The EASD-ADA 2018 Type 2 Diabetes Consensus Statement

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Management of Hyperglycemia in Type 2 Diabetes, 2018: The Report

The annual European Association for the Study of Diabetes (EASD) meeting just wrapped in Berlin. Our favorite part? The updated guidelines for the treatment of type 2 diabetes (T2D), released collaboratively from EASD and ADA (American Diabetes Association). This is huge. And, spoiler alert: we could not be more thrilled with their recommendations.

The report, a 33-page document outlining both the EASD’s and the ADA’s latest recommendations for type 2 diabetes treatment, pulls from nearly 500 different papers published in the last 4 years, all of which focus on improving blood glucose management and reducing T2D complications to, ultimately, provide an improved quality of life for those living with type 2.

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Perhaps the statement’s most central theme, and one that deeply resonates with us here at One Drop, is its call for patient-centric care. At the helm (literally, on the second page), we’re given a kind of cheat-sheet graphic with a strategic, step-by-step breakdown of how exactly this patient-focused care should look:

1️⃣ Assess key patient characteristics
2️⃣ Consider specific factors that impact choice of treatment
3️⃣ Shared decision-making to create a management plan
4️⃣ Agree on a management plan
5️⃣ Implement management plan
6️⃣ Ongoing monitoring and support
7️⃣ Review and agree on management plan

And, once all 7 steps (and their subsequent actions) have been successfully implemented, returning to Step 1 and going through the full cycle at least twice each year. As noted in the image below, the patient always remains at the center of this treatment cycle, along with those two fundamental goals of preventing complications and optimizing quality of life.

 

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MIC. DROP. 🎤

Because although we, as people with diabetes, all know that we should always be at the forefront of care, patient-advocacy like this displayed from both groups is groundbreaking. And so often, overlooked. But empowering people with diabetes in this way, by putting them in the spotlight of their own care, is imperative. Because empowering people to take charge of their diabetes, to take pride in their own self-care, encourages better diabetes management in the long-run. That kind of relentless empowerment serves to benefit all people with diabetes, everywhere.

Additionally, and also for the very first time, the committee offers specific medication recommendations according to patient profile and health history.

Along with overall patient-centric approach and medication suggestions, the two associations offer tons of additional recommendations throughout the paper. Here are a few of our favorites:

Other key insights 🗝

Our major takeaway from this statement is its central message and goals: keeping the person with diabetes (PWD) always at the forefront, with the constant pursuit of preventing complications and enabling better life outcomes. 💪 That theme is reiterated throughout the paper, with statements in favor of ongoing self-care education and support around diabetes management. 🔥

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Not only that, but the committee also urges healthcare providers to take into consideration a person’s preference when it comes to treatment. They also address many real-world concerns, such as patient burden and/or cost. In fact, they assess the global health care situation quite frankly:

“An important consideration for society in general and for many patients in particular is the cost of medications; sulfonylureas, pioglitazone and recombinant human insulins are relatively inexpensive, although their cost may vary across regions. Short-term acquisition costs, longer-term treatment cost and cost-effectiveness should be considered in clinical decision making when data are available.”

“The availability of glucose-lowering medications, patient support systems, and blood glucose-monitoring devices can differ worldwide, depending on a region’s economy, culture, and health care system. Cost of and access to newer medications and insulin remain important issues throughout the world.”

Language like this is a major win for us as people with diabetes. Finally, two major world leaders in diabetes education, research, and support recognize the PWD’s individual circumstance and what a vital role it plays in overall care.

While we as people living with diabetes know all of this intuitively, this is a great step in the right direction for both the EASD and the ADA, as well as diabetes care globally. Check out the full paper here. And while you’re at it, why not discuss it with your healthcare provider? We’d love to hear about any insightful conversations you have around the topic.

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3 Savory Low Carb Recipes You Have to Try

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In my endless pursuit of eating healthy, low carb meals, my key focus is always the meat and the veggies. If you’re trying to cut out the processed, starchy carbs in your diet, and eat more wholesome, real foods, these meals will give you plenty of satiating fat and protein, along with loads of veggies! My only food rule when it comes to low carb eating? EAT 👏 REAL 👏 FOOD👏

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There are so many real-food options out there! But today, we’re covering three. You can think of these are three great low carb dinner options, low carb lunch options, low carb anything options! But the common denominator? They all contain a hearty, healthy serving of veggies and meats. Let’s dig in.

1. Veggie-Loaded Sloppy Joes

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The hardest part about this recipe is chopping up the vegetables. That’s it, really! These Joes are loaded with veggies. And the large quantity of mushrooms makes for a light, but low carb and nutritious filler!

Carb-Estimate

I dose insulin based on the estimate that 2 cups of this meal adds up to about 8 grams of carbs. If you omit the tomatoes and use green peppers (instead of yellow, red, or orange) the carb count could be as low as 5 grams. But I love yellow bell peppers, and when it comes to carbs from non-starchy veggies, I eat as many as I please! They’re worth it. 😋 I bet you’re thinking: how’d I get that carb count so low?! It’s a Sloppy Joe! And herein lies the differentiating factor: this is a bunless Sloppy Joe. A not-your-momma’s Sloppy Joe. But if you’ve just got to have that buttery, bread-y feel and taste, we’ve got you covered there, too. Just check out recipes for our super low carb bread options here!

Ingredients

❏ 1 carton of mushrooms

❏ 1 large yellow onion (or 2 if you love onions — they’re so low carb!)

❏ 1 bell pepper (you pick the color! 🎨)

❏ coconut oil (or butter, olive oil, etc.)

❏ 1 lb. *Grass-fed beef or ground turkey

❏ 1-2 tomatoes (optional — will add a bit more carbs, but nutritious!)

❏ 1 packet of dry Sloppy Joe sauce mix (use 2 packets if you want mega flavor)

❏ salt

*If there’s one place worth spending more money on meat, it’s with ground beef. Grass-fed beef will produce so much less fat in your pan. You won’t even have to drain the fat! Instead, you’ll use it to make the Sloppy Joe sauce. Win-win. 🏆

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Directions

1. Dice up 1 carton of mushrooms, 1 large yellow onion, 1 bell pepper.

Pro-Tip 💡 If you hate chopping veggies, you could put them in the food processor. But you’ll risk over-chopping them if you aren’t careful. Small, bite-sized chunks will be tastiest.

2. Saute all those veggies on medium heat in a large fry pan with coconut oil (or butter, whichever you prefer).

3. Stir often!

4. In a separate fry pan, saute 1 lb. grass-fed ground beef or ground turkey on medium heat.

5. No need to add oil to the pan for this step! Just use the fat that comes from the meat.

6. Once it’s thoroughly cooked, add in a packet of dry Sloppy Joe sauce! (McCormick, or whatever your grocery store sells, works perfectly).

