10 Factors That Indirectly Affect Blood Sugar

Even those that don't know the first thing about diabetes know that food affects blood sugar.  But anyone who lives with diabetes can tell you that food is not even half the story.  There are countless other factors that influence blood sugar in one way or another.  Here is my top 10 list:

1. Stress:  This illusive phenomenon has its hands in everything, including blood sugar.  Since stress can't be avoided, it's best to keenly observe trends and patterns in blood sugar while it's happening.  Then you will be able to develop a game plan for its return.

2. Activity Level:  Generally speaking, increased activity will decrease blood sugar, and vice versa.  See number 9 for possible exceptions.

3. Change in Routine/Schedule:  When you have a regular schedule and your medication is in rhythm with that schedule, any changes or disruptions in the routine have the potential to cause havoc on the blood sugar.

4. Hydration Level:  Medication, including insulin, is better absorbed if the body is hydrated.  This is one reason that drinking water is suggested when blood sugars are running high.

5. Medicine Mechanics:  We have to give our meds the best opportunity to do their job.  For instance, if our instructions are to take once daily, then we should be taking at the same time every day.  Additionally, pump users must be vigilant for tubing or site problems such as kinks or occlusions.  All insulin users must watch out for lack of absorption due to poor injection sites and lipohypertrophy.

6. Nerves:  I'm referring here to the sensation of nervousness.  For example, I find my blood sugar spikes just before I'm about to give a presentation.

7. Calculation Errors:  These can be carb-counting mistakes, insulin correction factor mistakes, or timing issues with medications.  Mistakes will happen, we just have to take note and adjust accordingly.

8. Illness:  Blood sugars will usually run high during sick days.  Remain hydrated and contact your healthcare provider about temporarily increasing meds.  Better yet, don't get sick ;)

9. Exercise:  Depending on the type of work-out you're doing, and the time of day you are doing it, you may have unexpected results.  For instance, I have noticed that doing high intensity interval training (HIIT) early in the morning will increase my blood sugar.  Cardio typically decreases it.  Again, you will have to learn your body and come up with a plan to prevent blood sugar swings.

10. Lack of Sleep:  This could be a sub-category of stress, change in routine/schedule, and medicine mechanics all at the same time.  When our sleep cycle is off, it's not only tougher on the body, but it throws off our circadian rhythm.  For someone whose livelihood is fostered by daily doses of medication, it's tough to know how the sudden change in schedule and added stress will affect the distribution of hormones and the uptake of meds.

What other things affect your blood sugar?  Let us know so that we can all be less than seven, greater than low!

An Example of False Hypoglycemia & the Truth Behind "High Normal"

The all-too familiar words, "We need to find a way to get these blood sugars down", can be a scary sound at times.  Not scary because of the time, effort, and vigilance it will take.  Not scary because we will actually have to stick to a plan and/or a diet.  Not even scary because we've heard these words in the past.  Sometimes this statement is scary because it asks us to purposely make ourselves feel terrible.

After seemingly hundreds of attempts to drive down our HbA1c, we conclude that the high numbers are just "our normal."  Sure, the average A1c should be less than 7.0, but that's just an average.  I'm an individual diabetic.  I feel atrocious when I approach that level....quite hypoglycemic, actually.  I must have a "high normal."

Without adequate education, I must admit that this argument is fairly logical.  We constantly have to listen to our bodies, and make insightful decisions about the way we feel.  However, this "high normal", while undeniably a real phenomenon, is actually a simple "threshold reset."  In plain English, we let our blood sugars run high for long enough to train our brains to rely on those levels.  When we suddenly try to drive blood sugar levels down, the brain resists by signaling that our blood sugar is getting too low.  Hence, the terrible "hypoglycemic episode."

Okay, nice to know; but that doesn't help me lower my HbA1c without feeling like a drunk chicken.


Right.  So, we've also determined that said threshold can be restored to default, if you will.  Generally speaking, this can take up to 2-3 weeks if blood sugars are well controlled.  One method is to just push through, and bear the symptoms until your body adjusts.  If you're not in to asceticism, the other option is to "treat" the episode with 5 grams of carbohydrate (or less) to simply rid yourself of the feeling, while not raising blood sugar enough to impede your progress.

Example: Feeling hypoglycemic, BG reading is 110 mg/dL.  Consume 1 peppermint candy (5g carb).  Retest BG in 20-30 minutes => 135 mg/dL. Hypo feelings gone.

It's better to be 110 rather than 135 mg/dL, but you also have to manage the symptoms.  As long as blood sugars are indeed coming down overall, this can be a reasonable method to discuss with your healthcare team about resolving the issue at hand.  In addition, we don't want this to be something we rely on long-term.  Should you continue to feel these symptoms well above 70 mg/dL for several weeks, you should again contact your healthcare team.

