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Glycaemia – Understanding Blood Glucose Levels

Glycaemia refers to the concentration of glucose in the blood. Maintaining balanced blood sugar levels is essential for overall health and bodily function.

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Things worth knowing about "Glycaemia"

Glycaemia refers to the concentration of glucose in the blood. Maintaining balanced blood sugar levels is essential for overall health and bodily function.

What is Glycaemia?

Glycaemia (also spelled glycemia) refers to the level of glucose (sugar) present in the bloodstream at any given time. Glucose is the primary source of energy for the body´s cells, especially for the brain and muscles. Blood glucose levels fluctuate naturally throughout the day and are regulated within a narrow range by a complex hormonal system.

In medicine, different states of glycaemia are distinguished: a normal blood glucose level is called normoglycaemia. When blood glucose is abnormally high, it is referred to as hyperglycaemia; when it is too low, it is called hypoglycaemia.

Regulation of Blood Glucose

Blood glucose levels are primarily regulated by two hormones produced in the pancreas:

Insulin: Released when blood glucose rises, insulin lowers blood sugar by promoting glucose uptake into cells.
Glucagon: Released when blood glucose falls, glucagon raises blood sugar by stimulating the liver to release stored glucose.

Other hormones such as adrenaline, cortisol, and growth hormone also influence blood glucose levels, particularly in response to stress.

Normal Values for Glycaemia

Blood glucose reference values are typically expressed in millimoles per litre (mmol/l) or milligrams per decilitre (mg/dl):

Fasting blood glucose (after at least 8 hours without food): 3.9 – 5.6 mmol/l (70 – 100 mg/dl)
Postprandial blood glucose (2 hours after a meal): below 7.8 mmol/l (below 140 mg/dl)

Values outside these ranges may indicate a metabolic disorder and should be evaluated by a healthcare professional.

Hyperglycaemia – High Blood Glucose

Hyperglycaemia occurs when blood glucose levels are persistently or repeatedly elevated. This is a hallmark of diabetes mellitus (type 1 and type 2), but can also result from stress, certain medications, or pancreatic disorders.

Common symptoms include:

Frequent urination
Excessive thirst
Fatigue and weakness
Blurred vision
Slow wound healing

If left uncontrolled over time, hyperglycaemia can lead to serious complications, including cardiovascular disease, kidney damage (diabetic nephropathy), nerve damage (diabetic neuropathy), and eye damage (diabetic retinopathy).

Hypoglycaemia – Low Blood Glucose

Hypoglycaemia occurs when blood glucose drops below 3.9 mmol/l (70 mg/dl). In people with diabetes, it can be triggered by too much insulin or blood glucose-lowering medication. In otherwise healthy individuals, it may result from prolonged fasting, intense physical activity, or alcohol consumption.

Typical symptoms include:

Trembling and sweating
Rapid heartbeat (palpitations)
Difficulty concentrating and confusion
Intense hunger
In severe cases: loss of consciousness

Diagnosis

Glycaemia is assessed through a simple blood test. Common diagnostic approaches include:

Fasting blood glucose test: Measured after at least 8 hours of fasting.
Oral glucose tolerance test (OGTT): Blood glucose is measured before and 2 hours after consuming a standardised glucose solution.
HbA1c (glycated haemoglobin): Reflects average blood glucose levels over the past 2–3 months and is a key marker for diagnosing and monitoring diabetes.
Continuous glucose monitoring (CGM): A modern technology that tracks blood glucose levels in real time, particularly useful for people with diabetes.

Treatment and Management

The management of glycaemia disorders depends on the underlying cause and the type of deviation from normal values:

For Hyperglycaemia

Dietary changes (low-carbohydrate, high-fibre diet)
Regular physical activity
Medication (e.g., metformin, insulin therapy)
Regular self-monitoring of blood glucose

For Hypoglycaemia

Immediate intake of fast-acting carbohydrates (e.g., glucose tablets, fruit juice)
In severe cases: glucagon injection or intravenous glucose administration
Adjustment of medication in consultation with a healthcare provider

Glycaemic Index and Glycaemic Load

Two important concepts relate to glycaemia in the context of nutrition:

Glycaemic index (GI): A measure of how quickly a carbohydrate-containing food raises blood glucose levels. High-GI foods (e.g., white bread, soft drinks) cause rapid spikes, while low-GI foods (e.g., legumes, whole grains) result in a slower, more gradual rise.
Glycaemic load (GL): Takes into account both the GI of a food and the quantity consumed, providing a more accurate picture of the actual impact on blood glucose.

References

World Health Organization (WHO): Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. WHO Press, Geneva, 2006.
American Diabetes Association: Standards of Medical Care in Diabetes. Diabetes Care, 2024. Available at: https://diabetesjournals.org/care
Holt R.I.G., Cockram C., Flyvbjerg A., Goldstein B.J. (eds.): Textbook of Diabetes. 5th edition, Wiley-Blackwell, 2017.

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