Chapter 8, Welcome to the Real World (Part I).

Chapter 8 (Part I) — The “Other Stuff” That Can Raise Blood Sugar

Anxiety/Stress—Have a big test coming up? Trying to land your dream job at your next interview? To offset the stress hormones produced in anticipation of the event, consider raising your basal or injecting 1-2 units prior to these events. Be mindful of checking your sugar a little more around these events to help with better control as well. 

Caffeine—Caffeine can cause a rise in blood sugars in approximately one hour. Excess caffeine has shown to decrease insulin sensitivity, and result in a higher fasting glucose.  Check out this study for a more inside look:

Disease Progression—Upon initial diagnosis of Type 1, most go through a honeymoon phase, i.e. the pancreas is still able to produce a small amount of insulin. As time goes on, the pancreas loses the ability to secret sufficient amount of bolus insulin.  If you have been newly diagnosed, keep this in mind if your blood sugars become more erratic. 

Protein— Protein does effect blood sugars. Roughly 50% of protein can be converted to glucose if there is not other source of sugar in the meal.  How? “When you eat carbs, protein is used for purposed other than supplying blood sugar, such as bodily growth, repair, and creating hormones and enzymes, but without carbs protein becomes of source of glucose for nourishing the body’s cells.” Interesting huh!? Example: If you have zero carbs at a meal (think, turkey burgers or just a steak), count the protein grams, and dose 1/2 that amount as if it were a carb. 

Fats—Fat can cause blood sugar levels to rise for up to 10 hours or more! While there is no specific amount of fat that causes a delayed blood sugar rise, having more than 20grams certainly increases the likelihood that a delay will occur. Pizza, beef, cheese, dessert items, fast food, and most restaurant foods are commonly high fat content meals.  

Growth and Weight Gain— When growth and and weight gain occur, insulin needs will rise as well. Example: (1) As a young person’s body changes, insulin needs will increase because of the excess production of hormones. (2) Or, any extra weight that you put on will also directly affect your insulin needs because fat cells secrete hormones that cause insulin resistance. 

Illness and Infection— Infections trigger stress hormones which drive up blood sugars and make insulin less effective. You will likely need to increase your long acting insulin to minimize elevated blood sugars. 

Couch Potato Syndrome— Sitting extended amounts of time when you are normally active can trigger a gradual rise in blood sugar. Withdrawing activity results in less glucose burning so keep this in mind the next time you have a long flight, meeting, test, etc. ahead of you! Tip: Prior to traveling I try to get a good workout in! This helps boost my metabolism and fat burning state for the day even if I will be sitting for an extended amount of time.

Somogyi Phenomenon Rebound— Elevated morning blood sugars doesn’t always mean you need more insulin, it could mean that you dropped (low) and rebounded (high) because of adrenaline (triggered from the low) kicking in. It’s crucial to monitor your blood sugars mid-night to ensure that your blood sugars aren’t dropping while you sleep! Weird dreams, feeling hung over, night sweats, cold body temp are a few symptoms of mid-night lows. 

Steroids— Steroidal meds create significant insulin resistance and will raise blood sugar levels—including inhalers and even topical creams! Depending on how long you will need them, adjusting insulin dose will be necessary until the steroids are fully out of your body. 

Medications—Beta blockers, estrogen, testosterone, cold/flu meds, and even thyroid medication can directly cause increased blood sugar levels.  The insulin adjustment generally comes into play when you are introducing a new medication that the body is typically not used to. I.e. if you have been on something for a while, the likelihood of needing to adjust now is unlikely. 

Surgery— All medical procedures (big and small) cause stress on the body (mental and physical). Generally extra basal insulin will be necessary to offset the stress prior-to and during the procedure. 

That's it for now!

All of these "factors" can seem very daunting.... I know.

The more I learn about what effects blood my sugars the more demanding this disease seems to be. And while this may be the reality, the more I (you) learn, the better we can relieve some of the burden that comes with it!

Next week we will continue on with the highlights from Chapter 8 and factors that can lower your blood sugars.