Food: The Blood-Sugar Source
Glucose from food makes blood sugar go up within an hour or two of eating a meal, but the extent and speed of the rise can depend on what you eat and how much-and also on how insulin resistant you are. Testing will help you gauge your responses to different foods.
- Adjust your meal plan. If the meals you’ve worked up with your doctor or dietitian fail to keep blood sugar under control, you may need to go back to the drawing board. You could be getting too many total calories in a sitting or eating too many sugars and starches-which raise blood glucose faster and higher than other types of food-at once. Mealtime monitoring will help you determine how your blood sugar changes in response to what you eat, and this will provide your medical team with the information they need to guide you to better choices.
- Be consistent. Using your monitoring data as a guide, try to identify foods that seem better at keeping your blood sugar within your target range. Then try to eat those foods in consistent quantities at the same time every day. The more you control the glucose going into your body, the more you’ll be able to predict-and control-the rise and fall of your blood sugar.
- Limit alcohol. If you drink, try to have only one or two alcoholic drinks a day, preferably with food. Alcohol lowers blood glucose, putting you at risk of hypoglycemia. And mixed drinks are usually high in sugar and calories.
- Consider medication. If your meter readings indicate you’re having trouble keeping your blood sugar in line through diet and exercise alone, you may be a good candidate for drug intervention, most likely with an oral medication such as acarbose (Precose) to start with.
Exercise: The Glucose Gobbler
Moving your muscles revs the body’s engine, boosting its fuel consumption. Result: Glucose levels tend to drop when you’re physically active. Overall, this is a good thing, and monitoring can provide insight into ways in which you can strategically use exercise to lower your blood sugar. Be sure to work with your doctor to figure out how exercise should factor into your approach to diabetes management.
- Adjust your drug regimen. Strenuous exercise can sometimes lower blood sugar for hours after your workout-even for as long as one or two days. If you’re tightly controlling your glucose with insulin or medication, your post-exercise monitoring may suggest that you lower your dosages to avoid hypoglycemia. Ask your doctor for specific advice with regard to your condition and activity levels in order to adjust your drug regimen accordingly.
- Tank up ahead of time. If you’re planning to exercise vigorously, you may want to eat more food earlier in the day or take less insulin to make sure you have enough glucose readily available to fuel working muscles. Aim to work out an hour or two after eating, when blood sugar will be naturally high.
- Keep well fueled afterward. Depending on how strenuous your workout has been, it might be a good idea to increase your food intake for up to 24 hours after exercising to make sure blood-sugar levels don’t fall too low.
- Use exercise as medicine. If you’re taking insulin and understand through monitoring how exercise affects your blood sugar, you may find that it’s possible to use a workout essentially as an insulin substitute-specifically intended as a way to bring blood sugar down at certain times. (Talk to your doctor before adjusting your drug regimen.)
- Be alert to the unexpected. Certain types of vigorous exercises-weight lifting, for example-that unlock glucose stored in muscles can make blood sugar go up rather than down. Your doctor can suggest how you might adjust insulin or drug treatments accordingly.
Insulin: Fine-tuning the Control
If you’re taking insulin, the point is to keep blood sugar down, but hypoglycemia can occur if your injections bring your levels too low. On the other hand, you may experience hyperglycemia if your doses are improperly timed. Monitoring can help you figure out how to use insulin to keep glucose levels steady.
- Inject earlier to bring down highs. Patients taking regular (fast-acting) insulin normally inject it about 30 to 45 minutes before a meal. But if monitoring shows that your blood-sugar levels tend to be high either before or about an hour after you eat, you may want to add more time between injecting and eating to give the insulin a better chance to bring glucose levels down. You might also do some exercise for a similar effect. This advice does not apply if you’re taking rapid-acting insulin analogs such as lispro, aspart, or glulisine, which must be injected 15 minutes or less before eating.
- Wait a bit to raise up lows. If your blood sugar tends to be on the low side 30 to 45 minutes before you have a meal, you may want to wait until you’re closer to eating before injecting insulin to keep blood sugar from dropping lower before you’ve had a chance to get some food into your system. Even if you’re taking a rapid-acting insulin analog, you may want to wait until immediately before eating, or even just after eating, to inject your insulin if your blood sugar is already on the low side.
- Add small snacks. If insulin injections tend to produce hypoglycemia, you might want to eat a small amount of carbohydrate (such as a handful of raisins) around mid-morning and mid-afternoon to keep blood-glucose levels steady between meals. Or discuss with your doctor the possibility of adjusting your insulin regimen.
Illness: You’re Low, Sugar’s High
Illness and the stress that sometimes precipitates it can boost blood-sugar levels by stimulating the release of hormones that work against the action of insulin and cause glucose to be released from storage sites in the muscles and liver. Naturally, you mainly need to treat the illness, but you also need to take some extra steps to keep your blood-sugar levels down.
- Drink more water. If blood sugar is higher than usual, your kidneys are probably working harder and producing more urine. The result: You become dehydrated from the unusually high urine output. Therefore, keep yourself hydrated by drinking at least a cup of water every half hour or so.
- Avoid exercise. Even if you think it might bring blood sugar lower, there’s the possibility that exercise will cause the release of glucose from muscles. In any case, it’s more important that you rest in order to fight the illness.
- Consider adjusting insulin. If you’re taking insulin, ask your doctor if and when you should take additional or increased doses while you’re sick.
Morning: The Dawn Phenomenon
You’d think blood sugar would be low when you wake up. After all, you’ve gone an entire night without food. Often, however, blood sugar is high in the morning. The reason: Your body clock triggers the release of hormones that inhibit insulin so that more glucose is available to the body at the start of the new day. This is natural and not necessarily a problem. But if monitoring reveals that your blood sugar becomes excessively high in the morning, you may want to consult your doctor about what actions you can take.
- Take insulin later. If you’re using insulin and take an evening dose, you may find it works better to inject it closer to bedtime for longer-lasting control during the night.
- Skip the bedtime snack. Try eating less food at night so there’s not as much glucose in the blood when morning rolls around. You may also want to eat less at breakfast.
- Exercise in the evening. Because the glucose-lowering effects of exercise can last for many hours, a workout shortly after dinner can help keep your blood-sugar levels under control the following morning.