A healthful eating plan and increased physical activity have not brought my blood glucose under control. What is the next step?
How much exercise should I aim to do each week?
Performing at least 150 minutes of moderate-intensity aerobic activity a week and/or at least 90 minutes of vigorous aerobic exercise a week is recommended.
Fat should make up no more than 30% of your total energy intake, and most of that fat should be monounsaturated or polyunsaturated.
Limiting the amount of saturated fat, trans fat, and cholesterol you eat and engaging in an increased amount of physical activity can help to lower your blood cholesterol levels.
Your cardiovascular risk factors should be assessed by your physician at least once a year.
High LDL (“bad”) cholesterol, high triglycerides, high blood pressure, and uncontrolled blood glucose levels all place you at risk for heart disease. Carrying extra weight around your waist also raises your risk of heart disease, and smoking doubles your risk of developing heart disease. The ACCORD study and others have raised questions about the belief that high blood glucose is the biggest risk factor.
If your new job will mean a big change in your daily schedule or activity level, speak to your doctor before you begin to discuss how and when any changes in your diabetes self-management regimen should be made. If possible, adopt your new schedule before you actually start your new job so you can see what effect, if any, it has on your blood glucose levels.
In most cases, pump users should change the insulin in their pump's reservoir, as well as their infusion set, every 48 hours. However, in mid-July, Novo Nordisk announced FDA approval for a labeling change to insulin aspart (brand name NovoLog) that allows people to use the insulin in their pump for up to six days.
The expiration date on insulin packaging is for unopened, refrigerated vials, disposable pens, or pen cartridges. Once opened, most vials of insulin last for 28 days, even if refrigerated, but many pens and pen cartridges are good for only 7, 10, or 14 days (and should not be refrigerated).
Working with a registered dietitian can be helpful in fine-tuning your carbohydrate-counting skills. Carefully reading nutrition labels on food products and measuring portions will also help you to meet your carbohydrate goals.
Yes — during periods of stress, the body releases so-called stress hormones, which cause a rise in blood glucose level. If stress becomes chronic, high blood glucose can also become chronic.
Meals that are high in fat may contribute to prolonged elevations in blood glucose after eating.
The best way to identify high blood glucose, or hyperglycemia, is to routinely monitor your blood glucose levels on a schedule determined by you and your health-care team and to get regular HbA1c tests, also on a schedule agreed on by you and your health-care team (usually two to four times a year).
Since fiber is not digested or absorbed, you should subtract the grams of fiber from the total carbohydrate on the label if there are more than 5 grams of fiber per serving. People who are very sensitive to insulin may wish to subtract all fiber, even if there are fewer than 5 grams per serving.
For people with diabetes and celiac disease, starting a gluten-free diet requires learning the carbohydrate content of new, gluten-free foods, so they can be introduced into a meal plan or so that insulin doses can be adjusted accordingly.
In people with Type 1 diabetes, malabsorption of nutrients from undiagnosed celiac disease can lead to frequent, unexplained low or high blood glucose readings. Wouldn’t malabsorption of nutrients have the same effect in people with Type 2 diabetes?
If your physician suspects celiac disease, you should continue to eat gluten-containing foods until after the biopsy. If the biopsy confirms that you have the condition, the treatment is a lifelong, 100% gluten-free diet.
Celiac disease is an inherited disease that occurs at a higher rate in people with Type 1 diabetes. All first-degree family members — parents, siblings, and children — of people with celiac disease should be screened for the condition.
Be careful when taking extra insulin to "cover" for high blood glucose. Take into account any insulin that is still active from your previous dose, as well as any variability in the effect of the "correction" insulin based on the time of day or other factors.
If you are aiming for tight diabetes control with insulin or another medicine that creates the risk of hypoglycemia, accept that an occasional low will occur and have a plan for when it does. This is usually better for your long-term health than keeping blood glucose higher than recommended to avoid hypoglycemia.
A variety factors can influence your blood glucose levels, including food, medicines, exercise, stress, infection, and normal hormonal variation in the body. A single high blood glucose level is of little concern, but a pattern of high blood glucose needs to be addressed.
If your blood glucose levels are rising despite your best efforts to control them, speak to your physician about adding, increasing, or changing your dose of diabetes medicines.
Unless otherwise directed, don’t skip insulin or oral medicines when you’re sick, even if you’re eating less than usual. The stress of an illness may actually increase your insulin needs temporarily.
If a difficult situation can be anticipated (for example, a funeral or an exam), and you know how your body typically responds to stress, you may be able to prepare for it by changing your basal insulin or oral medicine dose, or by altering some other aspect of your diabetes regimen.
To treat low blood glucose, or hypoglycemia, eat or drink 15 grams of carbohydrate, wait 15 minutes for the carbohydrate to be absorbed, and check your blood glucose level again. If it has not increased in 15 minutes, eat or drink another 15 grams of carbohydrate and check again in 15 minutes. Using preportioned glucose tablets or gel to treat hypoglycemia instead of food or juice may help you control the amount of carbohydrate you consume.
Never use an open vial for more than a month, and always check the expiration date on your insulin before using it.
A good set of records should include blood glucose values, insulin and/or oral medicine doses, the amount of carbohydrate eaten at meals and snacks (with notes about high-fat or extra-large meals), and physical activities.
Both your premeal blood glucose level and the glycemic index of the foods you are planning to eat should be taken into consideration when deciding when to take a mealtime insulin dose.
Substituting foods with a lower glycemic index for foods with a higher glycemic index in your diet may help to reduce your after-meal blood glucose spikes.
Keep a food diary for several days, noting the foods and amounts you eat. Also write down the amount of insulin or other diabetes drugs you take and when you take them relative to your meals. Look for patterns in your records to guide you in making changes to your mealtime routines.
The most practical way to detect after-meal blood glucose spikes is to check your blood glucose level with your meter about one hour after finishing a meal or snack.
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