Managing High Blood Sugar Levels in Diabetes: Tips and Insights

High blood sugar?

Hello Dr.
Lee, I would like to ask how to handle high blood sugar levels? My mother has been a diabetic for about 15 years.
She was previously controlled with oral medications, but for the past three years, she has started using insulin injections, which have not been very effective.
She injects about 25 units of insulin at night.
Her height is 155 cm, and her weight is 82 kg, which is considered overweight.
Recently, I bought a blood glucose meter, and her readings before the evening injection are around 250-300 mg/dL, while in the morning, they are about 150-170 mg/dL.
Why are her evening levels so high? (She doesn't eat much for dinner, about half a bowl of rice and some vegetables.) Is her insulin dosage insufficient? What could be the reason? How can we stabilize her blood sugar levels? She does go for walks, but she has been less active lately due to the cold weather, which might be contributing to the high levels, right? What is the proper way to manage her condition on a daily basis? Thank you for your help.

A-Ming, 30~39 year old female. Ask Date: 2010/02/25

Dr. Li Zhiyao reply Internal Medicine

Hello Amin,
Your question can be summarized as "how to effectively manage diabetes." In addition to the patient and their family, a team consisting of physicians, dietitians, and diabetes educators should be involved in managing diabetes.
Currently, health bureaus in various counties and cities have established "Diabetes Shared Care Networks." Your mother can choose to seek care at medical institutions that are part of this network to receive appropriate care.
Below is an overview of the principles of diabetes management, which I hope will be helpful.
Diabetes management should include the following four components:
1.
Dietary control
2.
Exercise
3.
Medication
4.
Education (also addressing the control of cardiovascular disease risk factors such as hypertension, hyperlipidemia, and obesity)
The details are as follows:
1.
Principles of diet for diabetes patients:
- Balanced diet: Adequate intake of staple foods, vegetables, fruits, fats, dairy, and protein sources such as meat, fish, eggs, and legumes.
- Timely and portioned meals: Eat smaller, more frequent meals at regular intervals, including breakfast, lunch, dinner, and one to two snacks.
For those on insulin, a small snack may be consumed before bedtime based on individual circumstances.
- High fiber, low fat (reduce fried foods): Limit high-fat foods and animal fats, such as fatty meats, chicken skin, bone broth, egg yolks, and organ meats.
Use vegetable oils for cooking and prefer methods like stewing, braising, steaming, boiling, or tossing salads.
Choose high-fiber foods such as brown rice, whole grain bread, whole grain crackers, cereals, fruits, vegetables, and legumes.
- Low sugar, low salt: Avoid high-sugar foods, including candies, sodas, cakes, candied fruits, condensed milk, honey, and egg rolls.
Limit processed foods and condiments such as pickled foods, ketchup, and sweet and sour sauces.
- Limit alcohol and quit smoking.
2.
Recommendations for exercise for diabetes patients:
- Do not exercise on an empty stomach, especially after using insulin or oral hypoglycemic agents.
- Consult with a physician before deciding on exercise activities and choose those that are suitable and enjoyable.
- Gradually increase exercise intensity, and perform appropriate warm-up and cool-down exercises before and after.
- The best time to exercise is one hour after meals, aiming for 30 to 60 minutes of exercise at least three days a week for effectiveness.
- Always wear shoes and socks during exercise to prevent foot injuries, and avoid exercising in extreme heat or cold.
- Carry candy or juice during exercise to quickly address hypoglycemia, and have a diabetes identification card.
- If any discomfort occurs during exercise, stop immediately and contact a physician or diabetes educator.
Choose moderate-intensity endurance exercises such as aerobic activities: brisk walking, jogging, cycling, swimming, dancing, tai chi, qigong, or gymnastics.
Since these activities require significant energy expenditure, a five-minute warm-up and five minutes of stretching should precede each session, followed by a ten-minute cool-down at the end.
3.
Regarding medication, your mother is currently on insulin therapy.
It is advisable to discuss with her physician to adjust the dosage based on changes in hemoglobin A1c and blood glucose levels.
4.
Education: It is best to have a dietitian and diabetes educator provide individualized guidance on your mother's dietary and exercise habits to achieve optimal results.
Wishing you good health!

Reply Date: 2010/02/25

More Info

Managing high blood sugar levels in diabetes is a multifaceted approach that requires careful monitoring, lifestyle adjustments, and sometimes medication management. Given your mother's situation, let's break down the factors contributing to her elevated blood sugar levels and explore strategies for better control.

Understanding High Blood Sugar Levels
1. Insulin Administration: Your mother is currently using insulin, which is essential for controlling blood sugar levels, especially in individuals with type 2 diabetes who may not respond adequately to oral medications alone. The fact that she injects insulin only at night may not be sufficient to manage her blood sugar throughout the day. Insulin needs can vary based on several factors, including diet, activity level, and stress. If her evening blood sugar levels are consistently high (250-300 mg/dL), it may indicate that her insulin dosage is inadequate or that she requires a different insulin regimen.

2. Dietary Considerations: Although you mentioned that her dinner consists of a small portion of rice and vegetables, it's essential to consider the overall carbohydrate intake throughout the day. Carbohydrates have the most significant impact on blood sugar levels. Even small amounts of carbohydrates can lead to elevated blood sugar if not balanced with adequate insulin. It may be beneficial to consult with a registered dietitian who specializes in diabetes management to create a meal plan that aligns with her insulin regimen.

3. Physical Activity: Regular exercise plays a crucial role in managing blood sugar levels. Physical activity helps improve insulin sensitivity, allowing the body to use insulin more effectively. The colder weather may have reduced her motivation to exercise, but finding indoor activities or shorter bouts of exercise can help maintain her routine. Aim for at least 150 minutes of moderate aerobic activity per week, along with strength training exercises at least twice a week.

4. Monitoring Blood Sugar Levels: Regular monitoring of blood sugar levels is vital for understanding how different foods, activities, and medications affect her glucose levels. Keeping a log of her blood sugar readings, along with notes on food intake and physical activity, can help identify patterns and triggers for high blood sugar.

5. Medication Review: It may be worth discussing with her healthcare provider whether her current insulin regimen is appropriate. There are various types of insulin (e.g., long-acting, short-acting) that can be used in combination to provide better control throughout the day. Adjustments to her insulin dosage or the addition of other medications may be necessary.

Practical Tips for Managing High Blood Sugar
- Consistent Meal Timing: Encourage regular meal times to help stabilize blood sugar levels. Skipping meals or eating at irregular times can lead to fluctuations in blood sugar.

- Balanced Meals: Focus on balanced meals that include a mix of carbohydrates, proteins, and healthy fats. This combination can help slow the absorption of sugar into the bloodstream.

- Hydration: Ensure she stays well-hydrated, as dehydration can affect blood sugar levels. Water is the best choice.

- Stress Management: Stress can significantly impact blood sugar levels. Encourage relaxation techniques such as deep breathing, meditation, or gentle yoga.

- Regular Follow-ups: Regular check-ups with her healthcare provider are essential for ongoing management of her diabetes. They can help adjust her treatment plan as needed.

Conclusion
Managing diabetes effectively requires a comprehensive approach that includes medication, diet, exercise, and regular monitoring. Given your mother's history and current situation, it may be beneficial to reassess her insulin regimen and dietary habits with her healthcare team. By making these adjustments and maintaining an active lifestyle, she can work towards achieving better blood sugar control. Always consult with her healthcare provider before making any changes to her treatment plan.

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