October 16, 2015

Tips to Manage Blood Glucose on Insulin

Do you use insulin to manage your diabetes? How do I occasionally manage swings in my blood glucose levels? What can I do if my high blood glucose levels won't go down while using insulin? These are common questions I receive in emails.

First, I have to ask some questions. I ask if they have had classes given by a CDE/RD. What did they tell you about the food plan you should follow? I also ask if they need to lose weight that they have recently gained. This generally elicits the following answers – yes, they have had classes and they were advised to consume whole grains and eat between 45 and 70 grams of carbohydrates per meal. Many tell me they were overweight to start, are gaining more weight on insulin, and have not been able to lose any weight.

These answers tell me there are changes that need to be recommended. I always emphasize that diabetes is not their fault and ask if they are open to changing their food plan. I suggest that they avoid the whole grains and lower the amount of carbohydrates they consume. I suggest that they consider eating no more than 80 grams of carbohydrates per day and preferably only 60 grams with 20 grams for each meal.

I do tell people that for about two to three weeks, they may feel hungry, but after three weeks, this will often not be the case. This will vary by individual, some people can be hungry for two weeks, and some will take four weeks.

I do tell people that Dr. Bernstein recommends a lower carbohydrate food plan of 6-12-12, meaning six grams for breakfast, 12 grams for lunch, and 12 grams for dinner. I suggest that if they want to do this that they start out by lowering the number of carbohydrates over a period of about four weeks.

I warn these people to reduce the amount of insulin used as they reduce their carbohydrates. I do suggest that they immediately talk with their doctor about how fast they should reduce the amount of insulin, both basal (long acting) and rapid acting. I tell them that they want to do this to avoid hypoglycemia (lows).

I also warn then to be prepared to further reduce their insulin as their weight decreases, as insulin resistance can ease as well. I warn them that the doctor may want to take them off insulin and they should decide what they want.

If they are using oral medications, I give them the same advice and tell them that the amount of medication may need to be reduced and especially if they are taking a sulfonylurea.

I emphasize these three items, exercise, following a lower carb meal plan, and easing stress. I also tell them that if they cannot find a nutritionist that they trust, I will suggest one. Yes, I inform them that the person is a relative, but that they should find one that they trust and is not pushing carbohydrates. Find one that wants to work with them and balance the nutrition for a day, a week, and give them something to work with for the daily living.

Finally, I suggest that if anyone is pushing carbohydrates, they need to be careful and stay away from them. I tell them that it is not healthy to increase carbohydrates and expect to cover them with increased medication (oral or insulin). This will cause weight gain that will be difficult to lose. I do advise these people to stay away from low carb/low fat plans as this often causes weight gain, as the carbs are often not low.

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