Optional: slice up a couple of large tomatoes and add them to the beef after it’s cooked.

7. Mix the meat with the veggies in a big bowl,

8. Add 2 teaspoons of salt (if necessary!).

Double this recipe to easily create enough for a week’s worth of dinner or lunch! You’ll be prepped and ready with an easy to grab, delicious to eat low carb staple. Enjoy!

2. BLT or Salami Lettuce Roll-Ups

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Turn any great sandwich into a low carb feast just by nixing the bread! You get to eat way more of the best ingredients. And when we’re talking BLTs, one without the bread tastes so much better! Bread blunts the flavor (re: awesomeness) of the bacon, onions, salami, and mustard!

Carb Estimate

If you’re making 3 to 4 of either of these “sandwiches,” and you are using both mustard and tomatoes, you may find you need insulin to cover about 8 grams of carbs. Without mustard or tomatoes, my estimate of “impact” carbs is essentially zero. But! You may find you need the tiniest smidge of insulin to cover the protein and fat.

Ingredients

❏ jumbo romaine lettuce (or Bibb/Butter lettuce)

❏ sliced red onion

❏ cooked bacon or salami (scissored in half for easier eating)

❏ mustard of choice (I prefer sweet and spicy Mister Mustard)

❏ mayonnaise

❏ black pepper

❏ sliced tomato (*optional: will add more carbs, but still nutritious!)

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Directions

1. Use at least two pieces of lettuce for each “sandwich” serving. If using romaine, lay them on top of each other so the “toes” of each lettuce piece is on the “face” of the other lettuce piece. This provides greater coverage for your meat and onions (limits the spillage!).

2. Spread mayo and mustard on the lettuce.

3. Sprinkle some black pepper on the mayo and mustard.

4. Lay 2 pieces of bacon per “sandwich,” or 1-2 slices of salami that has been cut in half.

5. Lay the red onion and tomato slices on the meat.

6. Using both hands, wrap one “sandwich” up and take a bite!

NOM NOM! Don’t forget to add your basically non-existant carb-count in your One Drop app! 😉

 

3. Taco or Pulled-Pork Salad Bowl

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The taco ground-beef is definitely easier to make than pulled-pork. But either works super well in this recipe! Instead of the deep-fried taco shell, you’ll save yourself 50+ (😱) grams of carbs and a heck of a ton of fat by swapping it for lettuce instead. 🥙 Even my stubborn, carb-loving, non-person-with-diabetes husband loves Taco Salad Night!

This recipe focuses on tacos. But if you already have a pulled-pork recipe you love, or often find yourself eating high-carb pulled-pork sandwiches, consider this easy switch! I like to skip the BBQ sauce and make a Cuban-Mojo-Pineapple version of pulled-pork instead. Here’s a quick rundown of the pulled-pork version:

Quickie Pulled-Pork Directions

Use a bottle of Goya’s “Mojo” sauce, a sliced yellow onion, pork shoulder that fits in a slow-cooker. Cook on low for 8 hours, drain the juices, save the onions and meat, shred the meat, then stir in a drained can of shredded pineapple. It just tastes far more interesting, is surprisingly lower in carbs (despite the pineapple), and feels so much lighter in my stomach.

Carb-Estimate for Quickie Pulled-Pork

8 grams for a hefty serving of pulled-pork on romaine lettuce.

Carb-Estimate for Taco Salad

For one hefty serving of Taco Salad, I personally dose my insulin as if this meal is 10 grams of carbs. If you’re adding lots of cheese, though, you may find you need to account for another 5 grams of carbs.

Ingredients (for Taco Salad)

❏ 1 lb. ground beef

❏ 1 packet of taco seasoning

❏ Sliced red onion (don’t cook it unless you really want to)

❏ 3 to 4 heads of Romaine lettuce

❏ Banana peppers (optional)

❏ 1 tbsp. chipotle Ranch salad dressing

❏ ⅛ cup shredded cheddar cheese (or more! 😍)

Directions

1. Mix all of the salad ingredients in a big bowl.

2. Add a bit of chipotle Ranch salad dressing.

3. Add a heaping scoop of taco meat.

4. Add the cheddar cheese on top!

The best part? You can go back for more! As many times as you’d like! But you’ll probably be pretty full after two helpings; this bad boy mix is so hearty and filling. ¡Buen provecho!

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What Causes Insulin Resistance?

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But first: what is insulin resistance?

Insulin is often referred to as “the most powerful hormone” in the body of any mammal — including humans. Without it, we wouldn’t be able to convert the glucose (sugar) in our bloodstream in order to use it for energy. (Read all about insulin here!) If we can’t convert it to use for energy, it sits in our bloodstream. And as it sits, that glucose builds to higher blood sugar levels, which can lead to severe complications and even death if left untreated.

Insulin resistance is a state in the body in which the body needs more insulin than “normal” in an effort to maintain healthy blood sugar levels. As the degree of insulin resistance increases, the body’s demand for more insulin can surpass what the pancreas can actually produce. That increasing need for more insulin can lead to weight gain, high blood sugars, pre-diabetes, and type 2 diabetes.

Read all about type 2 diabetes here!

“The person’s body may not be producing enough insulin to meet their needs, so some glucose can’t get into the cells,” explains the Joslin Diabetes Center. “Glucose remains in the bloodstream, causing high blood glucose levels. In many cases, the person may actually be producing more insulin than one might reasonably expect that person to need to convert the amount of food they’ve eaten at a meal into energy.”

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Eventually, the pancreas begins working “overtime” to produce more and more insulin, while the body’s cells continue to be “resistant to the effects of insulin.”

“Basically the cells, despite the presence of insulin in the bloodstream, don’t become unlocked and don’t let enough of the glucose in the blood into the cells,” Joslin goes on to explain.

Insulin resistance causes

While mainstream media oftentimes oversimplifies insulin resistance as a self-induced cause of type 2 diabetes, the cause of it is actually much more complex, and still somewhat of a mystery.

“In people with type 2 diabetes, a combination of problems occurs, and scientists aren’t really sure which is the chicken, and which is the egg,” explains the Joslin Diabetes Center. “Scientists don’t know exactly what causes this insulin resistance, and many expect that there are several different defects in the process of unlocking cells that cause insulin resistance.”

