Should We Use More Than Insulin?

If you use insulin for diabetes, you still might get swings in your blood glucose levels occasionally. But what if the levels won't go down, even with insulin? Don't worry. It's not the only way to get your condition under control. Healthy habits and diabetes medicine can also help.

Some of best ways to prevent high blood glucose levels are old-school:

#1. Exercise. When you do it regularly, it's like adding another medicine to your care. It makes the insulin you take work better, and it removes the sugar, or glucose, from your blood.

It also helps you lose weight, which can lower blood glucose. Try to build up to at least 30 minutes of moderate exercise most days, even if you start with just 5 minutes. Talk to your diabetes care team first about how to work out safely.

#2. Eat right. A healthy diet keeps your blood sugar within a safe range. It's the most important way to help you shed pounds if you're overweight. Work with a registered dietitian or a certified diabetes educator to learn about the best food to eat and how to build a meal plan that works for your lifestyle.

Weight loss medications are another option you can consider if you need to get thinner. Talk to your doctor about which ones might be a good choice for you.

#3. Relax. Stress blocks your body from releasing insulin, and that lets glucose pile up in your blood. If you're stressed for a long time, your glucose levels will keep building. Regular exercise and relaxation techniques -- like yoga, meditation, tai chi, and breathing exercises -- can help.

If the insulin you take isn't enough to lower high blood sugar, your doctor may change how much you take and how you take it. For instance, he may ask you to:

• Increase your dose.
• Take a fast-acting type before meals to help with swings in blood sugar after you eat.
• Take a long-acting type once or twice a day to help give you smoother blood glucose control.
• Use an insulin pump, which may make it easier to manage your blood glucose levels.

Other Medications:

You may take other drugs along with insulin to fight blood glucose highs. Some common ones are:

Exenatide and liraglutide (GLP-1 receptor agonists). If you have type 2 diabetes, these drugs lower glucose highs and make you feel full after a meal, which can help you eat less and lose weight. You take these medicines by injection. They can cause some side effects, such as nausea, vomiting, weakness, or dizziness.

DPP-4 Inhibitors. These include drugs like alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia). If you have type 2 diabetes, they can help you lower your blood glucose after meals. You take them as a pill. Side effects vary, depending on the type you take.

Other Reasons for High Blood Sugar:

There are other possible reasons your blood sugar may be high, such as insulin resistance, which may run in your family. That's when your body doesn't respond as well as it should to the insulin it makes. Or, you may be taking a drug for another health problem that keeps your body from using it well.

How you use insulin can also matter. If you give yourself shots in the same place repeatedly, for instance, that area may scar, which can affect how your body absorbs the hormone. It helps to rotate spots or use an insulin pump.

Some people also take less insulin than they should. It might be because they're afraid of low blood glucose, or they're nervous about needles. You might feel more comfortable by slowly increasing your insulin dose. Consider an insulin pump or pen if you don't like needles.

Whatever the cause of your blood glucose highs, work closely with your doctor to find a solution. And always talk with him before you make any changes in your insulin dose.

Cinnamon May Not Be Good for You

Someone had to say it! This article in WebMD explains why people should not depend on cinnamon to lower blood glucose levels. It is okay to sprinkle cinnamon on oatmeal or to use it in baking when a recipe calls for it as it often improves the taste. Some people are claiming it will help you manage diabetes, but don't count on it.

I agree with the WebMD article when it says that it is not clear if cinnamon is good for diabetes. While it is true that research has produced mixed results, much of the research is limited by the lack of funds. Therefore, most of the studies are too short and too limited in the number of participants. This has caused the American Diabetes Association to reject cinnamon for use on diabetes treatment.

A few small studies have linked cinnamon to better blood glucose levels and a few studies have shown that is may help in lowering insulin resistance. In one study, volunteers ate from 1 to 6 grams of cinnamon for 40 days. (One gram of ground cinnamon is about half a teaspoon.) The researchers found that cinnamon cut cholesterol by about 18% and blood glucose levels by 24%. In other studies, the spice did not lower blood glucose levels or cholesterol levels.

