A-Z of Managing Blood Sugar in Diabetes

The 3 most important factors for self-regulation of blood sugar levels in diabetes are:

✔ Blood Sugar Monitoring
✔ Diet
✔ Exercise

Let us look at each factor in detail:

Blood Sugar Monitoring:

Blood sugar testing at home helps you:

• Identify how well you are reaching overall treatment goals
• Evaluate how diet, exercise and medicines affect your blood sugar levels
• Understand how factors such as infection, stress or lack of sleep can affect sugar levels
• Detect critically low (below 70) or critically high (more than 350) blood sugar levels

With this information, you can work with your doctor to create the best treatment plan for managing your diabetes with minimum medications.

Glucometer:

You can easily check your blood sugar at home with the help of a portable electronic device (commonly known as Glucometer) that measures sugar level with a small drop of blood. It is a minimally invasive method where you have to make just a tiny prick in your finger.
Many studies (links below) have proven that self- monitoring of blood sugar helps in managing and in some cases even reversing your diabetes and reduces the risk of complications.
Study published in 2018- Reduced Diabetes Mellitus-related Comorbidities by Regular Self-monitoring of Blood Glucose: Economic and Quality of Life Implications
Study published in 2010- Self-Monitoring of Blood Glucose: Practical Aspects

How often to check?

Your doctor or your diabetic educator (Dietitian) should give you guidelines about when and how often to check your blood sugar. Generally, the frequency of blood sugar testing depends on the type of diabetes and 3 months values of Glycosylated hemoglobin (Hb1Ac). For example, a Gestational diabetes patient requires much more blood sugar testing as compared to type 1 or type 2 diabetes patients.

Newer methods of blood sugar monitoring:

Continuous Glucose Monitoring (CGM):

There is a Continuous Glucose Monitoring System also called Ambulatory Glucose Monitoring System. It is a newer technology that measures your blood sugar every few minutes using a sensor inserted under the skin. It is more commonly used for people with Type 1 diabetes who take insulin because their sugar level can fluctuate rapidly. So using a 24 hrs glucose monitoring system is better for them.
However, it also plays a huge role in the treatment of type 2 diabetes. Doctors recommend CGM for people with type 2 diabetes who have uncontrolled or fluctuant sugar levels because it is very hard to treat them only on the basis of 1-2 sugar tests per day. A sensor is inserted by the doctor or nurse under the skin of your arm in a quick and painless fashion. It is absolutely non-invasive procedure and insertion of the sensor is painless. This FDA-approved system tracks your blood sugar levels day and night. It records readings automatically every 5 to 15 minutes and creates a detailed report called as Ambulatory Glucose Profile (AGP). In the report, your doctor can see the fluctuations in the sugar levels each day for 2 weeks. This helps the doctor to evaluate what time your sugar level falls and rises. According to the report, they can customize your diet, medication, insulin and exercise routine.
For more information on CGM kindly check this video

Sample of CGM report attached here:  View Report

Know your target range:

Your doctor will set target levels (fasting and post-prandial) for blood sugar test results. They will do that depending on several factors, like:

• Type and severity of diabetes
• Duration of diabetes
• Pregnancy status
• The presence of diabetic complications

The American Diabetes Association has recommended the following target blood sugar levels:

• Fasting blood sugar: It should be between 80 and 130 mg/dL (4.4 and 7.2 mmol/L)
• Post Prandial blood sugar (2 hours after meals): It should be less than 180 mg/dL (10.0 mmol/L)

Blood sugar and diet logging:

It is essential to record the readings of your glucometer. Always discuss with your doctor about how often you should record your blood sugar results. If you manually log your results, always record the date, time, test results, medication and dose, and diet and exercise information. Don’t forget to carry your recorded results with you to all appointments with your doctor.
Attaching a sample of blood sugar logging sheet: Sample Logging Sheet

Apps for logging:

There are many phone apps now, which can simplify the tracking and recording of blood sugar levels. You can use them to consolidate health information at one place, make informed choices and manage your diabetes in a better way. Try to choose an app which logs diet along with sugar levels and insulin.
Some of the commonly used apps are:

• Beat Diabetes
• MySugr
• BG Monitor Diabetes
• Diabetes Connect
• Glucose buddy
• Sugar Sense

Diet in Diabetes:

“You are what you eat” – foods we eat affect our body differently. Therefore, it is utmost important to meet your dietitian at least once a year or whenever required.
Healthy nutrition is the art of knowing what, when, how much and how frequent to eat. This is an integral part in the management of diabetes as different foods affect the blood glucose levels differently. Eating a healthy diet does not have to be boring and monotonous. You can beat this by making the right choices and having the right balance. For managing diabetes, your eating plan is a powerful tool. Diabetes does not mean you completely eliminate your favourite foods or stop eating in restaurants. Add flavour to your daily routine—include healthy twists in your favourite foods. Work with a dietitian to make an eating plan. Here are some useful tips:
✔ Eat regular meals: Prevent high or low blood sugar– Blood sugar that is either too high or too low can cause complications.
✔ Make healthy food choices: Always read the food labels of packages – it can give you an idea just how healthy (or unhealthy) the food is.
✔ Control your portion sizes: Measure each serving as over eating is very easy
✔ Develop an eating plan: You can plan meals for a full week or for each day
✔ Set goals for healthy eating: Change your eating habits, make a plan that works for you and fits into your lifestyle. Start with achievable goals and a realistic plans
IDF (INDIAN DIABETES FEDERATION) recommendations for a healthy diet for the general population:

1. Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.
2. Eating at least three servings of vegetable every day, including green leafy vegetables.
3. Eating up to three servings of fresh fruit every day.
4. Choosing nuts, a piece of fresh fruit, or unsweetened yogurt for a snack.
5. Limiting alcohol intake to a maximum of two standard drinks per day.
6. Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat
7. Choosing peanut butter instead of chocolate spread or jam.
8. Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.
9. Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil.
10. Limit or avoid foods with added sugars and refined grains.
11. Drink water instead of diet soda, soda or sugary drinks and juices.
12. Low-carb diet, vegetarian diet have shown positive effect on lowering HbA1C.
13. Choose whole unprocessed foods over processed foods.
14. Eat non starchy vegetables.

A DIABETIC PLATE

Exercise and Diabetes

In diabetes, exercise is just as significant as diet and medication. The American Diabetes Association recommends at least 30 minutes of workout that increases the heart rate five days per week.
Any aerobic exercise for at least 40 minutes to 1 hour is very beneficial. Walking, jogging, cycling and swimming are the best ones and cost free. Exercise need not be boring. One can make it a fun activity. Playing a sport with friends or dancing to music are some options to try. Carry your carbs with you always. Keep a small carbohydrate rich snack, fruit or drink handy to prevent hypoglycemia. You can also do strength-training twice a week along with aerobic exercise. Most importantly make exercise a part of your daily life.
Inputs given by,
Dr. Chhavi Goyal-Mehra – MBBS, MD, Internal Medicine U.C.S.F (USA)
Ms. Vidya Narasimhan – Senior Dietitian, RxDx
Compiled By,
Dr Manjari Bansal– Content Writer, RxDx
For further details, please contact: 080-49261111, 6745-8111