High Blood Sugar in Diabetes: Causes and Dietary Solutions

Diabetes Care and Nutrition

Hello Dr.
Shi: My father is 62 years old and has a history of diabetes for ten years.
Recently, for more than three months, his postprandial blood sugar levels have been high, reaching 280 and 300.
It is puzzling because he does not eat snacks, has normal meals (one bowl of brown rice, vegetables, fish, and a small amount of meat per meal), exercises in the morning and afternoon, takes his medication on time, and maintains a normal lifestyle.
Why are his blood sugar levels so high? I am really worried that this could lead to complications.
He used to be able to control his blood sugar with medication, but now it seems ineffective.
Is there a possibility of drug resistance? How should his diet be adjusted, or what could be the underlying issue? Thank you, doctor.

Ms. Lin, 30~39 year old female. Ask Date: 2005/12/22

Dr. Shi Guangzhong reply Internal Medicine

The target for good blood sugar control should be maintained at 80-120 mg/dL before meals and less than 160 mg/dL two hours after meals.
Your father's blood sugar levels of 280 and 300 mg/dL are too high.
If he is already managing his diet and exercising but his blood sugar remains elevated, it is advisable for him to adjust his medication.
Research has shown that diabetes patients often need medication adjustments after 2 to 5 years, as pancreatic function declines with the duration of the disease.
Since your father has had diabetes for 10 years, his pancreatic function is gradually deteriorating, which is why his blood sugar levels are slowly rising.
Therefore, it is recommended that you discuss medication adjustments with his doctor during the next outpatient visit to help control his blood sugar levels.

Reply Date: 2005/12/22

More Info

High blood sugar levels, particularly in the context of diabetes, can be a complex issue influenced by various factors, including diet, medication, physical activity, and physiological changes. In your father's case, despite adhering to a seemingly healthy lifestyle, his post-meal blood sugar levels remain alarmingly high. Let's delve into potential causes and dietary solutions.

Causes of High Blood Sugar
1. Insulin Resistance: Over time, the body's cells can become resistant to insulin, the hormone responsible for regulating blood sugar levels. This means that even with adequate insulin production, glucose cannot effectively enter the cells, leading to elevated blood sugar levels.

2. Medication Efficacy: Diabetes medications can lose their effectiveness over time, a phenomenon sometimes referred to as "secondary failure." This could be due to the progression of the disease, where the pancreas produces less insulin or the body becomes more resistant to the effects of insulin.

3. Dietary Composition: While your father is consuming whole grains and vegetables, it's essential to consider the overall carbohydrate intake and the glycemic index (GI) of foods. Even healthy foods can cause spikes in blood sugar if consumed in large quantities or if they have a high GI.

4. Physical Activity: Although your father exercises regularly, the intensity and duration of the exercise matter. If the exercise is not sufficient to lower blood sugar levels, or if he is experiencing periods of inactivity, this could contribute to elevated levels.

5. Stress and Hormonal Changes: Stress can lead to the release of hormones like cortisol, which can increase blood sugar levels. Additionally, age-related hormonal changes can affect glucose metabolism.

6. Underlying Health Issues: Conditions such as infections, inflammation, or other metabolic disorders can also lead to increased blood sugar levels.

Dietary Solutions
1. Carbohydrate Monitoring: It's crucial to monitor the total carbohydrate intake at each meal. While brown rice is a healthier option compared to white rice, it still contains carbohydrates that can impact blood sugar levels. Consider using carbohydrate counting or the plate method to ensure balanced meals.

2. Low Glycemic Index Foods: Incorporate more low-GI foods into his diet. Foods like legumes, non-starchy vegetables, and whole grains can help maintain stable blood sugar levels.

3. Meal Timing and Frequency: Eating smaller, more frequent meals can help prevent spikes in blood sugar. This approach can also help manage hunger and prevent overeating.

4. Protein and Healthy Fats: Including adequate protein and healthy fats in meals can slow down the absorption of carbohydrates, leading to more stable blood sugar levels. Foods like fish, nuts, seeds, and avocados are excellent choices.

5. Hydration: Encourage your father to stay well-hydrated, as dehydration can affect blood sugar levels. Water is the best option, and he should limit sugary drinks.

6. Consultation with a Dietitian: A registered dietitian can provide personalized dietary advice tailored to your father's specific needs and preferences. They can help create a meal plan that balances carbohydrates, proteins, and fats while considering his medication regimen.

Medication Review
It may be beneficial for your father to have a thorough review of his current medications with his healthcare provider. Adjustments to his medication regimen may be necessary to achieve better blood sugar control. This could include changing dosages, switching medications, or adding new ones.

Conclusion
In summary, while your father is following a healthy lifestyle, various factors could contribute to his high blood sugar levels. A comprehensive approach that includes monitoring carbohydrate intake, focusing on low-GI foods, and possibly adjusting medications is essential. Regular follow-ups with healthcare providers are crucial to prevent complications associated with uncontrolled diabetes. Encourage your father to maintain open communication with his healthcare team to address any concerns and make necessary adjustments to his management plan.

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