Is cinnamon safe for people with diabetes? Generally, it is safe, but there are potential problems if you have liver damage. This means that you need to talk to your doctor and follow the doctor's instructions. If you have liver problems, such as fatty liver disease, be careful, because large amounts of cinnamon may exacerbate liver problems.

Talking to your doctor is even more important if you are taking other medications. This involves side effects and adverse reactions that may occur with some medications.

Then we have the complex interaction with herbs. Use caution if you also take other supplements that lower blood sugar levels, including:

• Alpha lipoic acid
• Bitter melon
• Chromium
• Devil's claw
• Fenugreek
• Garlic
• Horse chestnut
• Panax
• Siberian ginseng
• Psyllium

The same holds true with diabetes medications. If you and your doctor decide it's OK for you to try cinnamon, pay close attention to your blood sugar levels. Tell your doctor if your levels fall too low.

Taking cinnamon with drugs that affect the liver may make liver problems more likely.

How and When to Test Your Blood Sugar With Diabetes – Part 2

The chart below gives you an idea of where your blood sugar level should be throughout the day. Your ideal blood sugar range may be different from another person's and will change throughout the day.

Time of Test	Ideal for Adults With Diabetes
Before meals	70-130 mg/dl My suggestion is 75 to 105 mg/dl
After meals	Less than 180 mg/dl My suggestion is no more than 140 mg/dl

The above chart is the ADA chart before the latest guidelines. My suggestions are the numbers I am comfortable seeing. This is where you will need your own goals based on your tolerances. These will also vary depending on your age and abilities. Your doctor may also advise different numbers.

Home Blood Glucose Monitoring and HbA1c

Monitoring your HbA1c level is also important for diabetes control. Many home glucose monitors can display an average blood glucose reading, which correlates with the HbA1c.

Average Blood Glucose Level (mg/dl)	HbA1c (%)
126	6
154	7
183	8
212	9
240	10
269	11
298	12

For a more expanded chart, I suggest using this chart.

When Should I Call My Doctor About My Blood Sugar?

Ask your doctor about your target blood sugar range, and make a plan for how to handle blood sugar readings that are either too high or too low and when to call your doctor. Learn about the symptoms of high or low blood sugar, and know what you can do if you begin to have symptoms.

Many doctors order certain ranges for your blood glucose, but you need to decide what you are willing to tolerate and set your goals accordingly. Do talk to your doctor if you question his orders. Do this politely and ask if you can make changes if you are uncomfortable with his or her orders.

How Do I Record My Blood Sugar Test Results?

Keep good records of any blood, urine, or ketone tests you do. Most glucose monitors also have a memory. Your records can alert you to any problems or trends. These test records help your doctor make any needed changes in your meal plan, medicine, or exercise program. Bring these records with you every time you see your doctor.

Yes, keep the records! Many meters are capable of doing ketone tests, so make inquiries about this. Your records are important to find trends or problems. Discuss the changes the doctor wishes to make to your food plan, medicine, or exercise regimen. The doctor may have some good suggestions.

Do listen to the doctor, but don't let the doctor alter your goals unless you agree with what he/she has to say. He may set some short-term goals that could be better for you.

Why I Do Not Like the ADA

Each year I become more discouraged reading the new (supposedly) guidelines. So few changes are done that it should be only referred to as the (year) ADA Guides. Some areas actually use the term individual or individualized for treatment of diabetes, but when talking about us older adults it seems they have established three one-size-fits-all categories and like certified diabetes educators want to put square pegs in round holes.

