Blood glucose that swings from high to low can make you feel sick and increase your risk of long-term health complications. And, low blood sugar (hypoglycemia) can lead to serious complications, and even seizures and loss of consciousness if left untreated. Unfortunately, blood sugar management isn’t always a straightforward process, particularly for those who have just been diagnosed with diabetes. According to Anders L. Carlson, MD, medical director of Park Nicollet International Diabetes Center in Minneapolis, people diagnosed with type 1 diabetes require insulin treatment right away — and this is a significant adjustment, in and of itself, that requires a whole new way of approaching your lifestyle. “The idea of managing your blood sugar can be overwhelming, especially at first, and many people struggle with it,” he explains. “There’s a lot of trial and error involved.” Here are some common pitfalls that can wreak havoc on blood sugar levels, as well as some tips for avoiding them.
1. Eating too many carbs to correct a low blood sugar reading.
Ann Feldman, a registered dietitian and certified diabetes educator (CDE) at the Joslin Diabetes Center in Boston, says that overeating when your blood sugar is low can cause a swing in the opposite direction. She emphasizes the importance of following the “15-15 rule” when treating a low. If you check your blood sugar and it’s 70 mg/dl or less, eat or drink 15 grams of a fast-acting carbohydrate. This could be four glucose tablets or 15 grams of glucose gel, but drinks such as fruit juice and soda (in appropriate, well-defined amounts) and foods such as raisins and hard candies (again, in small amounts) are also excellent sources. Then, wait 15 minutes and check your blood sugar again. Repeat as needed. Too often, Feldman says, “people don’t re-check and assume they’re fine.”
2. Taking too much insulin to correct a high.
Conversely, over-treating with insulin to correct a high can actually cause blood sugar levels to drop too low. Feldman says that if you need to treat a blood sugar high, give your insulin time to work and avoid insulin “stacking” — or injecting another insulin dose within three hours of the previous dose. “We teach people with type 1 diabetes to look at their insulin-to-carb ratio (I:C) when they give themselves insulin at a meal or a snack, and to use their correction factor (CF) to treat a high,” she adds. Both the I:C ratio and the CF need to be tested to determine if they’re working.
3. Drinking alcohol on an empty stomach.
Alcohol can lead to low blood sugar — and that risk is increased if you drink on an empty stomach. Feldman advises people with type 1 diabetes to “stick to the limit” when you drink. The American Heart Association guidelines recommends no more than one drink per day for women, and two drinks per day for men. It’s also important to eat a balanced meal or snack that contains protein, carbs, and fat when you drink. “Adding carbs is crucial,” Feldman adds. “The effect of alcohol can last up to 12 hours, so you may get a low later on if you don’t eat carbohydrate-containing foods.” If you do drink, she also suggests checking your blood sugar more frequently to make sure it’s still at acceptable levels.
4. Thinking “sugar-free” foods and drinks won’t affect your blood sugar.
The phrases “sugar-free” or “no sugar added” don’t mean carb-free, and that’s key in managing blood glucose. According to Dr. Carlson, the primary source of glucose in the blood is carbohydrates, not just “sweet treats,” per se. “And some carbs are healthier than others,” he explains. “Processed sources of carbs like high-fructose corn syrup, which is found in white bread and in so-called ‘sugar-free’ soft drinks, can cause blood glucose to spike because they are processed so quickly by the digestive system.” Avoiding foods and drinks containing high-fructose corn syrup and other sugars can help as they have a high glycemic response (which means they cause the blood glucose levels to spike), Carlson notes. Adding low glycemic response foods such as dried beans, peas, chickpeas, non-starchy vegetables, and some of the newer pastas may benefit the glycemic response, Feldman adds. Pay attention to “total carb” content on nutrition labels and only eat or drink enough to fit in your meal plan.
5. Skipping meals or not eating enough.
“A lot of people skip meals,” Feldman says, “either because they get busy or want to intentionally restrict calories. Or, they simply don’t eat enough carbs with their meals.” According to Feldman, if you take insulin and then skip carbs, a low blood sugar reading can result. The obvious solution is to not skip meals but, if you simply don’t have time to eat a full meal, carry snacks that are excellent sources of carbs with you to prevent a drop. Skipping dinner, specifically, can cause blood sugar to drop overnight. Even if you’re not hungry for dinner (because you ate a large lunch, for example), have a well-balanced snack or small meal shortly before bedtime, Feldman notes.
6. Only counting carbs and not fat in meals.
Most people pay attention to the carbs in a meal or snack, but may be unaware of the effect of fat on blood sugar levels. Eating too much fat (generally 30 grams or more) at one time may cause a rise in blood sugar levels, starting two to three hours after you eat and lingering for up to six hours. A study published in April 2013 in Diabetes Care found that fat can increase blood glucose levels and, as a result, change your insulin requirements. “I can’t tell you how many times I’ve had people come to me and ask, ‘Why do I get a high after eating pizza?’” Feldman says. If you’re going to have a high-fat treat, first test your response to that meal or snack. If your blood sugar is out of range (higher than 180 mg/dl, three or more hours later), you may need to add more insulin upfront and split the insulin dose. Talk to your healthcare team about how to adjust your insulin doses if needed.
7. Not adjusting diet or insulin dose when you exercise.
Aerobic exercise, like jogging or walking, may cause blood sugar levels to drop, while anaerobic exercise, like weight training, may cause them to rise, according to Feldman. If you’re thinking of starting an exercise program, talk to your care team about possible changes to your diet and insulin therapy that can help balance out blood sugar levels before, during, and after your workouts.
8. Stressing out about managing type 1 diabetes.
While it’s important to focus on living and eating well with type 1 diabetes, stressing out about managing blood sugar can actually make it harder to control. According to the ADA, stress can cause blood sugar levels to rise or drop in people with type 1 diabetes — and neither is ideal. “We want people to live full and happy lives,” notes Carlson, who says the key to living well with the condition is education. This means working with your care team — which should include your endocrinologist as well as a CDE — to “learn self-management skills early on so that they become second nature.” And, “having support means you don’t feel alone,” Feldman adds.
9. Not caring for your mental and emotional health.
A type 1 diabetes diagnosis can lead to a number of emotions — fear, frustration, depression, anxiety, and stress among them, Feldman says. Too often, people with the condition don’t take this into account. While support groups, both online and in-person, can be helpful, she also recommends consulting with a health professional to manage your emotional well-being. “Thankfully, more and more people are recognizing that their care team needs to have CDEs, as well as registered dietitians, registered nurses, and exercise physiologist and behavioral health specialists,” she says. “A diagnosis of type 1 diabetes can be very stressful and a referral to a behavioral health professional can help provide coping mechanisms. There’s no need to go through this alone, and not addressing [the emotional] side can lead to problems that may keep you from focusing on your overall health.”
