Complicated Diabetes Management

Keeping your blood sugar levels within the range recommended by your doctor can be challenging. That's because many things make your blood sugar levels change, sometimes unexpectedly. Following are some factors that can affect your blood sugar levels.

Food

Healthy eating is a cornerstone of healthy living — with or without diabetes. But if you have diabetes, you need to know how foods affect your blood sugar levels. It's not only the type of food you eat, but also how much you eat and the combinations of food types you eat.

What to do:

Learn about carbohydrate counting and portion sizes.A key to many diabetes management plans is learning how to count carbohydrates. Carbohydrates often have the biggest impact on your blood sugar levels. For people taking mealtime insulin, it's important to know the amount of carbohydrates in your food, so you get the proper insulin dose.
Learn what portion size is appropriate for each food type. Simplify your meal planning by writing down portions for foods you eat often. Use measuring cups or a scale to ensure proper portion size and an accurate carbohydrate count.
Make every meal well balanced. As much as possible, plan for every meal to have a good mix of starches, fruits and vegetables, proteins, and fats. Pay attention to the types of carbohydrates you choose.
Some carbohydrates, such as fruits, vegetables and whole grains, are better for you than others. These foods are low in carbohydrates and have fiber that helps keep your blood sugar levels more stable. Talk to your doctor, nurse or dietitian about the best food choices and the appropriate balance of food types.
Coordinate your meals and medications. Too little food in proportion to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Talk to your diabetes health care team about how to best coordinate meal and medication schedules.
Avoid sugar-sweetened beverages. Sugar-sweetened beverages tend to be high in calories and offer little nutrition. And because they cause blood sugar to rise quickly, it's best to avoid these types of drinks if you have diabetes.
The exception is if you are experiencing a low blood sugar level. Sugar-sweetened beverages, such as soda, juice and sports drinks can be used as an effective treatment for quickly raising blood sugar that is too low.

Exercise

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently.

What to do:

Talk to your doctor about an exercise plan.Ask your doctor about what type of exercise is appropriate for you. In general, most adults should get at least 150 minutes a week of moderate aerobic activity. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week.
If you've been inactive for a long time, your doctor may want to check your overall health before advising you. He or she can recommend the right balance of aerobic and muscle-strengthening exercise.
Keep an exercise schedule. Talk to your doctor about the best time of day for you to exercise so that your workout routine is coordinated with your meal and medication schedules.
Know your numbers.Talk to your doctor about what blood sugar levels are appropriate for you before you begin exercise.
Check your blood sugar level. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that lower blood sugar. Exercise can lower your blood sugar levels even up to a day later, especially if the activity is new to you, or if you're exercising at a more intense level. Be aware of warning signs of low blood sugar, such as feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused.
If you use insulin and your blood sugar level is below 90 milligrams per deciliter (mg/dL), or 5.0 millimoles per liter (mmol/L), have a small snack before you start exercising to prevent a low blood sugar level.
Stay hydrated.Drink plenty of water or other fluids while exercising because dehydration can affect blood sugar levels.
Be prepared.Always have a small snack or glucose tablets with you during exercise in case your blood sugar level drops too low. Wear a medical identification bracelet.
Adjust your diabetes treatment plan as needed. If you take insulin, you may need to reduce your insulin dose before exercising and monitor your blood sugar closely for several hours after intense activity as sometimes delayed hypoglycemia can occur. Your doctor can advise you on appropriate changes in your medication. You may also need to adjust treatment if you've increased your exercise routine.

Medication

Insulin and other diabetes medications are designed to lower your blood sugar levels when diet and exercise alone aren't sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. Medications you take for conditions other than diabetes also can affect your blood sugar levels.

What to do:

Store insulin properly. Insulin that's improperly stored or past its expiration date may not be effective. Insulin is especially sensitive to extremes in temperature.
Report problems to your doctor.If your diabetes medications cause your blood sugar level to drop too low or if it's consistently too high, the dosage or timing may need to be adjusted.
Be cautious with new medications.If you're considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar levels.
Sometimes an alternate medication may be recommended. Always check with your doctor before taking any new over-the-counter medication, so you know how it may impact your blood sugar level.

Illness

When you're sick, your body produces stress-related hormones that help your body fight the illness, but they also can raise your blood sugar level. Changes in your appetite and normal activity also may complicate diabetes management.

What to do:

Plan ahead.Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your medication dosages, and when to call your doctor.
Continue to take your diabetes medication.However, if you're unable to eat because of nausea or vomiting, contact your doctor. In these situations, you may need to adjust your insulin dose or temporarily reduce or withhold short-acting insulin or diabetes medication because of a risk of hypoglycemia. However, do not stop your long-acting insulin. During times of illness it is important to monitor your blood sugars frequently, and your doctor may instruct you also to check your urine for the presence of ketones.
Stick to your diabetes meal plan.If you can, eating as usual will help you control your blood sugar levels. Keep a supply of foods that are easy on your stomach, such as gelatin, crackers, soups and applesauce.
Drink lots of water or other fluids that don't add calories, such as tea, to make sure you stay hydrated. If you're taking insulin, you may need to sip sugar-sweetened beverages, such as juice or a sports drink, to keep your blood sugar level from dropping too low.