Diabetes Dilemmas

You don’t need me or anyone else to point out that managing your diabetes isn’t easy. From checking blood sugar to counting carbs to taking medicine, taking care of yourself with a chronic condition not only takes time, but it can often be confusing and frustrating. In the spirit of National Diabetes Month, I thought I’d highlight a few common dilemmas that people often face with their diabetes. No doubt you could add many more to the list!

Your blood sugar levels are good (or within your target range), but your latest A1C level is higher than target. As a quick review, the blood sugar goal for most people with diabetes is 70 to 130 fasting and before meals, and less than 180 one to two hours after the beginning of meals. For A1C, the goal is less than 7%. Let’s say you check your blood sugar twice a day: first thing in the morning and again before dinner. And let’s say that your results are “good,” meaning that they usually fall within your target. You get your A1C checked and it’s 8.1%. What happened? One explanation is that your blood sugar checks are only capturing your premeal glucose levels. Most people’s blood sugars rise after meals, and in this case, they could be rising quite a bit. This may be due to eating too much carbohydrate at the meal, not taking any or enough diabetes medicine, or both.


What to do. Your blood sugar checks capture a moment in time, while your A1C is an average of your blood sugars over a 2–3 month period. Start doing a few blood sugar checks about two hours after your meals. And occasionally check before you go to bed and even in the middle of the night. If these readings are consistently too high, talk with your doctor about changes you may need in your treatment plan, such as taking more medicine or counting your carbs more carefully.

Your fasting blood sugar readings are always too high (above 130) even though you eat dinner at a reasonable hour and don’t eat anything before you go to bed. It’s one thing if you’re munching on tortilla chips while watching reruns of Law & Order late at night. But when you’re carefully watching your food intake and taking your diabetes medicine as directed, it’s frustrating and puzzling to see morning blood sugars that are sky high (or at least above your goal). What gives? This is a common issue among people with Type 2 diabetes, and you have your liver to thank for this. During the wee hours of the morning, the liver pumps out glucose. Basically, because you’re not eating anything while you sleep, your body is tricked into thinking that it’s in starvation mode. In order to supply enough fuel to your cells, the liver releases glucose. Because some of your hormones (like insulin and a few others) are out of whack, there’s nothing to stop this release of glucose. As a result, your morning sugars are too high.

What to do. If you’re experiencing this issue, talk to your doctor. You will likely need to start taking diabetes medicine (if you’re not doing so already), increase the dose of your medicine, or add another medicine. Metformin is often used because it can help stem the flow of glucose from the liver. But there are newer medicines, too, that may be helpful. You might benefit from injectable drugs called GLP-1 agonists (exenatide [Byetta, Bydureon], liraglutide [Victoza], albiglutide [Tanzeum]). And, if these aren’t enough, you will likely need to take bedtime insulin. Lifestyle measures that you can try including losing weight, making sure you do some physical activity on most days, and believe it or not, eating a small bedtime snack that contains 15–20 grams of carb (such as a small piece of fruit or 6 ounces of light-style yogurt).

Your spouse gets after you for eating a leftover piece of Halloween candy. Your coworker tells you that you should be on the Paleo diet. Your friend has sworn off gluten and believes you should, too. Recognize any of these folks? They sometimes go by the name “food police.” Are they well meaning? Sometimes. Hopefully, most of the time. Many people are genuinely interested in your health and truly want what’s best for you. There may be other people who try to sabotage or undermine your efforts, and this may stem from their own worries or insecurities. No matter the situation, it can be downright annoying to have people telling you how they think you should be managing your diabetes. Unfortunately, there are a lot of people out there who strongly believe that they know what’s good for them and for everyone else, too.

What to do. First, remember that your loved ones tend to want to help you and may be acting in a way that they think is helpful. Put yourself in their shoes for a moment and try to see the situation through their eyes. Your spouse or your children may be scared that something bad will happen to you. Let them (and your friends, coworkers, neighbors, etc.) know that you appreciate your concern. Tell them what has worked well for you. For example, you might say, “Sarah, it’s great that the Paleo diet has worked so well for your sister. What I’ve found helps ME is counting my carbs, focusing on eating more whole grains, and making sure I go for a walk after dinner every night.”

You might also let them know how they can help you: “John, after our 11 AM meeting today, how about we grab a quick lunch and then go for a 30 minute walk? I need to stretch my legs and a walk will help my diabetes.” There may be times when you need to be more assertive, especially if you get the sense that someone is nagging you. For instance, if your family is constantly critiquing your blood sugar results, you could say, “I know you care about me, but always asking me about my blood sugars after meals takes the enjoyment out of eating for me. How about if I let you know when I’m worried about my blood sugars?” If you need to, practice what you’ll say and it will be easier. Remind yourself that your diabetes is your own to manage.

What are some common diabetes dilemmas that you face?

  • mike

    Another horrible post (not just this blogger but each and every one wow)

    A1c aim for healthy 4.0-5.5, 6.1 not good BTW 7.1 wow very scary!

    A1c can be elevated for reasons which have nothing to do to avg. Blood sugars … My BS avg is 88 for past 3 months u check 15 times a day … Waking up 70-85 95% of the time but my A1C was 6.1 well if your red blood cells live longer than what is cobsidered average they have more time to accumulate glycated hymoglobin and conversly your A1C might be lower than your average BS if your reb blood cell turnover is quicker than what is considered average… Checking actual blood sugar many times a day and start at 1/hr after meal and even at night if you go to the bathroom is by far more accurate.

    As for elevated morning numbers, yes liver dumping or delayed gastric emptying sometimes my belly will dump its contenst 8hrs after eating so if I want no nightime rise finish eating by 3 or 4 pm is needed.

    There are reasons I have never seen a comment on here and it is the poor I do and even poorer representation of how to take care of ones self or rather not to wow!

    If you a reader see this just loom elaware for info from people doing it right meaning great numbers as a type 1 or reversal as a type 2, not this sad song and dance.

  • Joe

    One of the dilemmas I face is people who believe that diabetes can be magically “cured” by a combination of unbalanced diet, miracle herbs, obsessive testing and wishfull thinking.

  • BK

    Always appreciate Amy’s articles. Good explanations and accurate.

  • Janice

    Mike – are you talking about a T2D – a T1D with an A1C of 4.0 – 5.5 is probably suffering from a number of low blood sugars – it is very hard to keep your numbers under 100 all the time when stress, being sick or any number of other things will raise your blood sugar (it is not just food). Wearing a CGM full time is very illuminating on how your blood sugars are doing 24/7 as opposed to finger sticks that are just a window in time.

  • Ferne

    I was told by my doctor that when one is older it is better to have an A1c in the 7’s. I really don’t care anymore with a diagnosis of a rare cancer with no cure I’m through worrying about all the no-no’s of diabetes and enjoy my remaining days. None of that I going to make any difference. I had ice cream for lunch.