Why is diabetes so difficult to control? 

I talk with countless patients with diabetes, including my own sons who have had diabetes for many years now-and one question always resonates the strongest.  How can I be doing almost the same thing on two separate occasions, and wind up with blood sugars that are so very different almost every time?  The short answer is that diabetes control is affected by far more factors than just medication and food.   In fact, the factors that affect blood sugars are so numerous, it is impossible to list them all.  I will spend some time on some of the main causes of blood sugar variation below.  With this knowledge I hope to give you a better understanding of the dynamic and ever-changing nature of diabetes. More importantly, don’t be too hard on yourself; sometimes numbers get out of range and that’s ok.  The HbA1c looks at an average-the goal being to stay in range for the majority of the time. 

Here are just a few factors that can affect blood sugars: 

1. Exercise

We know that exercise can lower blood sugars by expending energy and making the body more efficient at burning calories/sugars.  Did you also know that certain forms of strenuous exercise can cause blood sugars to rise. This happens when muscles get strained; often from lifting weights or engaging in muscle building exercises.  This doesn’t mean you should avoid strength building exercise, strong muscles help burn sugars more efficiently in the long run.

2. Medications 

New medications can cause blood sugars to rise; many anti-anxiety medications can cause blood sugars to go up as well as oral steroids  which are often used for arthritis and asthma.  Check with your pharmacist when you are prescribed new medications to see if they can affect your blood sugars.  Certain medications can increase the risk of hypoglycemia, or low blood sugar.  A group of antibiotics have recently been given an FDA warning about the potential for hypoglycemia.  These are called quinolones; and include a popular antibiotic often used for respiratory infections called levofloxacin.

3. Illness 

Any illness, including injuries or surgeries can cause blood sugars to increase.  That is why if you are hospitalized for any reason you may be put on an insulin drip, even if you only take oral medications at home.

4. Hormone changes 

Hormones change as we enter puberty and as we age.  These fluctuations can alter blood sugars, making them higher or even lower at times.  Be aware of these changes as you may see unusual fluctuations.

 5. Stress 

Stress comes in many forms; as we all know too well, life is full of stressors.  Stress can cause increases in blood sugars.  Try to use relaxation strategies such as yoga, biofeedback, and warm baths to help you relax.  Sometimes talking to others in a support group or a healthcare professional; can be very helpful. 

6.Weather 

I know, nothing is predictable when it comes to weather-and the barometer affects blood sugars.  If your body is under stress from excessive heat or cold, blood sugar fluctuations can be common.  Insulin and other medications can be affected by temperature variations, pay attention to storage requirements.

7. Gut Health 

The bacteria in your digestive tract is important for digestive health and needs to stay balanced for optimal digestion and gut health.  The environment in your gut is also referred to as your microbiome, which is a complex eco-system.  Factors adversely affecting your gut include antibiotic use, unhealthy eating habits, and not getting adequate nutrition.  Some practitioners have touted the benefits of probiotic use which are supplements available at your local pharmacy and grocery store.  Check with your own health care team to see if probiotics may be right for you.  

You can see that many factors other than just food can affect blood sugars.  Being aware of these other factors can be helpful when trying to investigate causes of sugars that seem out of range.  Sometimes it is helpful to test more frequently to try to troubleshoot where blood sugar variations are coming from.

Stay well my friends!!

And 

Don’t forget that at TempraMed we are here to protect you and your insulin and to keep you safe.