Managing Blood Glucose

Self-Management of Blood Glucose

Carbohydrate-containing foods affect blood glucose levels the most. Fruit, starches, starchy vegetables, milk/yogurt groups are all carbohydrate-containing foods. A fast-acting carbohydrate food like orange juice will affect blood glucose more quickly than whole milk which contains carbohydrate, protein, and fat. The fat in the whole milk will take longer to be digested. The sugar takes longer to reach the bloodstream because the fat slows the digestive process.

Since carbohydrates raise blood glucose it is important to see a dietitian or certified diabetes educator help you plan an appropriate amount of carbohydrate for meals and snacks.

Eating consistent amounts of carbohydrate at meal and snack time and eating regularly scheduled meals to help keep blood glucose stable and controlled.

Portion size effects how much carbohydrate a food contains. A carbohydrate choice or serving is the amount of food that provides 15 grams of carbohydrate. Generally, most people with diabetes need between 3 to 5 carbohydrate choices per meal (45-75 grams carb) and possibly 1 or 2 carbohydrate choices (15-30 carb choices) for a snack between meals and sometimes at bed-time. Snacks are not always a necessary part of a diabetes meal plan. Sometimes snacks can just be a source of unwanted calories.

Remember, there is no one “diabetes diet” that is appropriate for everyone. The main objective for diabetes meal planning is to lower carbohydrate intake enough to keep blood glucose within target ranges. This may look different from person to person, but meals and snacks should include lean protein, healthy fats, lower-fat dairy, starches, and fruits and vegetables within carbohydrate allowance.

Work with your health care provider to set blood glucose target ranges, determine an appropriate monitoring schedule and develop a diabetes meal plan that fits your needs and lifestyle.

Blood glucose monitoring is a familiar day in and day out the task for individuals with diabetes. This is just one of the Self-Care Behaviors recommended by the American Association of Diabetes Educators. Blood glucose monitoring provides immediate feedback that can be used to make changes in your diabetes management plan. It is not surprising that the demands of diabetes management can lead to what has been called “diabetes burnout.” Sometimes it is easier to handle the demands of managing your diabetes if you understand the importance and reason for specific monitoring.

Blood glucose monitoring may be helpful for the following reasons

Detecting and preventing hypoglycemia (low blood glucose).
Avoiding severe hypoglycemia and hypoglycemia unawareness, which is a condition where blood glucose drops without any awareness of the physical symptoms of hypoglycemia.
Preventing and detecting hyperglycemia (high blood glucose).
Helping reach and maintain target blood glucose goals.
Understanding how blood glucose responds to different amounts and types of foods and physical activity.
Determining the need for insulin during gestational diabetes.
Calculating appropriate insulin for insulin pumps and for carbohydrate ratios, correction factors, and insulin dosages with multiple daily injections.
Adjusting medication or other treatments when lifestyle changes occur.

What Impacts Blood Glucose Levels?

Foods and Portion Size

Foods that contain carbohydrates will affect blood glucose levels the most. The foods that contain the most carbohydrate include those from the Fruit Group, the Starch and Starchy Vegetable Group, and the Milk and Yogurt Group. Foods with only carbohydrate may raise blood glucose more quickly than those that also contain fat and protein. Foods that are high in carbohydrate eaten with a meal that also contains fats and protein will have a slower impact on blood glucose than those eaten alone.

How quickly and how much blood glucose levels rise depends on:

Food composition
Portion size

Food composition

Blood glucose levels are affected differently depending on whether you eat foods containing carbohydrates, proteins, fats, or a combination of these three. Carbohydrates will cause blood glucose to rise the most and the most quickly. Liquids that contain carbohydrates (like milk and juice) will cause blood glucose to rise faster than solids that contain carbohydrates (like bread). Because of the impact that they have on blood glucose levels, carbohydrates are the most important macronutrient for people with diabetes to monitor.

Portion size

The amount of food that you eat also impacts blood glucose levels. Eating more food, or bigger portions, will cause your blood glucose levels to rise more than eating smaller portions. Since carbohydrates affect blood glucose levels the most, the amount of carbohydrate that you eat each day is very important in controlling your blood glucose levels. Talk to your health care provider or dietitian about how many grams of carbohydrates you should eat each day, or what meal plan you should follow.

Other Causes Influencing Blood Glucose

If you are trying to manage your blood glucose, and you are not having good results, sometimes you need to think about what else may be influencing your blood glucose. For instance, an infection or a cold or flu can cause blood glucose levels to rise.

Infections

Unfortunately, high blood glucose levels can also make healing time longer for infections, especially those like skin infections or bladder infections. Taking care of the infection will help lower your blood glucose levels.

Stress

Physical and emotional stress can also cause blood glucose levels to rise.

