How to Get Off the Roller Coaster of High & Low Glucose Readings
Are you feeling hopeless because you are on a roller coaster ride that you don’t want to be on between glucose going too high and too low?
Do you check glucose from blood glucose monitoring or continuous glucose monitoring (ex; Freestyle Libre)? Do you obtain glucose only to provide information for your doctor or do you do something with your glucose readings?
So many of my clients are confused on what the glucose (sugar) numbers mean. That is why some PWD (People with Diabetes) don’t check their glucose. In this blog I am going to recommend you check your glucose and help you figure out what the glucose readings mean. Checking glucose is the single most effective way to understand you your life affects glucose.
I was working with a client who has diabetes. She was concerned because HbA1c was high. “I have no idea why my A1c is so high, when I check my sugar in the morning it is always less than 130. Sometimes it will be about 150 but that is rare.” She was checking her blood glucose daily in the morning before she ate breakfast. What do you see as the reason her HbA1c was high?
To problem solve why HbA1c was high, I encouraged her to check glucose more often and record the numbers or consider getting a meter for CGM (Continuous Glucose Monitoring)
Self-monitoring glucose allows your health care provider, and YOU look at how your current diabetes treatment plan is working. To help you understand what the glucose numbers mean, this blog will focus on factors that influence glucose and make you aware of the skill of pattern management.
Blood glucose will vary. Aim for an ideal glucose range for you.
Standard guidelines from The American Diabetes Association suggests the following targets for most nonpregnant adults with diabetes:
· Before a meal (fasting or pre-prandial plasma glucose): 80–130 mg/dL
· 1-2 hours after beginning of the meal (postprandial plasma glucose): Less than 180 mg/dL
Checking glucose empowers and guides daily decisions. Self-monitoring your glucose lets you see how well your plan is working. Diabetes changes over time so changes may be necessary.
Many people need to adjust their treatment plan to reach their glucose goals.
Pattern management with diabetes is observing 2 or more glucose readings at a particular time of day over several days. Using patterns helps to make decisions.
You will in a sense be like a detective. Look at the high and low glucose readings. Use glucose results to better understand your diabetes and make changes needed.
The idea with pattern management is to look for “patterns” or “trends” of times when your blood sugar is too high or too low. Once you see a pattern, you will be able to problem solve the reason. Write down the reasons.
Below is an example of patterns from a person who tests blood glucose 4x/day and records in a BG log.
Breakfast Lunch Dinner Bed
2/7/22 150 250 67 325
2/8 173 201 111 298
2/9 125 195 98 280
2/10 130 199 107 182
2/11 116 222 62 300
From the example above, there are 3 patterns to problem solve. Glucose is too high pre-lunch, too low pre- dinner and too high at bedtime.
Interpretation of possible causes:
Pre-lunch: (Glucose too high) -too many carbohydrates for breakfast, if on insulin possibly too little insulin prescribed or insufficient dosing of insulin to cover breakfast, forgot diabetes medication, too much snacking after breakfast, pain or stress in the morning.
Pre-dinner: (Glucose too low)-low carbohydrate lunch, too long between meal or snack, exercise/activity, if on insulin-too much insulin prescribed or too much dosing of insulin to cover lunch.
Bedtime: (Glucose too high)-overtreated low BG pre-dinner, too many carbohydrates for dinner or snack, stress, or pain, forgot DM medication at dinner or if on insulin possibly too little insulin prescribed or insufficient dosing of insulin to cover dinner.
Possible solutions:
Pre-lunch: (Glucose too high)-Meet with RD CDCES to determine appropriate amount and types of carbohydrates to eat, incorporate exercise or activity during the morning, remember DM medication or insulin by using a mediset for DM pills or a clock with a timer. Take insulin before meal.
Reduce stress and or pain by stress management techniques such as exercise, meditation, reading, deep breathing etc.
Pre-dinner: (Glucose too low)- over 5 hours without any food puts PWD on DM medication at risk for a low, eat proper amount of carbohydrates for a meal (some PWD will eat a salad with meat only. Meat has no carbohydrates and typical salad ingredients have few carbohydrates-in this case add about ½-1 cup of legumes to add nutrients, protein, and carbohydrate), too much activity/exercise not balancing with snack during day, meet with a RN/RD CDCES to make sure correctly dosing insulin.
Bedtime: (Glucose too high)- Meet with RD CDCES to determine appropriate amount and types of carbohydrates to eat, incorporate walking after dinner meal, remember DM medication or insulin by using a mediset for DM pills or a clock with a timer. Take insulin before meal. Reduce stress and or pain by stress management techniques such as exercise, meditation, reading, deep breathing etc.
****Note: It is helpful to add comments in the comment section of the logbook to help figure out reasons BG is too high and/or too low.
If able to obtain a CGM (Continuous Glucose Monitor), the process of pattern management is easier due to many more glucose readings.
Understanding patterns can also help you learn how to correct high and low blood sugar more effectively.
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I wish you well on your Diabetes journey. Please contact me if in need of assistance.