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[1], 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?

  1. Type 2 diabetes: https://www.diabetesselfmanagement.com/articles/diabetes-definitions/type-2-diabetes

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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