September 5, 2014

Factors in Managing Your Blood Glucose – Part 1

This was somewhat surprising and made me realize how different each person can be when it comes to factors that affect the management of blood glucose. This is also why I become frustrated by the medical and non-medical professionals that use a one-size-fits-all approach in the advice they give to us. I have even had doctors not want to change a medication when I tell them that a medication is causing a particular side effect.

I am also upset by those that say there are only three things necessary to manage your blood glucose – diet, exercise, and medications. Oh, if only it were that simple. It is more complex than that by a country mile. With a couple of months short of 12 years with diabetes, I know that other factors can override the best of management skills. Even keeping a positive attitude gets tested severely at times. I have learned that blaming myself does not solve the problem and at first I occasionally let this happen.  I have rounded up seven categories that can have an influence on our blood glucose levels. They are human factors, biological factors, environmental factors, food/fluids, medication(s), activity, and health. Some writers only consider five and ignore human and health factors.  There are probably more that I have missed.

Human Factors:

Procrastination – okay, I realize some people don't like this, but I have seen this done and do it myself. I get to researching and writing, and it is time to test my blood glucose and I say to myself – in a bit, and then it is an hour later. I have seen other type 2's on insulin in a restaurant and instead of injecting the insulin before the meal; they wait until after the meal. Own up and admit that you have done something similar. Blood glucose can go high when you procrastinate.

Forgetfulness - We can forget and it is easy. Have unexpected visitors and they stayed longer than normal and you are tired and want to go to bed. What happens? You forget to take your before bed medication(s). None of us intends to do this, but life happens. Again, blood glucose can go high when you forget a medication.

Cognitive abilities -  As people age, cognitive abilities can decrease causing blood glucose levels to go high or low.  These people need help and careful management by caregivers and doctors.

Health Factors:
Hospitalization – This can create all types of blood glucose problems. Hospital food can be notoriously high in carbohydrates, especially the meals for diabetics. Then add to this the reason you are in the hospital. Operations can become bothersome and create high blood glucose levels.

Other diseases – Other comorbid conditions can also affect blood glucose levels at different times. It is wise to discuss this with your doctor to learn if other medications for them can cause higher blood glucose levels. Also consider a talk with the pharmacist if one doctor does not communicate with another doctor and you are not sure if he checks your medication list.

Carbohydrates - Carbohydrates affect blood glucose the most. Accurately counting carbohydrates can be very difficult, and getting the number wrong can dramatically affect blood glucose. The type of carbohydrate also matters – higher glycemic index carbohydrates tend to spike blood glucose more rapidly. Lowering the amount of carbohydrates consumed is often to wisest choice.

Fat - Fatty foods tend to make people with diabetes feel full sooner and curb the desire for carbohydrates. A medium to high fat meal plan with low carbohydrates will generally assist in helping you lose weight.

Protein - If you’ve ever eaten a protein-only meal with very few carbs (e.g., salad with chicken), you may have seen a noticeable rise in blood glucose (20-50 mg/dl). Though protein typically has little effect on blood glucose, in the absence of insulin, it can raise blood glucose. When I am eating a carbohydrate-free, protein-only meal, I still take a bit of insulin to cover it. This can raise blood glucose or have a neutral effect depending on your system and body chemistry.

Caffeine - Many studies have suggested that caffeine increases insulin resistance and stimulates the release of adrenaline. I know that if I have any caffeine in the morning, I’ll see at least a 20-30 mg/dl rise in blood glucose, particularly when I’m more insulin resistant.

Alcohol - Normally, the liver releases glucose to maintain blood glucose levels. But when alcohol is consumed, the liver is busy breaking the alcohol down, and it reduces its output of glucose into the bloodstream. This can lead to a drop in blood glucose levels if the alcohol was consumed on an empty stomach. However, alcoholic drinks with carbohydrate-rich mixers (e.g., orange juice) can also raise blood glucose. When drinking alcohol, make sure you test your blood glucose often and that someone responsible nearby knows you have diabetes.

I include this because many people just have to have their alcohol. Another good precaution would be having a designated driver to avoid legal problems.

Medication dose - For those of us with diabetes on any medication (pills or insulin injections), the dose of medication directly impacts blood glucose. In most cases, but not always, taking a higher dose of a diabetes medication means a greater blood glucose-lowering effect. Care needs to be taken to avoid stacking if possible.

Medication timing - In addition to dose, medication timing can also be critical. For instance, taking rapid-acting insulin (Humalog, Novolog, Apidra, and Afrezza) 20 minutes before a meal is ideal for me - it leads to a lower spike in glucose vs. taking it at the start of the meal or after the meal has concluded. Note that this works best for me, although this can vary among individuals – please consult your doctor to discuss the optimal timing of insulin. The timing of many type 2 diabetes medications matters a lot – some can consistently be taken at any time of day (e.g., Januvia, Victoza), while others are most recommended taken with meals (e.g., metformin).

Medication interactions - Non-diabetes medications can interfere with your diabetes medications and blood glucose. Consult the information included in both your diabetes and non-diabetes medications. If your doctor does not give you information, have a talk with your pharmacist.

Continued in tomorrow's blog.

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