How is your diabetes control? When I ask many of my patients, they respond, “Good,” then, add with some hesitation, “I think!”

Elliot P. Joslin said it best when he said: “The diabetic who knows the most, lives the longest.” This is a very simple, succinct statement that still holds true today. Dr. Joslin may not have had the current lingo down (we know that we now say “person/patient with diabetes,” not “diabetic”), but he had the knowledge part right.

You may be lulled into a false sense of security by thinking that just because a few random fasting blood sugars are good, that your overall diabetes control is good as well. Not so fast! Why then is my A1C higher than expected? If you are not testing your blood sugars pre- and post- meal consumption, you may not have the total picture. Post-meal glucose spikes not only affect your A1C, but they can contribute to diabetes complications in a big way. That is why we must pay close attention to not only what we eat, but how what we eat affects blood sugar, and how we can adjust insulin, medication, or our meal plan to improve blood sugar control.
Let’s look at pre-meal blood sugars for a moment. If your pre-meal blood sugar is high (over 180 for example), what can be done to avoid a post-meal spike? This really depends on what type of medication you take and many other factors, but here are a few suggestions:

  1. If your pre-meal BS is before breakfast , this is your fasting blood sugar. Reasons for a high level here can be attributed to too much food the night before, illness, not enough basal insulin or not enough pre-dinner insulin.
  2. If your pre-meal BS is high before lunch , this can be attributed to too much to eat at breakfast, not enough insulin pre-breakfast, or a high morning (fasting) blood sugar. High fasting blood sugars can throw off readings the whole day.
  3. If your pre-dinner BS is high , consider what you ate for lunch!

Things are not really that simple, right? Don’t we know it! These are just some basic guidelines of how to understand your blood sugars better. Exercise is one big way to help keep blood sugars in check. If you exercise regularly, and mix cardio workouts with muscle building exercise, your blood sugars will get better, as you will burn your fuel (food) much more efficiently.

If you’re not using insulin, you can’t adjust oral medications as easily to bring down blood sugars. With any adjustments in medication, insulin or otherwise, you need to identify a daily “pattern” of blood sugar highs and lows over several days or weeks. This will allow for the most efficient way of adjusting medications to your needs. If your blood sugars are high due to an infection or illness, this will only cause a temporary rise in BS’s generally. Your health care team may not adjust your medications until you are well again to see if your BS’s come back down.

If you have consistent BS increases across the board and you have type 2 diabetes; your body may be making less of your own insulin or you may have developed more insulin resistance. In any case your medications will most likely be adjusted, or perhaps insulin will be added, if necessary. Remember more muscle equals less insulin resistance, so talk to your health care team about an exercise program including resistance exercise if you are physically able.

High blood sugars can be the result of new medication, so check with your pharmacist if you have consistent high blood sugars that came on suddenly. Oral steroids or decongestants can cause blood sugar spikes, just to name a few.

Your food choices may not be matching your available insulin, so go over your meal plan with your health care team. Too may carbs can be the culprit as well as too much fat. Fat has a habit of sneaking in and raising blood sugars throughout the day because it is released slowly. Just because two hours after a high-fat meal your blood sugars are good does not mean they won’t go up later. For example, if you have a high-fat lunch, this may not reflect in your BS readings until pre-dinner.

Also you need to know that sometimes, consistent high fasting BS’s can be a result of going too low during the night. This is called the “Somogyi Effect,” and you can check this by setting your alarm for sometime around 1 a.m. to 2 a.m. and checking your BS then.

You can see that controlling diabetes can get a bit complicated, but once you get to know your body, these things become almost automatic. My boys can pretty much tell if they’re getting sick or they just plain ate too much of the wrong foods. Just one piece of sausage pizza won’t trick your body. You’ll see it on your meter way before you see it on your hips!

You can see now that diabetes control can not and should not be measured by one random fasting blood sugar, or two or even three. How many times should you test? Your own health care team can only answer this question. Maybe this article has shed some light for you to answer this question for yourself. Diabetes care is an accumulation of knowledge. My hope is that I can add to that knowledge so you can be the person with diabetes who knows the most and lives the longest!