Diabetes: Monitoring Your Sugar Levels

Last Editorial Review: 10/13/2004

WebMD Live Events Transcript

When living with diabetes, so much of your long-term success depends on what you do today to manage your levels. What's the best way to do this? And what are the proper levels? We got some guidance from WebMD's in-house expert, Brunilda Nazario, MD, when she offered tracking tips and took our questions on on Oct. 5, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this University course was provided by Medical Mutual.

Welcome to WebMD University: "Diabetes: Get the Advantage." Your instructor today is Brunilda Nazario, MD, our own in-house diabetes expert. She joins us for a look at managing your levels, a sometimes confusing, but always important task.

I'm type 2 and confused as to the cause and effect of diet and Bg levels. If the level is high first thing in the morning after not eating 10-12 hours, how does lowering carb intake at other times affect that reading?

The answer is not simple. The cause of type 2 diabetes is multifaceted; to blame its development on diet is wrong.

We still can't pinpoint type 2 diabetes to simply diet or simply genetics or simply weight. It's much more complicated. These things do play a role but do not play a single role in type 2 diabetes in any one person.

Having said that, the management of type 2 diabetes requires targeting these areas, which includes, under one umbrella, lifestyle modifications:

Diet does not include restriction of carbs but a restriction of calories . Go to well-respected sites like the American Diabetes Association, the American Dietetic Association, and WebMD and look at the various diabetic diets or diets in general, because there is no specific diet that is for diabetics, they're all classified as well-balanced diets. What they do specify is a restriction of calories so that an individual can lose weight.

One of the major risk factors for the development of type 2 diabetes is a person's weight, more so than a person's family history. So an individual can have many family members with type 2 diabetes but that doesn't guarantee that person will develop type 2 diabetes. But if that individual carries excess weight, you will push that pivotal point and they may well develop type 2 diabetes.

Exercise is another key target area in the management of type 2 diabetes. Not so much in helping an individual lose weight, or even in improving their cardiovascular fitness (a diabetic individual does not die of diabetes, they die of heart disease), but in that exercise improves insulin function. So exercise improves blood sugars in people with diabetes. It basically turns back the metabolic abnormalities that occur.

Having said that, blood sugars are elevated in individuals with type 2 diabetes because of a second malfunction that occurs.

We all normally release small amounts of sugar that's stored in our liver at night. The key phrase was small amounts of sugar. The reason that this occurs is we don't eat at night. This mechanism protects us from becoming hypoglycemic (low blood sugars) while we sleep. Individuals with type 2 diabetes have an exaggeration of this response. They flood their system at night with high blood sugars.

"We still can't pinpoint type 2 diabetes to simply diet or simply genetics or simply weight. It's much more complicated."

Do other illnesses or physical problems cause higher readings?

There are lots of reasons for high sugars to occur. Stress causes the release of many hormones in the body. Many of those hormones are commonly called the fight-or-flight response. These hormones prepare the body for several different types of attack:

  • Illness
  • Injury
  • Surgery
  • Even starvation

Sugar is an important source of energy for the body. It's the primary source of energy. When the body is under stress your body still functions and still requires a source of energy. These hormones kick in to continuously provide a source of energy and prevent the body from dropping its blood sugar. This can occur in any person.

I have seen very well-controlled diabetics whose sugar suddenly is out of control, even though they do everything right: They exercise, eat right, check their sugars -- and yet suddenly their sugars are spiking or erratic. Well then it's time for detective work. I'll:

  • Check urine
  • Check for infections on the skin
  • Swab their throats
  • Listen to their lungs
  • Ask for subtle symptoms that might signal the start of an infection somewhere

It's a typical scenario we'll see in clinical practice.

How often should I be testing?

That's a good question, but I can't tell you how often you should check. Sugars continuously fluctuate throughout the day. Whatever is recommended by your doctor is what you should do. The more frequently one checks, the more information is gained. In general, three to four times a day is usually suggested.

It's my feeling that anyone who's checking his sugar once a day or even twice a day is fooling himself if he thinks he is looking at any true or valuable information.

My husband is newly diagnosed; his count showed as 284 at 90 minutes after lunch, what is the ideal count?

That number after he eats is high but at this point, he shouldn't be overly anxious about it; he knows what it is. Two hours after eating he needs to get that sugar below 140. Tight control, meaning getting sugars as close to normal as possible, is what his goal should be, and it's what his doctor's goal should be. Unfortunately, many physicians have a blase attitude toward patients and it has led to an explosion of complications, including heart disease, kidney complications, and nerve complications -- unfortunate, because these conditions are preventable .

So your husband's sugar of 284 is something that, with routine exercise and a small change in his diet, he should easily be able to return to normal. The key word is easily. Meaning, if your husband simply eliminated 500 calories from his diet a day, just eliminate a small 500 calories every day, he will lose weight.

He also needs to incorporate a little bit of exercise into his life -- meaning he needs your help. Help him find the time to get in half an hour three or four times a week. Go out walking at a good pace; do that for maybe three months, then start cranking it up until his belt size begins coming down.

This is all under the assumption he's got the typical American physique. That typical American physique means he's got kind of a round belly, and that belly puts him at risk of heart disease and diabetes. He's got diabetes already. The thing that's waiting for him is the heart disease.

