Up, Up, and Away

Case studies of increasing weight and glucose values.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Does your ever changing diabetes picture boggle your mind? You’re not alone. Check out these two case studies about perplexing glucose values on the rise.

Q: When I was diagnosed about 5 years ago, I started Glucophage XR and went to nutrition classes. I lost 20 pounds and maintained a normal weight of 130 for a couple of years. Then my weight started to go up despite healthy eating and exercising regularly. My fasting morning blood glucose levels are now high at 150-190, regardless of the medication I take. When I talk to my doctors all they want is to add or use other meds that continue my weight increase. I am very frustrated with this. Can you suggest ideas?

A. Giving it your best effort to control diabetes only to have the numbers go the wrong direction is most aggravating. Many people give up trying to self-manage diabetes at this point because nothing seems to make a difference. Kudos to you for not throwing in the towel, but instead, reaching out for help.

Many people do not know that type 2 diabetes is progressive. Over time, the pancreas is less and less able to make enough insulin to meet the needs of the body which is why medications need to typically change or increase. Even if you eat like a saint (or a dietitian) and exercise regularly (like we all should), glucose levels can rise. You are not failing; your pancreas is simply trying to go on early retirement. Plus, high glucose levels create a toxic environment for the pancreas, further interfering with its limited capacity to make insulin.

A diabetes care team (physician, nurse, dietitian, and pharmacist to name a few) can put together the best approach to reduce those glucose values and look into the recent weight gain, as well as help you avoid problems. Diabetes doesn’t cause complications — uncontrolled diabetes does. I recommend seeing a certified diabetes educator who can help you look at the big picture. Perhaps it’s time to for a nutritional evaluation as a lot has changed in the past 5 years and a registered dietitian is the expert when it comes to weight management. Is one of the doctors you’ve mentioned an endocrinologist (a diabetes specialist) who can look into the best type and amount of medication? Has anyone discussed the possibility of taking the hormone insulin directly? It works wonders for preserving the remaining beta cells in the pancreas and can get those glucose values back down into the protection range.

How much exercise are you getting? A recent study showed we need to exercise 30 minutes a day for health, 60 minutes a day to maintain current weight, and – you might want to sit down — 90 minutes a day for weight loss. Build up to 10,000 steps a day, if you’re not there already.

Lastly, don’t give up. Advice from the diabetes experts can be the ticket to figuring out how to reverse those numbers.

Q: I went to the hospital for a 14-hour fasting blood test. Before I left home, I checked my blood sugar and it was 90. When I arrived back home about an hour and a half later, it was up to 153. Why such a change when I hadn't eaten anything? Could it just be the stress of having the blood work done?

A. The change in numbers may have had to do with the liver putting glucose into your system, which happens when we fast for several hours. That’s why some people wake up with a higher sugar than when they went to bed. The liver is only trying to help. It’s in survival mode. When we don’t eat, our bodies still need the glucose to function, so it taps into stored glucose. Stress can also cause this type of reaction within the liver as well.

If you are having trouble seeing the forest through the trees of diabetes management, get some assistance. Your healthcare provider can help make sense of diabetes patterns and trends that might not be obvious. Your health depends on it.

Read Theresa’s bio here.

Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: November 28, 2012

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
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