Physical stress includes surgeries and injuries. Emotional stress can include depression and anxiety. Even positive stress can affect blood glucose. Things like weddings, vacations, or new grandchildren. If you are having surgery or have endured an injury, make sure your doctor knows you have diabetes. They may need to change your medication to better cover your blood glucose as you recover. If you are depressed or have high anxiety, talk to your health care provider about getting help. Think about activities that help lower your anxiety level.

Gastroparesis

Gastroparesis is a condition that sometimes occurs in those with diabetes. Gastroparesis is a slowing of the stomach’s emptying because of nerve damage. Normally, nerves around the stomach make it contract and move the contents into the intestine. With gastroparesis, this slows down. With this slowing of gastric emptying, the food will be absorbed at different rates than normal. This can also cause blood glucose levels to be hard to manage.

Symptoms of gastroparesis include getting full after eating small amounts. Some people will vomit after eating very much. Others may just feel very full and lose their appetite. Some people experience reflux, where the food comes back up the esophagus from the stomach. Some also have stomach pain.

Gastroparesis may come and go, or get better and then worse. Sometimes eating smaller meals and lower fat meals and snacks will help. High fiber foods are not recommended since they are not well digested and can stay in the stomach too long. There is medication to help control gastroparesis. Talk to your health care provider if you feel these symptoms describe you.

Fingersticks

Sometimes poor results with fingerstick blood glucose levels can result from the glucometer – the machine that tests the blood on the strip. Make sure you wash your hands well before the fingerstick. If you have no water available, alcohol or hand sanitizer will work. This is important because any food or juice that might be on your finger would also get into the finger’s blood when you use the fingerstick. If you can’t wash or use alcohol or sanitizer, use the second drop that comes out after wiping the first away with a clean tissue or cloth.

Meter Testing

You should also test your meter once in a while with a control solution to make sure it is reading correctly. Be sure to check the expiration date on the control solution. Remember, once opened, the test solution is usually only good for 90 days. Make sure the strips you are using are not expired, and that they match your meter.

Medications

Last but not least, check any over-the-counter medications you may be taking. Pseudoephedrine, a decongestant for sinuses, can raise both blood glucose and blood pressure. Cough syrup can also cause these changes. Although not a medication, changing the amount of caffeinated beverages you drink can also cause changes in your blood glucose.

Monitoring Blood Glucose

As with other diabetes self-management behaviors and skills, blood glucose monitoring should be individualized. Be sure to discuss the following important factors with your health-care provider.

How often should blood glucose levels be checked?

It will depend on what type of diabetes medication you take, your diabetes management goals, age, and overall health and other medical issues. Someone who takes insulin and particularly those who use advanced carbohydrate counting will require more frequent blood glucose testing. For example, if you determine your meal-time insulin dose and correction factor depending on how much carbohydrate you ate, it is necessary to check your blood sugar prior to meals and snacks. A correction factor is a calculation used to determine an extra dose of insulin to bring elevated blood glucose into the target range. On the other hand, someone who manages their diabetes with meal planning and physical activity may be advised to check their blood glucose less frequently.

What time of day is best to check blood glucose levels?

Again, it all depends on your particular situation. Always follow your health-care provider’s recommendations as they are made for your specific needs and goals. Even if you have been advised to only do once a day blood glucose checks consider checking at different times of the day. If you only check your fasting glucose every day with good results it can give the false assumption that your numbers are normal the rest of the day. By checking two hours after the start of a meal you can assess how your blood glucose responds to the food eaten at that meal. Bedtime glucose monitoring is necessary for those who take insulin or medication that has the potential to drop glucose levels overnight. A bed-time snack may also be appropriate to assure blood glucose remains stable over-night.

Why does my blood glucose change so much even when I eat the same amount of carbohydrate, take the same diabetes medication, and stick with the same exercise routine?

Blood glucose fluctuates through-out the day and night. Factors other than food, diabetes medication, and activity affect blood glucose levels. Physical and emotional stress, certain medications, and hormonal fluctuations can all affect blood glucose levels.

What is my target glucose range?

General recommendations from the American Diabetes Association are 80-130 mg/dl before meals and less than 180 mg/dl two hours after the start of a meal. An endocrinologist who are physicians specializing in treating diabetes often recommends lower target ranges. Age, duration of diabetes, and other medical factors will influence your target glucose goals. The most important blood glucose monitoring test is Hemoglobin A1C, often known simply as A1C. This test is a reflection of an approximate three- month average blood glucose. Your doctor uses this test to assess your diabetes control. An A1C below 7 % is the goal for reducing the risk associated with diabetes complications. A lower A1C may be appropriate, so always discuss A1C targets with your doctor.