Generally, however, there are several known factors that worsen and contribute to a person’s insulin sensitivity and resistance levels:

➣ Weight gain and being overweight

➣ A sedentary lifestyle and lack of exercise

Sleep apnea and other sleep problems

➣ A diet consisting primarily of processed foods and fast-food

➣ Air pollution

➣ Excessive estrogen production

➣ Smoking cigarettes

➣ Certain diseases (like PCOS) or treatments for those diseases (like medications used to treat cystic fibrosis)

➣ Steroids (like prednisone and cortisol)

➣ Old age

“71 percent of people with type 2 diabetes have been diagnosed with sleep apnea,” says Jody Stanislaw, ND, CDE. Dr. Stanislaw has lived with type 1 diabetes since childhood.

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Who can develop insulin resistance?

Insulin resistance is often the catalyst in the development of type 2 diabetes and obesity. However, anyone can experience varying levels of insulin resistance, and it doesn’t necessarily mean you’ll develop diabetes.

If you’ve experienced a major stressor or event in life

Anyone can experience a short-term degree of insulin resistance because of a high-stress phase in their life which increases cortisol production. If you’ve experienced the death of a loved one, a divorce, a car crash or any other traumatic event, all of these things can lead to increased resistance to insulin. But that doesn’t necessarily mean you would go on to develop type 2 diabetes. When that phase of stress in your life ends or is reduced, your insulin resistance levels would ideally be reduced, too.

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If you’ve gained a little or a lot of weight

Gaining even 5 pounds will increase your body’s level of insulin resistance. But that weight gain would generally only cause a problem if the weight continues to pile on. When a 5-pound weight gain becomes a 30-pound weight gain, and then a 50-pound weight gain, that’s when insulin resistance levels begin to show a significant impact on blood sugar levels. On the flipside, losing weight (even just 5 or 10 pounds) will reduce your body’s level of insulin resistance, causing you to be more sensitive to insulin. Heightened insulin sensitivity reduces your overall risk of developing pre-diabetes or type 2 diabetes.

If your lifestyle habits have changed, even temporarily

If you’ve suddenly started eating a pint of ice cream every night or you haven’t been to the gym in three months, you can bet your personal level of insulin resistance has increased. Your daily lifestyle habits around food and exercise play a major role in how much insulin your body needs to produce in order to maintain healthy blood sugar levels. However, the length of time you continue those not-so-healthy habits will largely determine if your insulin resistance increases to the point of elevated blood sugar levels, and a possible pre-diabetes or type 2 diabetes diagnosis.

If you eat a diet high in processed carbohydrates

The carbohydrates in a strawberry are not going to impact your body the same as the carbohydrates in a bowl of mac & cheese or Cap’n Crunch. The more carbohydrates you eat, the more insulin your body needs to produce in order to take the glucose from those digested carbohydrates and convert them into energy. Even your “healthy” Nutrigrain bar is made with heavily processed carbohydrates. It’s a product, rather than a whole-food source of carbohydrates, like whole oats, rice, legumes, or fruit. While whole-food sources of carbohydrate still require large amounts of insulin, they provide more fiber, vitamins, and minerals than a heavily processed product.

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If you have a certain ethnic background

While anyone of any race or ethnicity can develop insulin resistance, certain ethnicities have shown to be at a much higher risk than others, explains Dr. Stanislaw:

● Asian Americans

● African Americans

● Mexican Americans

● American Indians

● Native Hawaiians

● Pacific Islanders

“94 percent of the children diagnosed with type 2 diabetes [as a result of insulin resistance] are minorities,” adds Dr. Stanislaw.

What are the symptoms of insulin resistance?

“The most obvious signs of insulin resistance,” explains Dr. Stanislaw, “are elevated blood pressure levels, elevated cholesterol levels, acanthosis nigricans, and PCOS (polycystic ovarian syndrome).”

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Inexplicable weight gain can also be a symptom for some. As the Joslin Diabetes Center explains, some people develop an inability to make use of the insulin they produce. Even if they have healthy habits and are at a healthy weight, that increasing production of insulin can lead to weight gain, which contributes to their overall insulin resistance.

When does insulin resistance become pre-diabetes or type 2 diabetes?

The point at which your level of insulin resistance becomes significant enough to warrant a diagnosis and purposeful treatment is based on your blood sugar levels and your HbA1c (or A1C).

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The American Diabetes Association states the following criteria for a diagnosis of prediabetes or type 2 diabetes:

Prediabetes

✔︎ A fasting plasma glucose reading between 100 mg/dL to 125 mg/dL

✔︎ An HbA1c result of 5.7 to 6.4 percent

Type 2 diabetes

✔︎ A fasting plasma glucose reading above 126 mg/dL

✔︎ An HbA1c result of 6.5 percent or higher

While an official diagnosis may be scary and daunting, it’s a crucial sign that it’s time to make changes in your lifestyle habits. Medications may be needed to help increase your body’s natural insulin production. But before you start on those medications, you have other options to try. Cutting down your carbohydrate intake and instead consuming more proteins, healthy fats, and veggies is a great step in the right direction. Adding in more cardio and strength training to your daily routine (even weekly!) is another great way to increase insulin sensitivity, thus decreasing insulin resistance. Even if you’ve already been diagnosed with diabetes, these two lifestyle habits alone can make major differences on insulin’s impact on your body. Give it a shot!

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3 Tips to Prevent Getting Stuck on the Blood Sugar Roller Coaster

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Nothing is more discouraging than a ride on the blood glucose (BG) roller coaster. 🎢 It’s a nasty one, and once you’re on, getting off is tricky.

The BG roller coaster starts with a super low blood sugar, or a super high one. The ride gets going when that super low is treated by carb-overloading, or the super high gets treated with insulin overkill — sending your blood sugar rocketing in the opposite direction. Then, you treat that new soaring blood sugar with excess insulin, or the plummeting one with carbs-on-carbs-on-carbs to prevent swinging back to where you just were. And so, the vicious cycle begins again. ♼

The worst and most common trigger for that coaster ride is the super low blood sugar that gets treated with an over-abundance of carbs. 🍌🍩🍟🍮🥧 We’ve all been there: a quickly descending blood sugar that prompts you to eat every morsel of food in sight.

You only need 15 grams of carbs to treat a low,” says your doctor.

Sure, that may be the truth most of the time, but if you’ve ever felt your blood sugar at 55 mg/dL and still dropping rapidly from a bit too much insulin at your last meal, 15 grams of carbs just feels like a drop in the bucket. Your brain begs you to eat more! To the point where you simply can’t control yourself. Even after your blood sugar is back up over 80 mg/dL, a severe enough low can leave you feeling shaky and weak for at least an hour (sometimes two) afterward.