Your husband needs to get more active, get his diet tweaked, and he needs to get on the message boards here at WebMD so he can feel like he's getting a handle on this complicated disease. He cannot do this alone. It will seem difficult and he will want to give up, but there are people out there to help.

"Anyone who's checking his sugar once a day or even twice a day is fooling himself if he thinks he is looking at any true or valuable information."

Would taking Metamucil after dinner slow down the liver's release of sugar by causing it to be absorbed more slowly?

The role of Metamucil is not to help control sugars, although there have been many studies looking at the role of fiber in helping smooth out the spike that one gets in sugars after a meal. Fiber certainly can help control sugars. Unfortunately, the load of fiber one would need to obtain this is huge. So Metamucil would not accomplish this, basically.

Fiber helps in that it has been shown to lower some of the secondary effects of diabetes. Diabetes has been associated with heart disease (meaning bad cholesterol), and taking fiber tends to bind some of the fat in one's diet, so in that sense it can lower your cholesterol and decrease heart disease.

But it will not, unless taken in huge quantities. It will not lower the sugars associated with a meal. The huge amount...there's just no way.

If, as you said, a diabetic diet restricts calories, not carbs, why is my doctor always making an issue about me checking my carbs?

Go to the ADA web site, our web site, or the Joslin web site (http://www.joslin.harvard.edu/). Go to any of the well-respected diet web sites and look at the diets. There are no specific diets that say this is a diabetic diet.

The "diabetic" diet does not restrict carbohydrates. For those individuals whose doctors have restricted carbs in their diets, these are most likely diabetics that are out of control.

Carbohydrates are extremely inexpensive foods: pasta, cheap; rice, cheap; breads, cheap. If your doctor has restricted carbohydrates it must be because your diabetes is out of control and they have done this in an attempt to lower your blood sugars.

A well-balanced diet is and has always been, and until science knocks it down, will always be the diet that is recommended for people with diabetes. For the person who has diabetes and is overweight a calorie-restricted well-balanced diet is what is recommended. This is where I stand and this is where the ADA stands.

Does chromium picolinate helps to control blood sugar?

Chromium picolinate is one of the herbal supplements that has been often studied. It has been shown time and time again to sensitize the body to insulin, meaning, it can help improve blood sugars.

I have type 2. My fasting blood glucose is always between 120 and 155. Does this mean my medication should be changed to try and get it down to 90?

These fastings of 120 to 155 that you're quoting are too high, if these are finger sticks. If I was to do plasma blood tests on you in the lab, they're going to be even higher. The finger sticks are after eight to 10 hours of not having eaten. Imagine what the sugars do during the day. Too many of us are blase on the issue of what our blood sugars should be. You have type 2 diabetes; your sugars are too high.

You need to get those sugars down. Don't concentrate on the fact that the fastings are high; concentrate on the fact your sugars in general are high. We need to concentrate on making you a fitter person. If you're not exercising, you need to start. If you are exercising then you need to crank up the intensity because you're not reaping the benefits of it.

Diet and exercise absolutely can help. The No. 1 thing I believe can help many people -- and we don't stress it enough as physicians -- is diet and exercise. I think we as physicians depend too much on writing prescriptions and we do not empower our patients to control their lives. If you can exercise, then get out there and do it. Get out there and do some exercise. Cut back on the belt buckle size and the waistline. Push your tolerance level. It doesn't have to be done overnight, but there is an urgency.

Cut back on some of the stuff you can cut back on. Put more vegetables on your plate. These are very simple things to do. Do not hone in on the fact these fastings are elevated. Look at the whole picture. The fact your fastings are elevated means to me your diabetes is not controlled. Forget the fastings.

The way we can get your diabetes controlled is to make you a fitter person. Exercise and diet will help. Yes, pills can work; yes, insulin can work. It's up to you how you want to go with this.

"I think we as physicians depend too much on writing prescriptions and we do not empower our patients to control their lives."

I swim, I diet, and I'm 72, but with Glucophage and Amaryl and Lantus (35 milligrams) why can't I lower my glucose, which averages 125 daily?

It sounds like you're doing as much as you can with the swimming. You just may be at the point where pills will no longer function. As we age, we become less and less insulin sensitive and require more insulin.

So your doctor may just need to stop the pills and put you on insulin to help improve your overall sugar control.

I was diagnosed in March with type 2. My A1C then was 7.9, then in July it was 6.3. I am a 53-year-old woman, with hypertension and emphysema but very good cholesterol and triglyceride levels. What would be an ideal A1C?

Good for you, for a menopausal woman you've done very well -- 7.9 is clearly in the range of someone who had diabetes. Your history of emphysema may have meant you were on steroids, which may have meant you put on some weight and increased your blood sugars, which steroids can do.

Between then and now, whatever you've done, you certainly have normalized your hemoglobin A1C. A normal hemoglobin A1C is less than 7. You say your doctor says your triglyceride and cholesterol are also normal, so congratulations for whatever efforts you have made in getting your health back in order.

You clearly have risk for diabetes, so continue your efforts and it doesn't stop here. You should probably have an oral glucose tolerance test in the very near future to check for diabetes again.

Thanks to Brunilda Nazario, MD, for sharing her expertise with us.

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