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BLOOD GLUCOSE: WHAT RAISES AND LOWERS IT?
Things that RAISE blood glucose levels:
Food & Diet. Your body breaks carbohydrates down into glucose. When you eat, your blood glucose levels rise. Different foods contain different amounts of carbohydrates, so blood glucose levels will vary. If you are on a low-fat diet, remember you still have to pay attention how many carbohydrates (sugars) you are eating, or your blood glucose level may rise. Also, some "low-fat" and "no-fat" foods contain modified forms of carbohydrate used as emulsifiers or bulking agents that can push up your blood sugar.
Stress. Stress produces hormones that cause glucose levels to increase.
Illness. Sickness often raises blood glucose levels because the liver releases extra glucose in response to illness, and the body also releases hormones that counteract the effects of insulin. In addition, some cough and cold medicines contain ingredients that also raise blood glucose levels (and blood pressure).
Exercise. If you have type I diabetes and do not have enough insulin aboard, exercise can make your blood sugar level rise. During moderate to vigorous exercise, nerves signal the liver to release stored glucose. If you do not have enough insulin to cover the extra sugar in your blood, ketoacidosis can result. That's why you should check your blood glucose levels both before and after you exercise to make sure they are O.K.
Dawn Phenomenon. Very early each morning, the body releases hormones that wake you up and tell the liver to release stored glucose to give you energy to start the day. These hormones also inhibit insulin. The result is that glucose level rises between 4 a.m. and 8 a.m., a reaction known as the dawn phenomenon. Dawn phenomenon is the reason why blood glucose levels are often unusually high when you wake up. If your glucose levels are high each morning, talk with your health care team. You may need to modify the dose or type of insulin you take before bed. You may need to get up around 3 a.m. and take insulin. Or you may need to eat less at breakfast or increase your morning insulin dose.
Menstruation. In some women, cyclic changes in blood levels of estrogen and progesterone wreak havoc on blood glucose around the time of menstruation. Depending on the individual, sometimes blood glucose may rise too high, or fall too low.
What should you do if your blood glucose levels tend to go up before your period?
Things that LOWER blood glucose levels:
Insulin. As nondiabetics digest their food, their blood glucose levels rise, which triggers their pancreas to release insulin into their blood. This insulin allows their cells to use glucose. As their cells use glucose, blood glucose levels drop. In people with diabetes, injected insulin does the same thing--it allows the cells to metabolize glucose, and as they do, blood glucose levels fall.
Oral Diabetes Medications. The purpose of all three oral diabetes medications--sulfonylurea drugs, acarbose, and metformin--is to reduce blood glucose levels.
Exercise. Glucose is found not only in the blood, but also in the liver and muscles, where it is called glycogen. When you exercise, your muscles use glycogen for energy. When these reserves start to run dry, your muscles retrieve glucose from the blood, causing blood glucose levels to fall. Exercise also makes the muscles and other tissues more sensitive to insulin, so you need less of the hormone to move glucose out of the blood. If you exercise regularly, you may be able to eat a little more, or inject a little less insulin, or reduce your dose of oral diabetes medication. Also, by increasing blood flow, exercise speeds up insulin absorption.
Alcohol. Alcohol lowers blood glucose levels. Normally, when blood glucose levels drop too low, the liver converts stored glycogen into glucose. But alcohol interferes with this process, and may considerably lower glucose levels fairly suddenly. It's okay to drink alcohol in moderation (no more than two drinks a day), but if you drink alcohol, monitor your blood glucose frequently to keep from suffering hypoglycemia.
Menstruation. In some women, cyclic changes in blood levels of estrogen and progesterone wreak havoc on blood glucose around the time of menstruation. Depending on the individual, sometimes blood glucose may rise too high, or fall too low.
What should you do if your blood glucose levels tend to go up before your period?
Exercise a little more to help bring glucose levels down.
Try to avoid extra carbohydrates.
If you use insulin, ask your doctor about gradually increasing your dose.
Sex. Sex is a form of exercise, and like exercise in general, it can cause your blood glucose levels to fall. If you use insulin, monitor your blood glucose level after sex.
JUST A LITTLE EXERCISE IS TERRIFIC FOR YOUR HEALTH
Benefits of low-intensity exercise:
Less risk of diabetes. Compared with not exercising at all, moderate physical activity just one day a week significantly reduces risk of diabetes.