So you eat, and eat, and eat. Sending yourself flying high, high, high. Then, you feel guilty for eating so much. So you take a whopping dose of insulin, sending you way back down. You get the picture: it’s a messy one. So how can you prevent yourself from getting stuck in this nasty loop? Here are three tips you can use the next time your BG roller coaster beckons.

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1. If you’ve got to have more carbs, acknowledge and account for what you’re going to eat.

Choose the carb-laden food you’re going to eat to give your brain a feeling of safety and satiety. Then, carefully calculate the insulin dose you’ll need for the carb content over the first 30 grams of carbs. The truth is that some low blood sugars do need more than 15 grams of carbs, especially the rapidly crashing ones. Because your glycogen stores (your body’s back-up glucose) need to be replenished, too.

Instead of going wild on carbs and then pretending you didn’t, acknowledge what you’re going to eat or what you’re already eating (like a giant bowl of Honey Nut Chex cereal), calculate the carbs as best you can, and take insulin using your insulin-to-carbohydrate ratio provided by your healthcare team to cover the carbs above 30 grams. That extra 15 grams of carbs gives you a little cushion; while you might end up a smidge higher than ideal, you won’t be sky high or take too much insulin that you risk going low again.

2. Write down what foods you will use (and not use) to treat low blood sugars.

Some people know there is no way they could only eat 10 fruit snack pieces to treat a low blood sugar. Others know they could easily resist eating all 30. Some people know they could eat a small bowl of Cheerios and not go back for more, while others know that one small bowl of Cheerios will quickly become 4 bowls.

What carbs are triggers for binge-eating during lows for you?

Personally, I hate bananas. Eating a banana makes me want to chug water and not eat anything else ever again. For that reason, they are my go-to treatment for severe low blood sugars. There’s absolutely no way I’m going to overeat bananas, or even want to eat anything else.

I also know that, for me, I will never run out of room in my belly for Honey Nut Chex. If I’m having a severe low and my brain is begging for something full of quick-digesting, heavily processed carbs to bring me back to that feeling of “safety,” I give myself permission to eat one or two small bowls. And that’s it. I have my game plan in advance; no more than two. Then, I already know to take a good dose of insulin for the excess carbs to prevent flying high in the other direction.

This is my plan. These are my triggers. Think about what foods are triggers for binge-eating during low blood sugars for you, and what foods you have more control over. Once you’ve got your designated foods, use them to come up with a surefire game plan you can use, even when you are zombie-low.

3. Forgive yourself for “causing” the super low or super high, and move on!

In the daily game of diabetes management, it’s so easy to blame yourself for those super low or super high blood sugars. We often know exactly what caused them — that extra slice of pizza or the sloppy job we did measuring out the carbs at lunch. And too often, we go from blaming ourselves to thinking, “Well, I’ve already screwed up today, might as well give up trying for the rest of the day.

The truth is, managing diabetes is not easy. Even when you have the best intentions! Like using an apple to prevent low blood sugars during yoga, only to find that you needed about half the carbs in that apple, and now you’re high. And there is no way we’re going to get it right every time. There are just too many variables in life!

When you find your blood sugar rocketing up and down, take a deep breath. Let yourself off the hook for making “a mistake,” and think rationally about how you’d like to handle the current blood sugar situation you’re facing. Know that you are not alone. You are not the only one on the BG roller coaster; there are others doing loop-de-loops, too. You will get off this coaster, and you’ll move on! Like the diabadass you are.

 

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5 Tips for Managing Blood Sugar During Exercise

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Exercising with type 1 or type 2 diabetes when you’re taking insulin, or any diabetes medication, is not easy. In fact, it’s quite complicated. But I want to state for the record: you are absolutely, 100% capable of figuring out the complicated details so that you can feel more confident and in control of what happens to your blood sugar while exercising. Whether you’re headed to the gym, to a mountain for a 4-hour hike, or to your garage for some jump-roping, once you figure out the tiny details, you’ll be able to get in your workout, no problem.

As people with diabetes, a massive part of living a healthy life means trying to keep our blood glucose levels in our goal range — even while exercising. Meaning, exercising with a blood sugar of 250 mg/dL just to prevent yourself from dropping low during your workout is not OK. Likewise, exercising with a blood glucose level of 50 mg/dL isn’t healthy either. The difference? Most of us can feel that 50 mg/dL when we exercise — we’re physically unable to exercise at all because that level is simply too low for strenuous movement. On the other hand, a 250 mg/dL blood sugar is, for some, a level that doesn’t prevent physical activity. But just because you can still run, leg curl, or spin doesn’t mean it’s good for you.

So then, what’s a PWD to do? 🤷‍♂️ 🤷‍♀️ You can’t go too low, but you can’t be that high either. Are you just supposed to not work out? No way! 👎 Ultimately, working out is one of the best things we can do to keep our blood glucose levels in range and insulin resistance low. But how to get there? How to make it worth it? ⬇️⬇️⬇️

Here are 5 tips for keeping your blood sugar in a safe, healthy range during exercise:

1. Know what type of exercise you’re doing: aerobic vs. anaerobic.

Understanding the difference here is perhaps the most important detail. If you eat a banana without insulin to cover the carbs right before your workout, but end up doing an hour of weights instead of an hour on the treadmill, you’re going to find your blood sugar well above 300 mg/dL by the end of your workout. Anaerobic exercise relies on energy stored in your muscles (a process known as glycolysis), as well as body fat for fuel. Conversely, aerobic exercise (also known as “cardiovascular” or “cardio”) will generally burn glucose for fuel, lowering your blood sugar. Anaerobic exercise, on the other hand, relies on energy stored in your muscles (a process known as glycolysis), as well as body fat for fuel.

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Anaerobic

Translated to mean “without oxygen,” anaerobic exercise simply can’t burn glucose for fuel because your heart-rate is so high during those short bursts of intensity. Instead, glucose stored in your muscles (known as glycogen) is cycled through the process of glycolysis for fuel. The added bonus is that during the rest periods between those bursts of intensity, your heart rate comes down and your body can burn fat for fuel, too. This means that if you’re going to do an anaerobic workout (like weightlifting, high-intensity intervals of spinning or sprinting combined with intervals of lower intensity, CrossFit, etc.), you can generally expect to see your blood sugar either remain stable or actually rise a little. Or a lot! For example, I know that an intense weightlifting workout will raise my blood sugar sometimes up to 100 points. I also know that short-bursts of sprinting combined with several minutes of slow walking will cause little to no rise in my blood sugar.

After anaerobic exercise, you can expect that your next snack or meal will need a lot less insulin because your muscles will want to refill those glycogen stores with glucose, easily burning up more of your meal. How much you can reduce your post-workout meal bolus is going to vary from person to person and based on what type of exercise you did. Caution, trial and error is your friend here!

