"Welcome to the Real World" (Part II)

....the stuff that can lower blood sugar:

Heavy Exercise—Also known as Delayed Onset Hypoglycemia can occur several hours after a high-intensity workout. This typically occurs 6-12 hours after a workout but can take place up to 24-48 hours later. How? Heavy exercise makes your cells sensitive to insulin and depletes glycogen (sugar energy stores) in the muscle and liver.

Weight loss—Losing as little as five pounds can affect your insulin needs and enhance your insulin sensitivity.

Aging—With advanced age comes reduction in hormones that would typically require more insulin—be prepared to reduce basal insulin after age 60.

Brain Work—Brain cells rely almost exclusively on glucose for energy. Whenever yourbrain is working hard…blood sugar levels may drop! Hosting a party, networking, studying, new surroundings all affect mental stimulation levels which can induce a blood sugar drop. Who knew?

Climate—Warm temperatures caused by heightened energy expenditure by the circulatory and respiratory systems. Sometimes basal and bolus insulin doses may need to be changed with seasons.

High altitude— Being at higher altitudes causes your metabolism (heart rate) to increase in order to deliver enough oxygen to the body’s cells. If your body is working extra hard to supply oxygen to your muscles… dosage reduction may be necessary.

Nausea—If you have an upset stomach after a meal, you are susceptible to hypoglycemia. When food sits (undigested) or is later vomited the risk of low blood sugar is likely because it had yet to reach your blood stream. If nausea is something that is predictable (pregnancy or chemo), consider blousing an hour or two after eating after you are sure the food stays down.

Medications—Some meds, including anti-depressants, nicotine patches, and antibacterial agents can reduce blood sugars. If you are adding any new med to your day-to-day regimen, be sure to speak with your doctor and do your research for possible dosing adjustments!

....the stuff that can lower and raise blood sugar:

Alcohol—Sugary, carb dense beverages (beer, dessert wine, hard lemonade) will raise blood sugars for the short term. BUT, alcohol has a tendency to lower blood sugars several hours later by keeping the liver from secreting its normal amount of glucose into the bloodstream. Making bolus (and sometimes basal) adjustments to offset the risk of the low is important!

Impaired digestion—Gastroparersis is a form of diabetes neuropathy which the stomach is slow to empty to the intestines. This = the likelihood of high blood sugars several hours later. Apart from medical treatment and diet medications ( to facilitate the movement of food), delaying mealtime bolus 30-60 minutes after the meal could be helpful!

Menstruation—Before your period typically raises blood sugars and during (a day or two after) they tend to drop. Trying noting the onset of you period and look for patterns of consistent highs or lows. Increasing basal several days prior your period starting, could be helpful in keeping your levels happy. Decreasing basal for the first 24 hours after the onset of your cycle may be helpful to reduce lows!

Travel—Due to change (meal time, activity, schedule) your blood sugars may vary quite a bit! The stress of travel, extra walking, and mental stimulation can each trigger an overall drop in blood sugars.

Irregular Sleep—lack of sleep can increase stress hormone which can increase blood sugars.If you are sleeping less than 6 hours per night, increasing bolus may be necessary. Conversely, if you are forced to work late into the night (when you would typically be sleeping) you may need to reduce your basal. The more consistent and regular your sleep schedule the better normalcy in your blood sugars.

Menopause—Because estrogen makes the body more sensitive to insulin, blood sugar control during this time can become more challenging. While changes are in order, be mindful of watching patterns over a few consecutive days versus making abrupt changes.

Pregnancy—Your needs and adjustments(basal and bolus) are ever-changing in each trimester. See the below graph the insulin requirements and visit here for a great resource!

Sports & Exercise—Higher intensity (weight lifting), intermittent bursts of activity (tabata), sprints (running) can each produce short term blood sugar rise. But as mentioned earlier, these same activities can produce blood sugar drop several hours after— reducing meal time insulin dose is likely needed!