Diabetes management: How lifestyle, daily routine affect blood sugar

When it comes to diabetes management, blood sugar control is often the central theme. After all,

keeping your blood sugar level within your target range can help you live a long and healthy life with

diabetes. But do you know what makes your blood sugar level rise and fall? The list is sometimes

surprising.

Food

Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that

affects your blood sugar level. How much you eat and when you eat matters, too.

What to do:

Be consistent. Your blood sugar level is highest an hour or two after you eat, and then

begins to fall. But this predictable pattern can work to your advantage. Simply eating about

the same amount of food at about the same time every day can help you control your blood

sugar level.

Even out your carbs. Carbohydrates have a bigger effect on your blood sugar level than

does protein or fat. Eating about the same amount of carbohydrates at each meal or snack

will help keep your blood sugar level steady throughout the day.

Coordinate your meals and medication. Too little food in comparison to your diabetes

medications — especially insulin — may result in dangerously low blood sugar

(hypoglycemia). Too much food may cause your blood sugar level to climb too high

(hyperglycemia). Your diabetes health care team can help you strike a balance.

Exercise

Physical activity is another important part of your diabetes management plan. When you exercise,

your muscles use sugar (glucose) for energy. Regular physical activity also improves your body's

response to insulin. These factors work together to lower your blood sugar level. The more strenuous

your workout, the longer the effect lasts. But even light activities — such as housework, gardening or

being on your feet for extended periods — can lower your blood sugar level.

What to do:

Get your doctor's OK to exercise. This is especially important if you've been inactive and

plan to start exercising regularly.

Adjust your diabetes treatment plan as needed. If you take insulin, you may need to

adjust your insulin dose before exercising or wait a few hours to exercise after injecting

insulin. Or your doctor may suggest other changes to your diabetes treatment plan.

Exercise good judgment. Check your blood sugar level before, during and after exercise,

especially if you take insulin or medications that can cause low blood sugar. Drink plenty of

fluids while you work out. Stop exercising if you experience any warning signs, such as

severe shortness of breath, dizziness or chest pain.

Medication

Insulin and other diabetes medications are designed to lower your blood sugar level. But the

effectiveness of these medications depends on the timing and size of the dose. And any medications

you take for conditions other than diabetes can affect your blood sugar level, too.

What to do:

Store insulin properly. Insulin that's improperly stored or past its expiration date may not be

effective.

Report problems to your doctor. If your diabetes medications cause your blood sugar level

to drop too low, the dosage or timing may need to be adjusted.

Be cautious with new medications. If you're considering an over-the-counter medication or

your doctor prescribes a new drug to treat another condition — such as high blood pressure

or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood

sugar level. Sometimes an alternate medication may be recommended.

Illness

When you're sick, your body produces hormones to help fight the illness. These hormones raise your

blood sugar level by preventing insulin from working effectively. This can help promote healing — and

wreak havoc with your diabetes management plan.

What to do:

Plan ahead. Work with your health care team to create a sick-day plan. Include instructions

on what medications to take, how often to measure your blood sugar and urine ketone levels,

how to adjust your insulin dosage, if you need insulin, and when to call your doctor.

Continue to take your diabetes medication. If you are unable to eat because of nausea

and vomiting, contact your doctor. In these situations, you may need to temporarily stop

taking your medication because of risk of hypoglycemia.

Stick to your diabetes meal plan. If you can, eating as usual will help you control your

blood sugar level.

Alcohol

The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is

busy metabolizing alcohol, your blood sugar level may not get the boost it needs. If you take insulin or

oral diabetes medications, even as little as 2 ounces (59 milliliters) of alcohol — the equivalent of two

shots of hard liquor — can cause low blood sugar.

What to do:

Get your doctor's OK to drink alcohol. Alcohol can aggravate diabetes complications, such

as nerve damage and eye disease. But if your diabetes is under control and your doctor

agrees, an occasional alcoholic drink with a meal is fine.

Choose your drinks carefully. Light beer and dry wines have fewer calories and

carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, stick with sugar-free

mixers — such as diet soda, diet tonic, club soda or seltzer.

Tally your calories. Remember to include the calories from any alcohol you drink in your

daily calorie count. Ask your doctor or dietitian how to incorporate calories from alcohol into

your diet plan.

Hormone levels

Hormone levels fluctuate for women during their menstrual cycle, as can blood sugar levels —

particularly in the week before a period. Menopause may trigger fluctuations in blood sugar levels as

well.

What to do:

Look for patterns. Keep careful track of your blood sugar readings from month to month.

Soon you may be able to predict fluctuations related to your menstrual cycle.

Adjust your diabetes treatment plan as needed. Your doctor may recommend changes in

your meal plan, activity level or diabetes medications to make up for monthly blood sugar

swings.

Stress

If you're stressed, it's easy to abandon your usual diabetes management routine. You might exercise

less, eat fewer healthy foods or test your blood sugar less often — and lose control of your blood

sugar in the process. The hormones your body may produce in response to prolonged stress may

even prevent insulin from working properly, which only makes matters worse.

What to do:

Look for patterns. Log your stress level on a scale of 1 to 10 each time you log your blood

sugar level. A pattern may soon emerge.

Take control. Once you know how stress affects your blood sugar level, fight back. Learn

relaxation techniques. Prioritize your tasks. Set limits. Most importantly, take good care of

yourself.

The more you know about factors that influence your blood sugar level, the more you can anticipate

fluctuations — and plan ahead accordingly. If you're having trouble keeping your blood sugar level in

your target range, ask your diabetes health care team for help.