Aerobic

Aerobic exercise, on the other hand, generally means your heart-rate is elevated for a prolonged period of time. Your body actually can’t cycle enough oxygen to your fat cells to use for fuel. Instead, your body relies primarily on glucose for fuel. This means that if you head up a small mountain for an afternoon hike, you can expect to be burning glucose constantly. The same goes for a power-walk: your pace is consistent and, thus, your heart-rate is elevated. When you’re hiking back down that mountain, however, your heart-rate will be remarkably lower and your body won’t need those extra carbs (or reduced basal rate) that they needed on the way up.

You see, it’s really all about your heart-rate! What it’s doing, when, and for how long. Even a medium-intensity yoga class can raise your heart-rate consistently and lower your blood sugar.

After aerobic exercise, you will likely be more sensitive to insulin and need a slight-to-moderate reduction in your basal rate or bolus for your next meal. How much you can reduce your post-workout meal bolus is going to vary from person to person and based on what type of exercise you did, and for how long. Caution, trial and error is your friend here!

2. If you exercise in the morning, try doing your workout before eating breakfast.

You can thank Schwarzenegger and Franco Columbu for this one. Bodybuilders have known about the benefits of fasted exercise for decades. I didn’t believe it at first when my powerlifting coach explained this to me years ago. After a few experiments, however, I came to fully trust this magical time of day for exercising without worrying about my blood sugar.

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Here’s how it works: when you perform any type of exercise on an empty stomach first thing in the morning, with an in-range blood sugar and accurate background insulin doses, your blood sugar will not drop. Instead, your body is going to burn body fat for fuel! If you are still in a truly fasted state (you haven’t eaten), then you haven’t taken a bolus of insulin for food either. The consumption of food, along with a bolus of insulin (even for people without diabetes) is what signals your body to start burning glucose for fuel when necessary, like during cardio exercise. By not eating breakfast, and, instead, heading straight to the gym or out for a long walk with your dogs, your body is going to burn body fat for fuel and your blood sugar will remain stable!

Here’s what it looks like in real life. I’ve been taking my dogs for an early morning, long walk at 6 a.m. I wake up and test my blood sugar to confirm I’m not low. If I’m high (over 200 mg/dL), I take no more than a ¼ unit of fast-acting insulin to help it start to come down with the help of exercise, chug a little water, and head out the door for a 40-minute fasted power-walk in the woods. I know I don’t have to worry about my blood sugar dropping too low because I haven’t eaten. Meaning, my body is still burning fat for fuel, and the correction dose I took for the high blood sugar was minimal. If my blood sugar is actually in perfect range when I wake up, even as low as 80 or 90 mg/dL, I would simply head out the door for the 40-minute walk in the woods because in a fasted state, I know for sure that my body is going to be burning body fat for fuel, not glucose.

In my real-life example above, I was doing aerobic exercise. But if you decide to do anaerobic exercise in the morning in a fasted state, you may see your blood sugar rise. This happens with more intense anaerobic exercises, like CrossFit or heavy weightlifting. The intensity of those workouts calls for more glucose (glycogen) to be released from your muscle stores. This is a normal, good thing! But it means you may find you need to actually give yourself a small dose of insulin before this type of fasted exercise.

Personally, this was my favorite time of day for weightlifting. I didn’t have the added variables of food and insulin on board. Instead, I knew I needed 1 unit of insulin before a fasted weightlifting workout, and I’d finish my workout effortlessly with a steady 100-ish mg/dL blood sugar level.

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To determine if your anaerobic workout affects you in this way, do your first morning fasted exercise session without an extra bolus of insulin and simply see what happens! If your blood sugar rises, start out with a very small bolus before that workout next time and see what happens. Tweak your dosing as needed!

3. If you exercise in the afternoon or evening, try doing your workout when it’s been at least 3 to 4 hours since your last insulin bolus or meal.

This one is slightly more tricky. You’ve inevitably been eating during the day, but you want to keep blood sugar management as simple as possible so your evening workout isn’t sabotaged.

How it works: Much like fasted exercise in the morning, you’re creating that fasted environment in the afternoon or evening by ensuring that any large doses of fast or rapid-acting insulin are well out of your system. This guarantees that your body isn’t going to easily burn glucose for fuel during aerobic or anaerobic exercise.

As a full-time mom, the only time of day I could enjoy a hearty session with my beloved jump-rope was in the evening, around 7pm. To prepare my blood glucose levels for my 7pm workout, I made sure that my last meal was no later than 3pm. That way, there was no active rapid-acting insulin in my bloodstream by 7pm. If I did end up needing (or wanting) to eat during that 3-7pm window, I would choose something that is extremely low carb so that I either needed only the slightest amount or no insulin at all.

By giving my last insulin dose a 4-hour window to get out of my system before my 7pm workout, I could jump to my heart’s content, feeling confident that my levels wouldn’t drop even with a starting BG of 90 mg/dL.

Again, if you are doing an intense weightlifting or CrossFit-type of workout, you could see your blood sugar rise during fasted evening exercise. To determine if your workout affects you in this way, do your first evening fasted exercise session without an extra bolus of insulin and simply see what happens. If your blood sugar rises, start out with a very small bolus before that workout next time and see what happens.

4. Use very specific foods before, during, and after your workout.

The food you choose to fuel your body before exercising is critical. Eating a cupcake with buttercream frosting before your afternoon treadmill session is going to throw a giant, messy variable into your blood sugar management. Choose foods that won’t cause a terribly tedious blood glucose upset.

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For example, lower carbs with a little bit of fat and/or protein. When I used to teach power yoga, I knew that one 6-ounce yogurt (with about 18-22 grams of carbs) eaten immediately before class started was perfect for keeping my blood sugar in my ideal range without dropping. If I ate it too soon before class, my blood sugar would spike, though. Then, I’d end up needing a tiny bolus of insulin to get it down so my blood sugar wasn’t sitting at 300 mg/dL during the entire class.

Even a spoonful of peanut butter is a great option for a simple boost. 🥄 If your favorite yoga class is somewhere between gentle and moderate, you may only need something that has the teeniest amount of carbs, plus a lot of fat. Peanut butter takes the win here!

The more protein or fat a food contains, the slower it will digest. Thus, the more slowly it will impact your blood sugar. If I’m going on a 4-hour hike and I know that 2.5 of those hours are uphill (meaning, my body will be working hard and requiring lots of glucose), I’ll eat ⅓ to ½ of a protein bar (my fave is the GFB bar) at the start of the hike. Then, I’ll eat the next portion halfway through going up. And finally, eat the last portion near the top, depending on my blood sugar at that point. All the while, keeping in mind that the trek down won’t burn nearly as much glucose, if any at all.

