Many variables, some of which are described here, can upset the delicate balance that is necessary for the best diabetes control. When dealing with diabetes, you will inevitably experience some if not all of the following issues.
If you eat more food than is balanced with your physical activity and, in some cases, diabetes medicines, your blood glucose level may rise above your goal range. Carbohydrate-containing foods directly affect your blood glucose level after eating, so reviewing the amount of carbohydrate in your meals and snacks may be helpful in determining the cause of hyperglycemia. Carefully reading nutrition labels on food products and measuring portions will help you to meet your carbohydrate goals. On packaged foods, the total carbohydrate per serving is listed on the Nutrition Facts panel of the label. Meals that are high in fat may contribute to prolonged elevations in blood glucose after eating. Working with a registered dietitian, preferably one with experience in diabetes management, can be helpful in fine-tuning your meal-planning and carbohydrate-counting skills.
If you experience hyperglycemia in spite of sticking to your meal plan most of the time, it may indicate that the medicines included in your diabetes regimen need adjusting. If this is the case, undereating will not help lower your blood glucose level; you should consult your physician.
Exercise usually lowers blood glucose levels because it improves your cells’ sensitivity to insulin and helps cells burn glucose for energy. But if your blood glucose level is high before you exercise, it may go higher during exercise. When you begin exercising, your liver pumps out extra glucose to fuel your muscles. If your body has too little insulin circulating in the bloodstream to allow the cells to use the extra glucose, your blood glucose level will rise. High blood glucose levels with exercise can also be a sign that you are working too hard and your body is under stress. If this is the case, you need to slow down and gradually work up to a more strenuous level of activity.
For people with Type 1 diabetes, the ADA advises avoiding exercise if fasting blood glucose levels are above 250 mg/dl and ketones are present in blood or urine; caution should be used if blood glucose levels are above 300 mg/dl and no ketones are present. People with Type 2 diabetes may wish to consult their diabetes care team for individual recommendations.
Insulin and diabetes pills are taken to lower blood glucose levels, so forgetting a dose, taking the wrong dose, or taking the right dose at the wrong time can contribute to hyperglycemia. If you develop hyperglycemia, here are some questions you may want to ask yourself regarding your medicine(s):
- Did you take the proper dose? Double-check to make sure your dose was accurate. Sometimes different doses of the same oral diabetes medicine or insulin are prescribed at different times of day. Did the correct dose coincide with the correct time?
- Could you have forgotten to take your medicine? It is only human to forget things from time to time, even parts of your daily routine. If you think you may have forgotten to take your medicine, ask yourself if you specifically remember taking it. Can you backtrack to determine if you took it? If you seem to forget to take your medicine regularly, look for patterns: Are you having difficulty remembering a certain dose? If so, you may want to brainstorm some ways to remember it, such as setting an alarm for dose time or posting a note to yourself in a place you can’t miss. Insulin pumps generally have a review screen that allows you to see whether doses have been delivered.