Better control of blood glucose with less insulin. For people with diabetes, a similar level of activity--a leisurely lap or two around the typical mall--significantly decreases insulin resistance. As insulin resistance declines, you need less of the hormone to move glucose out of the blood into the cells. Even a few moderate walks a week can reduce your insulin needs, possibly allowing people with type II diabetes to get off insulin altogether.
Less risk of cardiovascular disease. Similar leisurely strolls also reduce blood pressure and cholesterol, reducing risk of cardiovascular disease, the leading killer of people with diabetes. "For exercise to improve your health, you don't have to wind up panting." "To reduce cholesterol and blood pressure, low-intensity exercise works quite well. And the more out of shape you are to begin with, the more you benefit from any exercise."
Better weight control. In addition to burning extra calories while you're exercising, physical activity boosts "basal metabolic rate," the rate the body burns calories while at rest. When you're physically active, you continue to burn extra calories even after you stop exercising. With low-intensity exercise and a low-fat diet you'll probably lose a few pounds." Every pound lost helps reduce insulin resistance and risk of diabetes complications.
Exercise about 30 minutes a day. It does not have to be a half hour all at once. Any short-duration exercise that adds up to 30 minutes will be just as beneficial.
Getting Physical in Daily Living
Take a walk. Walking is wonderful exercise. It also helps prevent bone-thinning osteoporosis, which plagues older women.
Park a few blocks farther away. Walk the extra distance to work, the mall, the movies, church, or friends' homes. As you gain stamina, park even farther away and/or walk more briskly.
Take a walk before lunch. In addition to getting exercise, you may find you eat less for lunch and suffer less from mid-afternoon blahs.
Cancel "food dates." Instead of meeting friends for lunch, coffee, or dessert, make dates to take walks, go dancing, or go for bike rides. Or make a date to visit a health club. Most clubs allow free one-time visits to check out the facility. Try several.
Walk your dog. If you don't have one, consider getting one. Dogs are great exercise companions.
Don't automatically use the phone or intercom at work. Walk to neighbors' homes or coworkers' desks.
Put more energy into housework. Washing floors, taking out the trash, vigorous sweeping and vacuuming, and other chores provide more exercise than most people think. If you step up the pace a bit, you'll get finished faster and you'll get more exercise as well.
Tend a garden. Digging, weeding, raking, cutting, and hauling build strength, flexibility, and stamina.
FACTS ABOUT SUGAR....
*Fructose: (fruit sugar, levulose) One of the most common natural sugars. It's found mostly in fruit and honey. If your diabetes is under good control, it should not cause rapid or significant rise in blood glucose level.
Glucose: (corn sugar, dextrose, grape sugar) Another common natural sugar. It causes a quick and significant rise in blood sugar. The body creates glucose during digestion by breaking down carbohydrates in food and uses it for energy. Glucose builds up in the blood if your diabetes is not well controlled.
Sucrose: (beet sugar, brown sugar, cane sugar, confectioner's sugar, invert sugar, powdered sugar, raw sugar, saccharose, sugar, table sugar, turbinado) A naturally occurring sugar made from sugar cane or sugar beets. It's what we think of when we say the word 'sugar.' It's made of equal parts glucose and fructose.
Dextrin: Consists of chains of glucose molecules; effect on blood glucose may be similar to that of glucose.
Dulcitol: A naturally occurring sugar alcohol.
Honey: (comb honey, cream honey) A natural syrup that varies in sugar and flavor. It contains about 35 percent glucose, 40 percent fructose, and about 25 percent water.
*Lactose: This is milk sugar. It makes up 4.5 percent of cow milk.
*Mannitol: A naturally occurring sugar alcohol, mannitol causes less of a rise in blood sugar than sucrose or glucose. In large amounts it can cause diarrhea.
Molasses: (blackstrap, golden syrup, refiners' syrup, treacle, unsulphured) These contain from 50 to 75 percent sugar and should generally be avoided by diabetics.
*Saccharin: The most commonly used sweetener in the U.S.
*These sweeteners are generally considered appropriate for diabetics.
Carbohydrate Counting:
Many people with diabetes have used exchange lists to plan their meals. In this system, foods with the same amount of a given nutrient--protein, fat, or carbohydrate--are grouped together. You then pick and chose from the different categories to make a meal.
Carbohydrate is the sugar and starches in food, the substances that most directly affect blood sugar. With carb counting, you keep track of the carbohydrate in your food.