Choose wisely. Think about the macronutrients that make up the food you’re choosing. And be consistent!

5. Create different plans for different times of day and types of workouts. And take notes! 📝

Whether you exercise fasted in the morning, right after eating breakfast, or two hours after lunch, you’re going to need a different plan based on when you workout. The plan that works well after breakfast simply might not work that well if you’re exercising after dinner.

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Whatever time of day, type of workout, and type of food/insulin preparation you do, take notes. Consider them when you change any of those variables. Once you’ve tested out your 6pm Yoga Class plan enough times, for example, you can always refer to that page in your notebook. That way, you know exactly what your body needs to ensure your blood sugar doesn’t sabotage your zen! 🧘‍♂️

The whole thing is one giant science experiment. Control the variables. Take good notes. Be patient. And have fun!

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Don’t give up! You’ve got this.

You and I know both know that exercising with diabetes when you’re taking any kind of medication can be a complicated mess. On the flip side, exercise can do wonders for us. And there’s certainly no way I’m going to let diabetes keep me from doing the exercises I love! Even if my whole plan goes out the window and I can’t control all of the variables, and I end up having to eat 2 bananas to prevent a major LOW, that is totally OK. I tried. 💪

It might take a dozen “experiments” until you figure out exactly what helps you keep your blood sugar in a healthy, safe range during your favorite type of exercise. But that work is worth it! Ultimately, it means your body is moving, endorphins are flowing, and (believe it or not) your diabetes is benefitting.

Exercise is not a waste. Regardless of the highs or lows you may experience at first, the experimenting and persisting will be worth it in the end. Be safe. Be smart. Be patient. And have fun.

Automated Decision Support: One Drop Can Predict Blood Glucose

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Diabetes rates have doubled from 1980 to 2018, rising from 5% to 10% of the global population. Of those 500M people worldwide living with diabetes today, the prevalence has specifically increased in low- and middle-income countries.

Healthcare Out of Reach

In the current healthcare climate, nearly 4 billion people lack access to medical care. In the United States alone, more than 10% of the population lives without health insurance. Where medical intervention is available, access to treatment options is stratified by wealth and income inequality. As a result, the majority of low-income individuals have limited, if any, access to life-sustaining insulin, oral hypoglycemic agents, and other medications critical to gaining control of diabetes, including blood pressure and cholesterol medicines.

The citizens of the world are widely lacking proper diabetes care, and society is consequently bearing the financial cost. To that end, research indicates worldwide losses in GDP from 2011 to 2030, including direct and indirect costs of diabetes, will total $1.7 trillion USD.

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The One Drop Solution

How can we help those in need while simultaneously relieving the massive economic burden the diabetes pandemic has created? The solution is One Drop | Automated Decision Support (ADS). One Drop ADS uses advanced AI, machine learning, and proprietary data science techniques to efficiently deliver automated diabetes care through mobile devices.

As of 2018, over half the world’s population has Internet access via mobile devices. The cost of cellphones is decreasing and access to WiFi is skyrocketing. Therefore Automated Decision Support is an inexpensive and simple way to provide personalized diabetes care to people everywhere.

How it Works

A user enters a single blood glucose moment into One Drop | Mobile. One Drop | Automated Decision Support analyzes this moment, referencing 1.3 billion existing food, activity, medication, and glucose data points from over 1 million users . The user automatically receives an in-app notification including a relatively precise future blood glucose report and suggestions to counteract a possible blood glucose spike or drop.

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Today, One Drop is taking the first step in making Automated Decision Support available 24/7, 365 for nearly 300M people with diabetes worldwide. Those living with type 2 diabetes, not on insulin therapy will have customized blood glucose forecasts, actionable insights, and lifestyle recommendations to support behavior modification — up to the minute, accurate health information delivered right to their phone. All of the powerful, customized diabetes care at a tiny fraction of the traditional healthcare cost.

Try Automated Decision Support Today

One Drop | Automated Decision Support is available on One Drop | Mobile Android and iOS. In an initial September 2018 release, ADS predictions became available to a small pool of very active users. Over the next few weeks One Drop will roll out the feature to all eligible users.

So, how do I receive an insight?

First, download the free One Drop | Mobile app, available for iOS and Android.

App Store      Play Store

Users eligible to receive insights from One Drop | Automated Decision Support must meet the following criteria:

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An Automated Decision Support insight may be randomly triggered as soon as a blood glucose, activity or food moment is logged. Users will not receive more than one insight per day.

Eventually, One Drop | Automated Decision Support and predictive capabilities will expand to a larger audience. Notably, anyone who administers insulin as well as those living with a broader range of diabetes types, including type 1.

The Power of Information

One Drop | Automated Decision Support combined with scientifically-backed One Drop | Experts, award-winning One Drop | Mobile, and bluetooth enabled One Drop | Chrome results in an undoubtedly powerful, affordable, and clinically effective platform for millions worldwide.

One Drop is ready and able to deliver better care, to more people, at a lower cost.

We are not waiting. We are all in this together. 

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3 Easy Low-Carb Pizza Recipes 🍕❤️ (Without Cauliflower!)

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No more cauliflower! 😑

Personally, cauliflower pizza crusts really don’t do it for me. I’ve never had one I liked. But I love pizza. There’s something about parenting two children under the age of 4 that has given me an all-new appreciation for the cheesy joy and serenity of pizza. Oh yes, I know exactly what it is! Comfort eating fuel after chasing them around the house all day, answering a thousand incessant weird questions, and potty training! Give me all the pizza.

But, as you and I both know so well, pizza (as a person with diabetes) is not our friend. The perfect combo of all that cheesy fat and rich carbo-licious bread creates the perfect storm of blood glucose nightmares. Yep, you know the ones I’m talking about: you bolus too quickly for your ‘za and shoot down low for hours. Or, you don’t time it just right, and eight hours later you are riding so high (and dry, literally). So how can I still love pizza, when there’s this much to lose? Easy! Low-carb pizza for the win. 🥇

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Here are 3 deliciously easy pizza recipes that are supremely low-carb and so worth it.

3 Ingredient Flourless Cheese Breadsticks or Pizza Crust from Kirbie’s Cravings

This one is so easy. Too easy! You’ll look at the ingredients and the directions and think, “Low-carb pizza crust can’t be this easy and still taste this good!” But it does. All you need are eggs, a bag of shredded mozzarella, herbs (basil, oregano, parsley), and a food processor. I’ve also tried making a double batch and storing one in the freezer. I go ahead and roll it out, have it prepped & ready to go, and it works perfectly for a quick homemade pizza performance! Kirbie’s recipe is by far the easiest and fastest if you’re looking for the pizza experience without spiking your blood sugar.