I dislike saying this, but the ADA does not understand people. They would put me in the middle category and I would not like having an A1c that high. I will continue to stay below 7.0% and keep working to stay below 6.5%. Yes, this is less than 8.0%, but the diabetes clinic keeps insisting that I let the A1c rise above 7.0% and with this, I am not going back there. Thank goodness, I have the VA to test my A1c twice a year. I have attempted to get another doctor, but when the new doctor wants to convert me to Afrezza and mainly oral medications – no, thank you. I like the regimen that I am currently using and find that I have fewer problems when I concentrate on doing it correctly.

Yes, I am like many other people and I do make mistakes, some are doozies, but I do learn from them. I occasionally repeat the same mistakes, but normally this is when I am attempting to prove something to myself and the results were not what I expected. Do I sometimes wonder if I am having cognitive issues, all the time, but since I am still learning, I have to discount many of the mistakes as being cognitive issues.

As I age, I know my body is changing and I must adjust how I handle my medications and discuss some issues with my doctor. Occasionally we disagree, but after following his directions for a couple of experiments, we were in agreement. Since I have fired a couple of doctors, my primary care doctor, and my VA doctors are in agreement with me more often than not.

The number of hypoglycemic episodes has definitely decreased and for that I am happy, as I have not had one for more than nine months. Yes, some would disagree when I have readings of 67, 68, and 69 mg/dl, but to me these are not as long as I remain above 65 mg/dl. This is a minor excursion and not something that makes me stress. Most of these occur during the afternoon with one in the AM.

When I adjust my Lantus to avoid these, then I end up with readings above 180 mg/dl in the afternoon. Days that I move around more than normal, my blood glucose levels drop into the upper 60s to lower 70s. Then there are fasting blood glucose readings in the 110 to 130 range and are often difficult to understand the reason for this. These things seem to happen for days on end and then I can go for days with excellent readings. I have determined that when I have the above average blood glucose readings, I tend to sleep for longer periods of time and when the blood glucose readings are all below 130 mg/dl, then with eight hours of sleep I am feeling just fine.

Why I Won't Follow ADA's Glucose Guidelines

The above chart published in WebMD shows how the American Diabetes Association does not care for people with type 2 diabetes. Granted the above cannot cover every situation and each person must set their own goals. Hopefully your goals will be less than this chart displays.

The only point in the chart that I can agree with is the reading before exercise. In my research, it has been difficult to find conclusive answers for type 2 diabetes. Everyone agrees that a blood glucose level of 250 mg/dl (13.9 mmol/L) or higher means that you must not exercise until your levels have come down below this. The blood glucose guidelines for exercising for all types of diabetes are 100 to 250 mg/dl (5.6 to 13.9 mmol/L). For most people, this is a safe pre-exercise blood glucose range. If you are not on insulin or sulfonylurea treatments, then it is still necessary to discuss this with your doctor if you are about to start an exercise regimen after a long period of being sedentary. This applies to people controlling their blood glucose levels with diet and exercise as well to prevent possible cardiovascular problems.

Each time you test your blood glucose, log it in a notebook or online tool, or with an app. Note the date, time, results, and any recent activities:

1. What medication and dosage you took
2. What you ate
3. How much and what kind of exercise you were doing

This will help you and your doctor see how your treatment is working.

Well-managed diabetes can delay or prevent complications that affect your eyes, kidneys, and nerves. Diabetes doubles your risk for heart disease and stroke, too. Fortunately, controlling your blood glucose will also make these problems less likely.

Tight blood glucose management; however, means a greater chance of low blood glucose levels, so your doctor may suggest higher targets.

Before meals, glucose levels should be 70 to 95 mg/dl and not 70 to 130 mg/dl. After meals, glucose levels should be less than 140 mg/dl. The maximum increase from preprandial to postprandial readings should not exceed 40 mg/dl.

Even the A1c level of 7.0% is way above what we should strive to manage and while 5.0% may be too low for those of us on insulin, we do have people that are capable of managing their diabetes at this level. This is why we always declare that people are all different and vary in their abilities to manage their diabetes.