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Diabetes and your daily routine: How lifestyle factors affect your blood sugar
Diabetes and your daily routine: How lifestyle factors affect your blood sugar -- Posted by Gumbo on 11-05-04 17:51
Diabetes and your daily routine: How lifestyle factors affect your blood
sugar
By Mayo Clinic staff
When you have diabetes, keeping your blood sugar stable and under
control is vital. Uncontrolled blood sugar (glucose) can cause a variety of
short-term and long-term health complications, including seizures, coma,
heart disease, kidney disease and blindness.
But changes in your routine and taking part in seemingly ordinary
activities can cause unexpected fluctuations in your blood sugar, and it can
get dangerously high or low. If you know what can trigger such swings in
your blood sugar, you can learn how to cope so that you remain as near as
possible to your target blood sugar.
No matter what type of diabetes you have, keeping a record of each
blood sugar measurement you take can help you spot patterns and anticipate
potential problems. Self-monitoring can help you learn how your blood sugar
fluctuates throughout the day and how certain activities affect it,
sometimes from hour to hour. You may be able to plan ahead for changes that
can affect your blood sugar and adjust your diabetes treatment accordingly.
Here's a look at the factors that can cause fluctuations in your blood
sugar and what you can do about them.
Food
Food is a major culprit in altering your blood sugar level. Your blood
sugar is at its highest an hour or two after you eat, and then it starts to
fall. What you eat, how much you eat, and when you eat all affect blood
sugar.
Some issues to consider:
a.. Consistency. Strive for consistency from day to day in the time
and amount of food you eat. By controlling these factors, you can better
control when your blood sugar rises and even how high it rises.
b.. Type of food. Food is made up of carbohydrates, protein and fat.
Although all three can increase blood sugar, carbohydrates have the biggest
impact.
Coordinating your meals and your medications can be a fine balance,
especially if you take insulin. Too little food in comparison to your
medication may result in very low blood sugar and a hypoglycemic reaction.
Too much food and your blood sugar may be too high.
Exercise
Exercise and physical activity typically lower blood sugar levels, and that
effect can last for several hours after you're done. That's because exercise
promotes the transfer of sugar from your bloodstream to your cells, where
the sugar is used for energy.
However, exercise can lower your blood sugar too much. And in some people,
it has the opposite effect, raising blood sugar excessively. People who have
type 2 diabetes that's under control through a diet and exercise plan
usually don't encounter exercise-induced low blood sugar.
To prevent extreme fluctuations:
a.. Test first. Check your glucose both 30 minutes before you begin any
exercise and then again immediately before beginning. That will help you
determine if your blood sugar level is stable, rising or falling. For most
people, it's safe to start exercising if your blood sugar range is 100 to
250 milligrams per deciliter (mg/dL).
b.. Wait it out. If your blood sugar is too high or too low, don't
exercise, no matter what type of diabetes you have. If it's 300 mg/dL or
higher, don't exercise, or it could lead to an even more dangerous spike. If
it's under 100 mg/dL, eat a carbohydrate-containing snack before exercising.
You also may have to wait one to three hours after injecting insulin before
exercising because of the risk of developing low blood sugar.
c.. Continue monitoring. Test your blood sugar level during exercise -
yes, that means temporarily stopping what you're doing. And test when you're
done exercising, too. This way, you can keep close tabs on your blood sugar
and eat a snack or take medication, if necessary.
d.. Stay regular. It's also wise to perform your exercise on a regular
schedule rather than on a haphazard one. This way, you can better anticipate
your day's need for insulin.
Talk to your doctor about your exercise schedule and what sorts of
adjustments you may need to make in your meal plan or medication regimen.
Remember, even lighter activities, such as housework, gardening or being on
your feet for extended periods, can affect your blood sugar.
Illness
A cold, influenza or other illness can increase your blood sugar. When
you're sick, the physical stress causes your body to produce hormones that
can raise blood sugar by preventing insulin from working effectively. A
bacterial infection, trauma or a major illness, such as a heart attack, can
also raise your blood sugar.
That additional sugar usually helps promote healing. But when you have
diabetes, fluctuations like this can lead to both short-term and long-term
health complications. Excessively high blood sugar can lead to ketoacidosis,
especially in people with type 1 diabetes (formerly called juvenile or
insulin-dependent diabetes). Those with type 2 (formerly called adult-onset
or noninsulin-dependent diabetes) may develop a similar condition called
hyperosmolar hyperglycemic nonketotic coma. Both conditions can cause
confusion, labored breathing, coma and even death.
What to do:
a.. Have a plan. Prepare for sick days in advance by putting together a
sick-day plan. Know when to call your doctor or diabetes health care team,
have phone numbers readily available, know how often to measure blood sugar
and urine ketones, and what medicines to take. And stock up on foods that
are easier on your stomach, such as crackers, soups, applesauce, pudding,
yogurt and frozen juice bars.
b.. Maintain your medication routine. Even during times of illness, it's
important to continue taking your diabetes medications on schedule,
including insulin. If you just feel too sick, consult your doctor.
c.. Monitor your glucose. Test your blood sugar frequently when you're
sick so that you can adjust your insulin doses or other medications, if
needed. If your blood sugar is often above 300 mg/dL or you're unable to
keep fluids down because of vomiting, call your doctor's office. Fine-tuning
your medication needs during illness takes patience and diligence to achieve
the right balance.
d.. Stick to your eating plan. If you have only a minor illness, you may
be able to stick to your regular diabetes eating plan, and that will help
ensure blood sugar stability. You can also try eating dry toast, cereal or
soup, or sipping fruit juice or sweetened beverages to get enough
carbohydrates and avoid becoming dehydrated.
e.. Get vaccinated. Like many others with chronic illnesses, people with
diabetes should get vaccinated against pneumococcal pneumonia and the flu.
