When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising.
Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too.
What to do:
- Keep to a schedule. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. You can help lessen the amount of change in your blood sugar levels if you eat at the same time every day, eat several small meals a day or eat healthy snacks at regular times between meals.
- Make every meal well-balanced. As much as possible, plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. It's especially important to eat about the same amount of carbohydrates at each meal and snack because they have a big effect on blood sugar levels. Talk to your doctor, nurse or dietitian about the best food choices and appropriate balance.
- Eat the right amount of foods. Learn what portion size is appropriate for each type of food. Simplify your meal planning by writing down portions for the foods you eat often. Use measuring cups or a scale to ensure proper portion size.
- Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Talk to your diabetes health care team about how to best coordinate meal and medication schedules.
Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body's response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can lower your blood sugar level.
What to do:
- Talk to your doctor about an exercise plan. Ask your doctor about what type of exercise is appropriate for you. If you've been inactive for a long time, your doctor may want to check the condition of your heart and feet before advising you. He or she can recommend the right balance of aerobic and muscle-strengthening exercise.
- Keep an exercise schedule. Talk to your doctor about the best time of day for you to exercise so that your workout routine is coordinated with your meal and medication schedules.
- Know your numbers. Talk to your doctor about what blood sugar levels are appropriate for you before you begin exercise.
- Check your blood sugar level. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that lower blood sugar. Be aware of warning signs of low blood sugar, such as feeling shaky, weak, confused, lightheaded, irritable, anxious, tired or hungry.
- Stay hydrated. Drink plenty of water while exercising because dehydration can affect blood sugar levels.
- Be prepared. Always have a small snack or glucose pill with you during exercise in case your blood sugar drops too low. Wear a medical identification bracelet when you're exercising.
- Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Your doctor can advise you on appropriate changes in your medication. You may need to adjust treatment if you've increased your exercise routine.
Insulin and other diabetes medications are designed to lower your blood sugar level when diet and exercise alone aren't sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.
What to do:
- Store insulin properly. Insulin that's improperly stored or past its expiration date may not be effective.
- Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.
- Be cautious with new medications. If you're considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.
When you're sick, your body produces stress-related hormones that can help your body fight the illness, but they can also raise the level of blood sugar. Changes in your appetite and normal activity may also complicate diabetes management.
What to do:
- Plan ahead. Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your medication dosages, and when to call your doctor.
- Continue to take your diabetes medication. However, if you're unable to eat because of nausea or vomiting, contact your doctor. In these situations, you may need to temporarily stop taking your medication because of risk of hypoglycemia.
- Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar level. Keep a supply of foods that are easy on your stomach, such as gelatin, crackers, soups and applesauce. Drink lots of water or other fluids that don't add calories, such as tea, to make sure you stay hydrated.
The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is busy metabolizing alcohol, your blood sugar level may not get the boost it needs. Alcohol can result in low blood sugar shortly after you drink and for as many as eight to 12 hours more.
What to do:
- Get your doctor's OK to drink alcohol. Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if your diabetes is under control and your doctor agrees, an occasional alcoholic drink with a meal is fine.
- Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, stick with sugar-free mixers — such as diet soda, diet tonic, club soda or seltzer.
- Tally your calories. Remember to include the calories from any alcohol you drink in your daily calorie count. Ask your doctor or dietitian how to incorporate calories from alcohol into your diet plan.
Menstruation and menopause
Changes in hormone levels the week before and during menstruation can result in significant fluctuations in blood sugar levels. And in the few years before and during menopause, hormone changes may result in unpredictable variations in blood sugar levels that complicate diabetes management. Also, the similarity of some symptoms of menopause and low blood sugar can result in errors in adjusting what you eat.
What to do:
- Look for patterns. Keep careful track of your blood sugar readings from month to month. You may be able to predict fluctuations related to your menstrual cycle.
- Adjust your diabetes treatment plan as needed. Your doctor may recommend changes in your meal plan, activity level or diabetes medications to make up for blood sugar variation.
- Check blood sugar more frequently. If you're likely approaching menopause or experiencing menopause, talk to your doctor about monitoring blood sugar levels. You may need to do so more often or when you're experiencing symptoms that you normally interpret as low blood sugar.
If you're stressed, it's easy to abandon your usual diabetes management routine. You might exercise less, eat fewer healthy foods or test your blood sugar less often — and lose control of your blood sugar in the process. Additionally, the hormones your body produces in response to prolonged stress may prevent insulin from working properly.
What to do:
- Look for patterns. Log your stress level on a scale of 1 to 10 each time you log your blood sugar level. A pattern may soon emerge.
- Take control. Once you know how stress affects your blood sugar level, fight back. Learn relaxation techniques, prioritize your tasks and set limits. Whenever possible, avoid common stressors.
- Get help. Learn new strategies for coping with stress. You may find that working with a psychologist or clinical social worker can help you identify stressors, solve stressful problems or learn new coping skills.
The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations — and plan ahead accordingly. If you're having trouble keeping your blood sugar level in your target range, ask your diabetes health care team for help.