September 6, 2014

Factors in Managing Your Blood Glucose – Part 2

This is a continuation of the previous blog.

Light activity - Light activity can have a surprising glucose-lowering effect. Walking could be considered light exercise.

High-intensity and moderate exercise - Please read my blog on safe blood glucose levels for exercising. Also talk with your doctor before beginning exercise that fits in this category.
Exercise is often described as something that always lowers blood glucose; however, high-intensity exercise, such as sprinting or weight lifting, can sometimes raise blood glucose. This stems from the adrenaline response, which tells the body to release stored glucose. But this is not a reason to avoid high intensity exercise – studies show it can improve blood glucose for one to three days post-exercise! Please note that in some cases high-intensity exercise can also drop blood glucose very rapidly (2-3 mg/dl per minute), especially if you are taking insulin. This also happens to many people on oral medications until they have been exercising for a couple of weeks or longer. The best way to see how individual exercise sessions affect your blood glucose is to test prior and after exercise.

Dawn phenomenon - The “dawn phenomenon” normally occurs in people with type 2 diabetes. The term refers to the body’s daily production of hormones around wake up time. During this time, the body makes less insulin and produces more glucagon, which raises blood glucose. The best way to figure out how dawn phenomenon affects you is to wear a CGM or wake up and test your blood glucose early in the morning. Not everyone experiences dawn phenomenon, but it is common for about 50 percent of type 2 patients on oral medications,

Scar tissue and lipodystrophy – If you are taking oral medications only, this will not affect you. Using the same sites on the body for injections sights can lead to lipodystrophy and scar tissue buildup. These result in erratic absorption of insulin, leading to glycemic variability and making it harder to spend more time in range. To avoid these issues, rotate your injection sites and don't reuse needles.

Insufficient Sleep - In my experience, I have found that I need more insulin on days following less than seven hours of sleep. The highest blood glucose of the day is even higher on days following little sleep. These findings are consistent with many studies, which have found that not getting enough sleep leads to worse diabetes management, insulin resistance, weight gain, and increased food intake.

Stress and illness - Stress and illness can cause the body to release epinephrine (adrenaline), glucagon, growth hormone, and cortisol. As a result, more glucose is released from the liver (glucagon, adrenaline) and the body can become less sensitive to insulin (growth hormone, cortisol). In some cases, people are much more insulin sensitive right before getting sick and can tend to run low blood sugars.

Allergies – Research did not yield any results and apparently is not worthy of study. I do have one friend that suffers from ragweed allergy and has problems with his blood glucose levels during ragweed pollen season.

A higher glucose level (“glucotoxicity”) - Hyperglycemia can lead to a state known as “glucotoxicity,” which can actually cause insulin resistance. People going on insulin after being on oral medications can experience this and spend a few days up to two weeks adjusting insulin to bring this under management.

Periods (Menstruation) - There is not an easy answer to the question of how periods affect women’s blood sugars. Many women report having higher blood sugar levels a few days prior to their period starting, but some women notice a sharp drop in sugar levels. To figure out how you respond, your best bet is to test your blood glucose often during this time of month.

Smoking - Some studies suggest that smoking can increase insulin resistance, and people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and managing their diabetes. Smokers also have higher risks for serious complications.

Medication or insulin that has gone bad – Some people stop taking oral medications and when they need to restart, use the old medications, and get little or no help. Others ruin their insulin by exposing it to direct sunlight or leaving it in the car on a hot day. The worst part is that it’s hard to know if it has actually gone bad unless you try a new vial. In addition, the insulin may work unpredictably. Unopened insulin should be stored in a refrigerator at approximately 36-46 °F. According to the FDA, insulin can be left unrefrigerated at a temperature from 59-86 °F for up to 28 days.

An accurate blood glucose reading - While this seems fairly obvious, I occasionally find myself testing multiple times in a row, since I do not believe the initial value. In some cases, the second time I get a much lower value, and it’s because I failed to wash my hands. I suggest retesting if you don’t believe the value on the meter.

Altitude – People on oral medications generally notice little difference with being at higher or even lower altitude. People using insulin need to be careful as insulin resistance can increase insulin needs. Others that are climbing or skiing may need less insulin. Testing more frequently may be a necessity.

To the above and the previous blog, I would be remiss if I did not mention attitude. A positive attitude makes diabetes management easier and helps make diabetes burnout and mild depression easier to conquer. Then add developing good habits that become part of a daily routine and burnout seldom happens.

Another blog about the reasons for variability of blood glucose levels is this one.  There are overlaps with the ideas included in the blog from yesterday and this blog of today.

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