Almond Flour Pizza Crust from King Arthur Flour

If you don’t want to eat as much cheese as Kirbie’s recipe calls for (because you’ll also be putting cheese on top of the crust, along with your other toppings 🧀🧀🧀), Arthur’s recipe calls for a few more ingredients. It does not contain cheese in the actual crust, and it’s a good mix of flatbread crust on the edges with a thin-crust, chewy texture on the inside. It’s extremely simple — I didn’t even mix the dry ingredients first, I just dumped everything into a bowl and mixed it with my KitchenAid! I recently made this one with my favorite “white pizza” toppings: olive oil, garlic, cheese, salt, and tons of red onions. Even my carb-eating, gluten-loving husband enjoyed it! 😮

Cheese Bread & Focaccia Pizza Crust from Comfy Belly

This one is a deliciously coincidental mix of both Kirbie’s and Arthur’s recipes. It contains a lot of cheese and a lot of almond flour. The result? A remarkably soft and thick ‘za compared to the other two, which appear more like a flatbread crust. Comfy Belly has mastered the art of “fluffy” low-carb bread with this recipe. And I’m hankering to try it out with other types of non-pizza bread! If you’re looking for a thicker crust and base for your pizza toppings, this is the one for you. *Note: If you simply roll this crust out to a thinner degree, you’ll end up with thin, flatbread pizza!

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How to Lower A1C Without Medication

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Working to reduce your HbA1c (A1C) is not simple, but it’s extremely worth your while! A lower A1C means a healthier you. And, what it really comes down to, is improving your sensitivity to insulin, and reducing your body’s overall insulin resistance. The more sensitive you become to the insulin your body naturally produces, the more easily your body will maintain safe, healthy blood sugar levels without taking additional medications.

*Do keep in mind when trying to lower your HbA1C as a person with type 2 diabetes that some people simply will need the help of oral or injectable medications. Keep reading for red flags that indicate it’s time to consider taking diabetes medications.

How to Treat Diabetes Without Medication in 5 Steps! 

1. Keep a simple food diary for 5 days. 📒

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The first step to improving your nutrition in an effort to improve your blood sugars is to be honest about what your current eating habits look like. How many of the items in your grocery cart are simple, real, whole foods vs. processed snacks and meal items? (Hint: even that “whole grain” commercial bread counts as a processed starchy carb.) When you write down the exact foods you eat every day for 5 days, take a look and assess:

❓ How many times a day am I eating fresh vegetables and fruits?
❓ How many times a day am I eating items containing sugar?

(Remember, even “healthy” products can have tons of added sugar. Like yogurt!)

2. Eat more plants! 🌱 And fewer processed carbs.

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This certainly isn’t the first time you’ve read that eating more vegetables is good for the human body. But when it comes to managing type 2 diabetes, it’s crucial. Now that you’ve had a chance to look at what you’ve been eating in your food diary, it’s time to choose one meal and one snack of the day to improve. Maybe you’re swapping your Starbucks’ sugar-laden coffee beverage and sugar-laden muffin for two eggs and an apple. Ditch the sugar-loaded Nutrigrain bar for a homemade flaxseed muffin in a mug! Swap the processed, flavored oatmeal package for a serving of whole oats with a sprinkle of cinnamon and a handful of blueberries. Like Dr. Jody says, that Starbucks zucchini bread is just a cupcake without the frosting. That latte, it’s loaded with sugar! And whoa, if you’re still eating cereal for breakfast (even the “healthy” ones, like Kashi or Raisin Bran), then you’re definitely consuming loads of processed carbs and sugar. Ditch the cereal! Instead, find yourself a spoonful of peanut butter with your choice of fruit. 🍓

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3. Get moving, but start small. 🚶‍♂️

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If you haven’t been exercising at all, remember to start small. (Puttering around the yard doesn’t count.) Even just one 15-minute walk after lunch or dinner 5 days a week will do your blood sugars and your body wonders. 🌈 Especially after meals. Because, while your body is digesting what you just ate, you’re counteracting any glucose spikes with walking! Really, that’s all it takes. Just 15 minutes. When you find yourself thinking, “But I’m too tired for a walk! I just wanna sit and watch Jeopardy!” That’s OK, too! Just stand up, and walk in place while watching your favorite show. It’s just 15 minutes. And everyone has to start somewhere! I guarantee you’ll feel so good afterward that it’ll make you look forward to the next one.

4. Remember to include treats. Yes, include!

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Yes, you read that correctly: include some of the foods you love. A plan based on disciplined perfection, seven days a week, every waking hour is simply doomed for failure. After you’ve had time to look at just how often you’re consuming sugar-laden foods, then decide what your most valued treat might be. For some, it’s fresh bread and butter. 🥖 For others, it’s a bowl of ice cream. You might need to start with a once-daily bowl of ice cream while aiming to keep the rest of the day full of healthier choices. Or you might be ready to have your treat every other day, instead. Think about what’s realistic for you, at this point in time, so you can stick to the bigger picture. Improving your A1C does not require perfection. It just calls for improvements in your overall approach to nutrition.

5. If At First You Don’t Succeed…

Remember, nobody changes everything about how they eat and exercise overnight! Evolving your relationship with food and exercise, and your entire body, takes a time. If you give yourself the time and freedom to explore, be curious, and have fun with learning about new ways of eating and cooking and exercising, you might even find yourself having fun! In fact, you might love it. View it as a long-term evolving experiment rather than an upcoming deadline. 🕐

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You Know It’s Time to Consider Diabetes Medications & Insulin When:

You’ve tried all of the above (like, really tried), and you’re still not seeing the results you want. At that point, it may be time to add some medications into the mix. Here are the need-to-know-signs:

“The first sign of needing to start a medication to help lower your blood sugars,” explains Jody Stanislaw, ND, CDE, “is an elevated A1c level — over 6.5 percent — that is not responding well to your efforts to eat a healthier diet, eat fewer carbs, exercise more, and lose weight. If those four things aren’t lowering your blood sugars over the course of three to six months, it’s time to talk about an oral medication like metformin.”

Dr. Stanislaw, a diabetes coach and creator of diabetes training courses has lived with type 1 diabetes since childhood.

“Starting insulin early in your diagnosis of type 2 diabetes can help some patients actually improve their own insulin production by increasing your body’s natural beta cell function,” adds Dr. Stanislaw.

This isn’t guaranteed to be effective in everyone, but it’s a worthwhile reason to let go of your fears of starting insulin early.