High blood sugar can weaken your immune system, making you not only more
likely to get a cold or the flu, but also more vulnerable to serious
effects.
Alcohol
Alcohol disrupts the liver's normal production of sugar. While your liver is
busy metabolizing the alcohol you've consumed, it doesn't release its stored
sugar when your blood sugar level starts to drop. Your blood sugar can then
drop too low. If you take insulin or oral diabetes medications, even as
little as 2 ounces of alcohol - the equivalent of two drinks - can cause low
blood sugar. Sometimes, though not often, alcohol can cause the opposite
reaction, driving up your blood sugar because of the added calorie
consumption.
That doesn't necessarily mean you have to abstain altogether. Instead,
follow a few guidelines:
a.. Drink only moderately. If your diabetes is well controlled, you might
be able to have a moderate amount of alcohol. A moderate amount is generally
defined as no more than two drinks a day for men and one for women. One
drink equals one 12-ounce beer, one 5-ounce glass of wine, or one 1.5-ounce
shot of spirits. And remember to include this in your calorie count.
b.. Fill up first. Don't drink alcohol on an empty stomach. Food helps
moderate the effects of alcohol.
c.. Test your blood sugar. Check your blood sugar before drinking alcohol.
If it's already low, don't have that drink, because the alcohol can push
blood sugar even lower. Monitor your blood sugar before and after drinking
to see how your body responds to alcohol.
d.. Don't drink and work out. Both alcohol and exercise can lower blood
sugar. Although it may be tempting to down a couple of beers after a hard
game of baseball with the guys, you risk a more severe drop in blood sugar,
especially if you take insulin or oral diabetes medications. And remember,
injections of the fast-acting hormone glucagon aren't useful in treating
severe low blood sugar caused by alcohol. Instead, you'll need a
carbohydrate, such as oral glucose tablets or gels. If you pass out, you'll
need a glucose injection into your bloodstream.
e.. Watch what you drink. If you do drink, select drinks that are lower in
sugar. If you have mixed drinks, use mixers that are sugar-free, such as
diet soda, tonic water, club soda or seltzer. And choose alcohol with fewer
carbohydrates, such as light beer.
If you have diabetes-related complications, such as nerve damage or
retinopathy, don't drink at all. Alcohol can worsen the damage. If you're
not sure, ask your doctor if it's safe for you to drink any alcohol.
Menstruation
Your ovaries produce the hormones estrogen and progesterone, which regulate
your menstrual, or reproductive, cycle. As the hormone levels fluctuate
during the cycle, so can your blood sugar. Most women who have
menstruation-related changes in blood sugar notice differences in the seven
to 14 days before bleeding begins. Blood sugar generally stabilizes a day or
two after the period starts. Menopause can also affect your blood sugar
levels.
You can avoid problems by:
a.. Keeping a log. Keep track of all your blood sugar readings and look
for patterns related to menstruation that can help you predict fluctuations.
b.. Consulting your doctor. Your doctor may recommend changes in your
medication dose or schedule, or your eating and exercise regimens, to make
up for swings in your blood sugar.
Medications
Insulin and oral diabetes medications can, of course, lower your blood
sugar. When you take your medications and the dose determine how much your
blood sugar drops. But medications for other conditions can also affect
blood sugar, sometimes only minimally but sometimes significantly. Large
doses of aspirin, for instance, can lower blood sugar, as can certain
antibiotics in people with type 2 diabetes who take oral medications.
What to do:
a.. Review your dosing. If your diabetes medications cause your blood
sugar to drop too low, talk to your doctor about adjusting your treatment.
b.. Get informed about new medications. When you get a prescription to
treat another condition or if you want to take an over-the-counter
medication, be sure to tell the doctor or pharmacist you have diabetes and
ask if the medication can affect blood sugar. If the drug may make blood
sugar control more difficult, consult your diabetes doctor.
Stress
Stress can affect your blood sugar in two ways.
For one, when you're under heavy stress, it's easy to abandon your usual
routine. You might cut back your exercise, eat fewer healthy foods and test
your blood sugar less often. In that sense, stress indirectly causes your
blood sugar to rise.
Stress can also have a direct effect on your blood sugar level. As with the
stress of a physical illness, prolonged or excessive emotional stress can
cause your body to produce hormones that prevent insulin from working
properly. That, in turn, increases your blood sugar levels. This is more
common in people with type 2 diabetes.
To prevent stress from getting the best of your blood sugar:
a.. Write it down. To find out how you react to stress, log your stress
level on a scale of one to 10 each time you log your blood sugar level. Look
for a pattern after a couple of weeks.
b.. Take action. If high stress is causing high blood sugar, get your
stress under control by eating a healthy diet, taking part in regular
physical activity, getting adequate sleep and learning relaxation
techniques.
Living better
Remember to also look for other potential culprits in blood sugar
instability. Check the expiration date on your insulin, for instance. If
it's spoiled - or was improperly stored - it may not be effective. Check
with your pharmacist if you're uncertain.
And make sure you're following proper blood sugar monitoring techniques. If
you're not sure, your diabetes health care team can offer a refresher course
to review such things as the amount of your blood sample, storage and
handling of test strips, and meter calibration.
If you're having trouble keeping your blood sugar in your target range, ask
your diabetes health care team for help. Be sure to share your diary with
them, too. Awareness of the various factors that can affect blood sugar can
help you prevent complications and live a longer and healthier life.
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