose in your urine when your blood sugar levels are too high.
In healthy people, your kidneys filter the glucose and reabsorb most of it back into your blood.

Your body carefully controls glucose levels to maintain a steady balance. Too much glucose can
damage your organs and nerves, but your body does need enough sugar for energy.

A small amount of glucose in your urine is normal. If a random urine sample shows more than
0.25mg/ml, this is considered glycosuria and can be caused by too high blood glucose levels, a
problem with your kidney filters, or both.

Causes of Glycosuria

There are three main causes of glycosuria:

• Conditions with problems using or making the hormone insulin

GTT

•Glucose tolerance means ability of the body to utilize (tolerate) glucose in blood circulation.

• The effect of ingested carbohydrate can be studied under reasonably standard condition by means
of the Glucose Tolerance Test.

• It is indicated by the nature of blood glucose curve following the administration of glucose.

• Temporary rise of blood sugar after food intake for few hours.

• Extent and duration of rise depends on type of food (Glycemic index).

• Glucose level returns to normal within 2 hrs.

• If it take >2 hours = Decrease glucose tolerance.

1)Oral GTT (OGTT)

2)INTRAVENOUS GTT (IVGTT)

• OGTT is mostly preferred

• IVGTT use for patient who are unable to absorb an oral dose of glucose ( malabsorption
syndrome).
Hormones in Blood Sugar Regulation

How insulin works

The cells need glucose for energy. However, most of them are unable to use
glucose without the help of insulin.

Insulin gives glucose access to the cells. It attaches to the insulin receptors on
cells throughout the body, instructing the cells to open up and grant entry to
glucose.

Low levels of insulin constantly circulate throughout the body. A spike in insulin
signals to the liver that blood glucose is also high. The liver absorbs glucose then
changes it into a storage molecule called glycogen.

When blood sugar levels drop, glucagon instructs the liver to convert the
glycogen back to glucose, causing blood sugar levels to return to normal.

Insulin also supports healing after an injury by delivering amino acids to the
muscles. Amino acids help build the protein that is present in muscle tissue, so
when insulin levels are low, muscles may not heal properly.

How glucagon works

The liver stores glucose to power the cells during periods of low blood sugar.
Skipping meals and poor nutrition can lower blood sugar. By storing glucose, the
liver makes sure that blood glucose levels remain steady between meals and
during sleep.

When blood glucose falls, cells in the pancreas secrete glucagon. Glucagon
instructs the liver to convert glycogen to glucose, making glucose more available
in the bloodstream.

From there, insulin attaches to its receptors on the body’s cells and ensures that
they can absorb glucose.
Insulin and glucagon work in a cycle. Glucagon interacts with the liver to increase
blood sugar, while insulin reduces blood sugar by helping the cells use glucose.