“The goal is to get into as healthy of blood sugar control as possible, as soon as possible,” says Dr. Stanislaw. “High blood sugars create damage throughout the body, especially to the precious beta cells — the cells that make insulin. People should be more fearful of high blood sugars than insulin injections.”

Having to begin insulin injections is often seen as a permanent path, but Dr. Stanislaw explains that it’s simply a powerful tool to help get blood sugars immediately into a healthier range, while continuing to make improvements in your lifestyle like nutrition, exercise, and weight-loss. Eventually, a patient who has adopted those healthier lifestyle habits will reduce their need for insulin. Not only will they improve their insulin sensitivity, but they’ll also ideally be able to stop taking insulin altogether.

The real goal is to prevent the development of those long-term complications.

“If complications are developing,” explains Dr. Stanislaw, “especially if you’ve already started taking a drug like metformin, that’s a big sign that it’s time to consider starting insulin. Especially if your non-insulin medications aren’t keeping your fasting blood sugar below 90 mg/dL, and your A1c is over 6.5 percent.”

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A1C Advice: Change What You Consider High Blood Sugar

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When your A1C results are still too high 😣

If you’re frustrated that your HbA1c (A1C) hasn’t gone down despite your best efforts to exercise more, eat fewer carbs, and check your blood sugar more often, there may be one sneaky habit you haven’t noticed: what you consider an “okay” blood sugar is actually a “high” blood sugar that needs correcting with a bolus of insulin.

Your A1c is the culmination of your blood sugar levels over the course of the prior 2-3 months, which means an A1c of 8.0 percent translates to eAG” (estimated average glucose) of 183 mg/dL.

If your blood sugar is 183 mg/dL, this means that for a large part of every day, your blood sugar is either a little lower or a little higher than 183 mg/dL. Meanwhile, an A1c of 7.0 percent translates to 154 mg/dL. Merely a 30-point different, sure. But it has a tremendous impact on your A1c and overall blood sugar levels!

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High vs. High 

The trick, in this scenario, is to adjust the way you think of “high” BG. Sure, we all know 300 mg/dL is “high.” But, if you’re looking to get that 8.0% A1C down to a 7.0%, 183 mg/dL should now resonate with you as “high” as well.

It sounds so easy! But when you try putting it into practice, it can actually be quite tricky. So you see a 183 mg/dL on your meter screen; what do you do to correct it? It’s not high like a 300 mg/dL high, but it’s still, technically, “high” if the goal is to get to 7.0%. But are you registering it as such?

If not, it’s OK! Here are the steps to take to change that mindset, and reach your A1C goal. 🥅

Step 1: Get to the root of the problem 

You can’t fix something until you know (and understand) what the root cause of the problem is. Ask yourself: “What have I been considering a ‘high’ blood sugar that deserves an insulin correction?” Perhaps you need a week of observing and getting to know your honest answer to this question. By the end of the week, you might learn that you’re often around 200 mg/dL after lunch, or you spend the majority of your entire workday around 150 mg/dL and you never take a correction for it, because you’re used to that being “your normal.”

Step 2: Set a new standard of success (aka high BG)

Decide on your new standard of “high blood sugar.” In an ideal world, we’d all aim for that perfect, non-diabetic range of 70 to 120 mg/dL all day long. But, as you and I know all too well, that is pretty darn stressful! And fairly unrealistic for everyday life with diabetes. (The exception being those who are pregnant or eating The Bernstein Diet). Instead, you might decide that you’ll aim to correct any blood sugar over 140 mg/dL (based on the logic, of course, of how long it’s been since your last injection or bolus, to prevent “stacking” your insulin). Whatever your new goal is, write it down (tape it into your glucometer if you have to!) and embrace your new range as your new goal. ⭐️

Step 3: Establish your correction factor 

Establish your Correction Factor …and use it! Your correction factor (CF) is the number of points 1 unit of insulin will reduce your blood sugar. For instance, the common CF is 1:50 or 1:75. Once your CF is established as 1:50, for example, when you see a 150 mg/dL on your glucometer 3 hours after lunch (when your meal bolus is past its peak), you could take a ½ unit of insulin to bring your blood sugar down 25 points. (Remember that certain variables like exercise and stress can impact your CF in that moment. Exercise would cause you to need less insulin for that correction, whereas a stressful conversation or work event could cause you to need more.)

Step 4: Tighten up fasting BGs

Take a look at your overnight and fasting blood sugars. If you’ve been seeing 160 mg/dL on your glucometer in the mornings and don’t do anything about it, that’s going to be a big contributor to your A1c frustration.< That means you’ve spent all night with a blood sugar well above the range of your target A1C. That alone can explain why your A1C is so much higher than your goal, even if you’ve been staying closer to your goal range during the day. Nighttime is 8 hours of your A1C result! Nip that one in the bud by studying your overnight blood sugars more closely and adjusting your insulin and medication doses.

Step 5: Increase background insulin doses

If you aren’t getting enough background/basal insulin, your efforts to lower your A1C will be pretty pointless. When was the last time you did a little basal testing? Evan a small increase of 1 additional unit per day in your background insulin dose can have a huge impact on your overall blood sugars. If you’re seeing habitual spikes and/or long-term high patterns in your levels, rethink your basal settings. Consider that your overall background/basal insulin doses need an increase. It’s an easy fix!

Step 6: Pinpoint other BG trouble spots 

For example, if you usually exercise with your blood sugar around 200 mg/dL because you’re terrified of going low, that’s going to be a daily portion of the day when you’re well above your goal range (if you’re trying to achieve an A1c of 7.0 percent). Learning how to exercise with in-range blood sugars isn’t easy. In fact, it’s a lengthy process of trial and error and more learning, but it can be done! Here are a few resources to help you expand your knowledge around exercising with type 1 diabetes or type 2 diabetes using insulin:

Fit with Diabetes eBook by Diabetes Strong

The Diabetes Athlete’s Handbook by Sheri Colberg, PhD

Fasted Exercise with Type 1 Diabetes by Ginger Vieira

Bright Spots & Landmines by Adam Brown

Dealing with Diabetes Burnout by Ginger Vieira

The ongoing science experiment 

In the end, it’s all just learning, studying, improving and adjusting! The lifelong science experiment of life with diabetes. 🙌 You may have recently come out on the other side of a stressful divorce or been managing the diagnosis of something incredibly stressful like breast cancer–and those stressors in life had caused you to let your blood sugars run higher for a period of time. Hey, it happens! To any of us! (Mine, for example, was the addition of a 2nd child to keep alive on a daily basis! Parenting! Oy vey.) But when you’re ready to focus on reducing your A1c, make sure that your idea of a “normal” blood sugar vs. a “high” blood sugar lines up realistically with your goals.