I hope this takes away any discouraging feelings for those who have decided that low HbA1c's are an impossibility.  Please note that there are other possible causes of false hypoglycemia not discussed in this article, including rapid acute BG reduction, illness, and meter malfunction.  Feel free to send questions or comments about your own experiences with this phenomenon.  Thanks for reading; and let's be less than seven, greater than low! 

Related article from Joslin Diabetes Center

Oh shoot, do I really sound like Eeyore?

I'll be the first to admit, I'm the king of complaining.  The funny thing is, until just a few years ago, I didn't even know it.  You see, I have this "Mr. Fix It" approach to life.  I am quick to find the negatives of any situation, so that I can entertain myself with trying to come up with solutions for them.  This is all fine and good; however, in the meantime, I sound like Eeyore to all those around me as I mull over the problems I've discovered.

Perhaps it can be partially attributed to growing up with diabetes.  Over the last 30 years, I've trained myself to procure a constant vigilance over my blood sugar and the endless number of factors that influence it.  It's a daily (sometimes hourly) routine to pinpoint an issue, identify a probable cause, and execute a reasonable solution.  At this point in my life, it's not negative or depressing, it's just a game of survival.

However, when I place myself in the shoes of someone without diabetes, I can understand how it might be less than desirable to watch and listen to this struggle......Sort of like hanging out with Eeyore or The Boy Who Cried Wolf.  Consequently, I've tried to make a conscious effort to notice those things (diabetes-related or not) that are running smoothly.  It's an awesome thing to do, because not only does it lead me to admiration and gratitude, it spills over into my language and habits.

The result is a cool drink of water for me, and pleasant interactions for those whom I encounter.  As I write this post, I can't help but be reminded of the fact that we are integrated and imperfect persons.  More often than not, difficulty controlling diabetes is just a symptom of a greater, deeper problem in our lives.  And sometimes that problem is not so obvious.  Therefore, it's good practice to frequently reflect on the big-picture-happenings that make us who we are, and how these events are affecting our mood, sanity, spiritual / physical / mental health, stress level, behavior patterns, and diabetes control.    

So keep your chin up, stay positive, and get to know yourself a little better.  It'll help in more ways than you think.  And then, let's be less than seven, greater than low!  Thanks, and God bless.

20 Very Low Carb Snacks

Linda here! Over the years, I have been asked several times by patients, (both people with type 1 and type 2 diabetes), to provide them with a list of low carb snack ideas.  Snacks are not always necessary, but they sure can help you to stay on track if you are trying to lose weight and/or control blood sugar.  As with all things, snacking should be done in moderation.  Below is a list of some very low carb snacks (less than 5 grams of carb per serving).  Some of them will contain more fat and/or protein than others therefore increasing the calorie content.  I listed them from lowest calorie to highest calorie (give or take a few).  I hope this helps.  Thanks for reading!

 

Carbohydrate Range: 0-5 grams Carb.

Calorie Range:  about 0-200 Calories.                                                                                                                                           

1.   Sugar free Jell-O (any amount)
2.   1 dill pickle*
3.   5 Pickled Okra*
4.   1 Sugar free popsicle
5.   1 Sliced Cucumber
6.   1 Raw tomato
7.   1-2 Cups Kale Chips (see recipe below)
8.   1 cup celery/bell pepper sticks
9.   1 cup raw broccoli/cauliflower/cucumber with 2 tbsp Ranch dressing
10.   5 black/green/Kalamata olives*
11.   1 hardboiled egg (or any egg cooked any way you like)
12.   1 slice of cheese (Swiss, Provolone, Cheddar, etc)*
13.   1 string cheese stick*
14.   1 Tablespoon Almond/Cashew/Peanut/Sunflower butter
15.    1 slice of cheese, rolled up in one slice of turkey*
16.    ¼ cup of sunflower seeds (in the shell)*
17.    ¼ cup of shelled walnuts
18.    ¼ cup of almonds
19.    ¼ cup pistachios without shell
20.    ¼ cup peanuts                                                                                                                                                                                                                                                 

*These items may be high in Sodium.  Read food labels.

Kale Chips Recipe

This Recipe is nothing new.  I did not come up with the idea of Kale chips all by myself.  But, I wanted to share it because these are very easy to make and are a great substitute for regular potato chips (which are high in fat and carb).

 

What you will need:

·      1 bunch of Kale

·      1 pinch of salt

·      1 tbsp olive oil

Directions:

Dried Kale (before cooking)

·      Preheat oven to 350 degrees Farenheit.

·      Remove Kale leaves from the stem.

·      Wash and thoroughly dry Kale.  (This step is very important. Make sure Kale is completely dry.)

·      Break Kale into chip sized pieces.

·      Line a baking pan with parchment paper and place Kale on the paper.

·      Drizzle the Kale with olive oil then sprinkle with salt.

·      Bake for about 10 minutes or until edges of brown but not burnt.  

 

Cooked Kale Chips