Diabetes Self-Management Articles

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How Well Do You Know Your Diabetes Management Plan?

by Allison Blass

Exercise
Do you know how exercise affects your blood glucose level?
Exercise most commonly lowers blood glucose level. If you’ve been feeling unmotivated to exercise for whatever reason, checking your blood glucose level after a walk or bike ride may be just the positive reinforcement you need. Once you see the positive effects physical activity has on blood glucose, you may look forward to an after-dinner walk.

That being said, however, the major risk associated with exercise is hypoglycemia, so it’s important to make sure your exercise routine isn’t lowering your blood glucose level too much. The degree to which exercise lowers (or raises) blood glucose level may depend on the person, the type of exercise, the time of day, the person’s blood glucose level when starting to exercise, and other factors, as well. By checking your blood glucose level before, during, and after exercise, you will see what is happening in your body. You may find that your blood glucose level drops rapidly, drops slowly, stays in range during exercise but drops several hours later, rises during exercise then drops later, or rises and stays high. The pattern may be different for different activities or different intensities of exercise.

To develop a plan for keeping your blood glucose level from dropping too much or going too high with exercise, share your monitoring results with your doctor or diabetes educator. You may need to change the amount or timing of your insulin doses or other medicines, add snacks to your workout plan, or change the timing or content of your meals.

Even if you have an exercise plan that usually prevents too-high or too-low blood glucose, be sure to carry water and some sort of treatment for hypoglycemia with you when you exercise or are physically active just in case.

Food
Do you know how much carbohydrate you consume at each meal?
You’ve most likely heard that carbohydrate is the component of food that has the most immediate effect on blood glucose level. You may also have been advised by your doctor or dietitian to limit the amount of carbohydrate you consume at each meal or snack to a particular number of grams or number of “carbohydrate choices,” with each choice containing 15 grams of carbohydrate. Or maybe you’ve learned how to adjust your premeal insulin doses to the amount of carbohydrate in the meal or snack you’re about to eat. Both of these approaches can limit the amount your blood glucose rises after meals and contribute to overall blood glucose control.

But do you really know how much carbohydrate you eat? If you see your blood glucose levels rising higher than expected after meals, it may be worth reviewing the basics of carbohydrate counting.

The first question to ask is whether or not a food contains carbohydrate. If it’s made from grains, beans, fruits, vegetables, or milk or contains caloric sweeteners, it does. But it’s worth having a look at the Nutrition Facts panel of any packaged food to see what’s listed under Total Carbohydrate. The amount of carbohydrate in certain condiments, prepared dishes (including meat-based dishes), nuts, and sugar-free products may surprise you — and be enough to have an effect on your blood glucose level.

The second question to ask is how much carbohydrate is in the portion of food you plan to eat. Again, check the Nutrition Facts panel. While you might think that a slice of bread from one loaf has about the same amount of carbohydrate as a slice from another, in fact, the amount can vary by as much as 20 grams, depending on the ingredients used to make the bread and the size of the slices. The carbohydrate difference between a small apple and a large apple can also be substantial. (You may need to weigh apples and other fresh produce to determine the amount of carbohydrate they contain.) Even nonstarchy vegetables, which many people think are carbohydrate-free, can have enough carbohydrate to make a difference if you eat enough of them. (See “How Vegetables Stack Up” for some carbohydrate counts.)

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