Inspiration And Expert Advice: Expert Columns
Diabetes Question Marks - Part 1
Glucose Highs and Lows Unsettling for Many
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
On a regular basis, dLife members write in and ask questions about diabetes. I wish I could answer each one personally, yet, the volume of emails preclude that. This column will address some of the issues raised in a general sense, but will not substitute receiving good medical care. My concern is that dLife members have a resource for urgent-related situations, or everyday inquiries. It pains me to know so many of you are facing problems and need assistance. Resources in your area, like your physician, pharmacist, and diabetes educators can provide individual advice. (Call 800-832-6874 to locate a certified diabetes educator nearest you.)
Thank you for writing and I hope this information will be of help. Remember to check with your healthcare provider before making any changes to your diabetes treatment regime.
High Sugars in the Morning
Q: Why is it that when I check my blood sugar at 2:30 a.m. it's around 100 or so, and when I check it at 7:00 a.m., it's around a 170?
Q. Why is my blood sugar so high in the morning? I take Lantus insulin at 9 p.m.
Q.: Why are my numbers lower in the evening than when I get up in the morning? I have type 2, and am not taking medications. My doctor doesn't seem to be very informed. He has not referred me to anyone else.
Q. I’m on oral meds and a Lantus shot once a day at night. Does an acid reflux disease attack have any effect on my readings? The attacks always happen at night and the next morning my readings are higher than expected.
A: Many factors affect glucose values. One possibility in this circumstance might be related to the liver. Did you know sugar (glucose) enters our bodies 2 ways: eating food and through a release of glucose stored in the liver? When a person goes for long period without eating, the liver releases some of its stored glucose, a process called glycogenolysis. It is through this system that people can survive without any food for about a week. If you have an early dinner, and don’t eat anything until breakfast, that may cause the release of glucose through the night, and explain the rise in glucose values. One approach is to try a small snack between dinner and bedtime. The idea is to eat about a 15 gram carbohydrate snack (couple of crackers with cheese, a small apple, a piece of toast, some yogurt, etc.). See how that affects your a.m. values.
Other points to consider that may be the culprit of high glucose levels in the morning: eating a high fat dinner or huge snack before bed, having pain in the night (pain raises glucose), being preoccupied or stressed about something and not sleeping (stress raises glucose), and not having enough diabetes medicine to cover glucose trends. Also, if you suffer from acid reflux disease and are taking over-the-counter pills to help, check their sugar content. If you are taking several of those antacids in the middle of the night, it could affect your a.m. glucose reading. The important thing to consider is your A1C (the 3-month glucose average). If your A1C is less that 7%, then those high glucose readings in the morning are of less concern.
For those on insulin, a high a.m. glucose can be a rebound effect from a middle of the night low. To be sure this is not the case, set your alarm for 2-3 a.m. and check your glucose. Or better yet, ask your doctor about a continuous glucose monitoring device, which is worn for 3 days, and provides a printout of glucose values every 10 seconds, so patterns can be analyzed. (It does not give “real time” values—you can’t see the glucose levels until the printout is generated in the healthcare provider’s office.)
You have a right to see a certified diabetes educator. Ask your doctor for a referral.
Skyrocketing Glucose
Q: I am a new, type 2 diabetic female, over the age of 50. What causes your blood glucose to skyrocket ? I've been averaging 130-140, and today it was 207! How do you get it to come down? Any quick fixes? I am taking Glyburide 1.5 mg daily, and I must admit, I forget to take it sometimes. What are the "key" basic steps to keep this under control? The class that I took for this was very overwhelming—a lot of information to take in all at once! I don't remember half of it. I don't like diets or counting calories.
A. This is what I call diabetes overload, a common condition when one is first diagnosed. The keys to managing diabetes are:
Easier said than done. I recommend some one-on-one time with the diabetes educator, that way, you can figure out which one of these “keys” needs attention without being inundated with data. Glucose levels can skyrocket if you ate too much, were less active, don’t take medications regularly, or you are stressed or in pain. There really aren’t any quick fixes, per se. For those taking insulin, glucose values can be corrected with a little extra insulin (as approved by the physician), but that is not your case. The key is consistency with diabetes management to keep it under control. Hang in there. You are not alone in trying to find ways to control diabetes. I think with a little more guidance, you’ll be on track.