Blood Sugar

Blood sugar concentration, or glucose level, refers to the amount of glucose present in the blood of a human or animal. Normally, in mammals the blood glucose level is maintained at a reference range between about 3.6 and 5.8 mM (mmol/l). It is tightly regulated as a part of metabolic homeostasis.

Mean normal blood glucose levels in humans are about 90 mg/dl, equivalent to 5mM (mmol/l) (since the molecular weight of glucose, C6H12O6, is about 180 g/mol). The total amount of glucose normally in circulating human blood is therefore about 3.3 to 7g (assuming an ordinary adult blood volume of 5 litres, plausible for an average adult male). Glucose levels rise after meals for an hour or two by a few grams and are usually lowest in the morning, before the first meal of the day. Transported via the bloodstream from the intestines or liver to body cells, glucose is the primary source of energy for body's cells, fats and oils (ie, lipids) being primarily a compact energy store.

Failure to maintain blood glucose in the normal range leads to conditions of persistently high (hyperglycemia) or low (hypoglycemia) blood sugar. Diabetes mellitus, characterized by persistent hyperglycemia from any of several causes, is the most prominent disease related to failure of blood sugar regulation.

Normal values

Despite widely variable intervals between meals or the occasional consumption of meals with a substantial carbohydrate load, human blood glucose levels normally remain within a remarkably narrow range. In most humans this varies from about 82 mg/dl to perhaps 110 mg/dl (4.4 to 6.1 mmol/l) except shortly after eating when the blood glucose level rises temporarily up to maybe 140 mg/dl (7.8 mmol/l) or a bit more in non-diabetics. The American Diabetes Association recommends a post-meal glucose level less than 180 mg/dl (10 mmol/l) and a pre-meal plasma glucose of 90-130 mg/dl (5 to 7.2 mmol/l).

It is usually a surprise to realize how little glucose is actually maintained in the blood and body fluids. The control mechanism works on very small quantities. In a healthy adult male of 75 kg (165 lb) with a blood volume of 5 litres (1.3 gal), a blood glucose level of 100 mg/dl or 5.5 mmol/l corresponds to about 5 g (0.2 oz or 0.002 gal, 1/500 of the total) of glucose in the blood and approximately 45 g (1½ ounces) in the total body water (which includes more than merely blood and will be usually about 60% of the total body weight in men). A more familiar comparison may help – 5 grams of glucose is about equivalent to a small sugar packet as provided in many restaurants with coffee or tea, with people using typically 1 to 3 packets per cup.

Health effects

If blood sugar levels drop too low, a potentially fatal condition called hypoglycemia develops. Symptoms may include lethargy, impaired mental functioning, irritability, shaking, weakness in arm and leg muscles, sweating and loss of consciousness. Brain damage is even possible.

If levels remain too high, appetite is suppressed over the short term. Long-term hyperglycemia causes many of the long-term health problems associated with diabetes, including eye, kidney, heart disease and nerve damage.

Low blood sugar

Some people report drowsiness or impaired cognitive function several hours after meals, which they believe is related to a drop in blood sugar, or "low blood sugar". For more information, see:

• idiopathic postprandial syndrome
• hypoglycemia

Mechanisms which restore satisfactory blood glucose levels after hypoglycemia must be quick and effective, because of the immediately serious consequences of insufficient glucose; in the extreme, coma, but also less immediately dangerous, confusion or unsteadiness, amongst many other symptoms. This is because, at least in the short term, it is far more dangerous to have too little glucose in the blood than too much. In healthy individuals these mechanisms are generally quite effective, and symptomatic hypoglycemia is generally only found in diabetics using insulin or other pharmacological treatment. Such hypoglycemic episodes 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.