‘Tis the season for self-improvement! All around the world people will take the opportunity of the dawn of a new year to dwell on the last year’s failures, and promise to make things better. This process comes naturally to people with diabetes – after all, we get report cards in black and white at the doctor’s office. It’s more serious too. When your pancreas can’t get the job done by itself, it’s up to you to make sure you avoid the twin threats of hypoglycemia and chronic hyperglycemia.
It takes discipline and hard work to thrive with diabetes, but it’s possible and it’s definitely worth the effort. If you think you’re ready to take your blood sugar management to the next level, here are some ideas that could serve you well in the coming year:
Hit the Weight Room
How many how many times have you rocked the treadmill in January only to fall off the wagon long before the first signs of spring? Make this year different and commit to pumping iron two to three times a week. If you think that lifting weights is just for the bodybuilders among us, you’re out of the loop. Resistance training is now recommended to just about everyone, regardless of age or gender, and is even seen to be of particular benefit to those who need to lose weight. Some of the many benefits include boosted metabolism, improved bone health, and better endurance, and a good weights session can be accomplished with more speed (and less sweat) than miles on the elliptical machine.
And there are some special benefits for a person with diabetes. Resistance training improves insulin sensitivity, and as a bonus, many find that it’s easier to manage glucose levels during a strength-training session than it is during aerobic exercise.
No More Bedtime Snacks
The late-night snack has been a mainstay of the diabetes diet for decades, but now is probably a good time to consider whether you can do without. The research is in – food consumed late at night is particularly unhealthy– and the issue is even more important for people with diabetes, as it may cause your blood sugar to behave unpredictably while you’re asleep and cannot monitor it.
A late-night snack may have been important to avoid overnight lows back when most patients using insulin were on the older generation of long-acting insulins, which lasted less than 24 hours and had distinct peaks. But the modern 24-hour basal largely avoids this issue. If you still need a snack before bedtime to prevent your blood sugar from dropping overnight, you likely need to adjust your basal insulin dosage. “Feeding” your insulin is a good way to eat more than you need to.
Check Your Blood Sugar Twice as Often
Fingersticks: they sting, they’re annoying, and they can be expensive. But perhaps the single most important thing you can do to improve your glucose management is to check your blood sugar more often.
How often do you check now? Make a promise to yourself to double it. The less often you check your blood sugar, the less information you have about how diet and exercise affect you. A single fingerstick after a meal is a mere snapshot of what’s actually happening in your body, and can never give you the type of actionable data you need to optimize your blood sugar control.
Even better? Ask your healthcare provider about a Continuous Glucose Monitor.
Drink Water, not Sugar
This might be the single easiest way to instantly improve your health.
We should all know by now that soda is emptiest of all “empty calories,” basically a scourge on your metabolism, triggering the vicious cycle that causes you to overeat and drive up insulin resistance and then go back for more. Soda contains an unbelievable amount of sugar and essentially zero nutritional value.
But fruit juices, even 100% juice, are just about as bad. The same goes for energy drinks and sweetened coffee and tea drinks; it’s pretty much just liquefied sugar, with zero added nutrition. It’s bad for your teeth, bad for your waistline, and simply ruinous for your blood sugar management. Knock it off!
Banish all of these beverages and choose water instead.
A word of warning about diet sodas and other diet drinks: many studies have found that these alternatively sweetened beverages still drive sugar cravings and are otherwise correlated with bad health outcomes. They may have no calories and no immediate blood sugar impact, but they’re not a healthy choice.
Pre-Bolus, Every Time
It’s so easy to forget to pre-bolus for meals, but that little infusion of insulin 20 or 30 minutes before a meal can make a big difference in leveling out your blood sugar. High glycemic variability (wild blood sugar swings up and down) is associated with the development of complications above and beyond what is already predicted by A1C. Endocrinologists are increasingly looking at patients’ time-in-range and standard deviation, and the pre-bolus is one of the most powerful techniques for improving those markers.
Pre-bolusing can be tricky, especially when eating out, when you don’t know exactly when your meal will arrive, or how many carbs it will contain. But then again, cooking your own food and eating more consistently are probably good habits to get into too.
Get Serious about Site Rotation
Whether you use a pump, a pen or an old-school syringe, if you’re using insulin, you are constantly deciding where to stick yourself with the pointy objects that deliver your life-saving medicine. You’re probably been told that rotating those sites is important, but do you really understand why?
When you inject insulin into the same spots repeatedly, you develop lumps of unhealthy fat under the skin, causing the insulin to be absorbed unpredictably. This is called lipohypertrophy, and you may be surprised to learn that it can result in a host of major negative consequences: more frequent hypos, rollercoastering blood sugars, increased insulin needs, and rising A1C.
It’s astonishingly common. Even if you don’t have visible lumps on your body, you may have some measure of lipophypertrophy, and you may be suffering its insidious consequences without even knowing it. Time to take site rotation seriously.
Switch to Glucose Tabs for Hypos
We’ve all done it before: used a low blood sugar as an excuse to snack. Sometimes your brain is screaming “FOOD!” and it seems like there’s no way to hold back. Nothing tastes better than carbs when you really need them, but there’s no surer way to set off another blood sugar rollercoaster than by overindulging yourself and overcorrecting, sending your blood sugar skyrocketing up again.
So why not use glucose tabs? They are precise – no more ransacking the pantry at random. They are fast-acting – unlike chocolates or cookies or ice cream there’s no protein or fat or fiber to slow down absorption.
It’s true, most glucose tablets don’t taste all that great. But, hypoglycemia shouldn’t be an invitation to indulge! Treat it like the serious medical condition it is.
Update Your Glucagon Rescue Plan
Many of us have a glucagon kit lurking somewhere – at the bottom of a handbag or in the back of a closet. It may or may not be expired. Ideally, we never have to use these rescue devices, but because they can save your life, we have to take them seriously.
Who have you trusted with your glucagon rescue kit? Who knows where you keep it, who is trained on its use?
All of these questions are getting a lot easier to answer. Baqsimi, the first nasal glucagon spray, is now on the market, and it will soon be joined by other next-gen glucagon devices that also promise to make hypo rescue easier than ever. The days of nervously mixing and swirling during an acute emergency are over.
This year consider updating your prescription to one of these snazzy new glucagon rescue options, and when you do it, take the opportunity to reengage and retrain family members, friends, coworkers, caregivers and whoever else might be able to help. The new glucagon rescue products are easier to use than ever, which makes a good opportunity to bring even more people into your confidence.
Happy New Year!