To understand how carb counting works, you have to understand how glucose gets into your blood in the first place. Let's say you just devoured a juicy cheeseburger and washed it down a big vanilla milkshake. Most of this food will eventually end up in your blood as glucose. But how much, when, and how fast?
Research shows that very little of the fat you eat is converted into glucose. Some of the protein you eat is converted into glucose, but very slowly.
By contrast, within an hour or so more than 90 percent of the carbohydrate you eat becomes glucose. This means that when you test your blood one to two hours after a meal, most of the rise in blood glucose that you see comes from the carbohydrate you ate.
Carb counting assumes that if you know how much carbohydrate you eat, you can predict where your blood glucose level is headed. If you eat a little carbohydrate, your blood sugar rises a little. If you eat a lot of carbohydrate, your blood sugar shoots up a lot.
Insulin balances glucose, so one way to control your blood glucose levels is to match insulin to carbohydrate. This is exactly what carb counting does.
Dangers of dietary fat:
Diabetes. Diabetes contributes to more than 250,000 deaths a year. More than 90 percent of people with diabetes have type II disease. The main risk factor for type II diabetes is obesity, and a prime cause of obesity is a high-fat diet.
Obesity. "Obese" means that you weigh 20 percent more than the recommended weight for your height and build. Obesity is the prime risk factor for type II diabetes. It also increases risk of heart disease, several cancers, hypertension, and arthritis. It is a problem only in countries with a high-fat diet.
Heart Disease. The nation's leading cause of death, heart disease kills 720,000 Americans a year, most as a result of heart attacks. Compared with nondiabetics, people with diabetes have three times the risk of heart disease. A high-fat diet is a key cause of the cholesterol-rich deposits called plaques that narrow the coronary arteries and trigger heart attacks. Virtually all Americans, especially diabetics, have these plaques in their coronary arteries, because they begin to develop as soon as people start eating a high-fat diet, which usually begins during childhood.
Stroke. Stroke is the nation's third leading cause of death, claiming 144,000 lives a year. Compared with nondiabetics, people with diabetes have five times the risk of stroke. There are two major types of stroke, one caused by bleeding in the brain (hemorrhagic), the other by blockage of an artery there (ischemic). About 75 percent of strokes are ischemic, and the vast majority of ischemic strokes are caused by cerebral thrombosis, blockage of a brain artery in a process similar to heart attack. Just as a high-fat diet contributed to heart attack risk, it also boosts risk of stroke.
Fat Facts
Carbohydrates, including fruits, vegetables, beans, and grains provide most of the body's energy, people with diabetes must control their carbohydrate intake to prevent hyper- and hypoglycemia. But for people who eat a healthy number of daily calories (around 1,500 to 2,000 depending on your height and activity level), carbohydrates are not fattening. Only fat is.
If you limit the fat calories you consume, you don't have to worry all that much about your total caloric intake.
One gram of carbohydrate or protein contains only 4 calories, however, one gram of fat contains 9.
Carbohydrates have a lot of bulk per calorie. Eating them triggers feelings of fullness. It's difficult to overeat if you base your diet on them.
In addition to their high calorie content, fats are also metabolized differently from carbohydrates. The body uses most carbohydrates quickly, and can only store about one day's worth as glycogen in the liver and in muscle tissue. "
Fats, on the other hand, are not metabolized right away. They are stored in adipose tissue, which has an almost unlimited capacity to bulge with fat.
Everyone must consume some fats because they are necessary for the synthesis of essential fatty acids.
Tips on Coordinating Exercise and Diabetes
Regular exercise is crucial to the management of both type I and type II diabetes. Exercise increases cellular insulin sensitivity, which can help you reduce your dose of insulin or oral medication. It decreases risk of cardiovascular disease, by far the leading killer of people with diabetes. It burns calories, which helps weight control. And it has an antidepressant, mood-elevating effect, which improves self-esteem.
But exercise can also increase risk of hypoglycemic crises. So, while diabetics should exercise regularly, they also need to exercise prudently.
Everyone with diabetes responds individually to exercise. Beyond the need to exercise, no generalizations apply to everyone all the time. That's why it's important to test your blood glucose frequently, so you get a good feel for how you personally respond.
Choose an exercise program that fits your physical condition. If you've been out of shape for a long time, start with something nonstrenuous, for example, a leisurely walking program. If you don't have much feeling in your feet, walking, running, and dancing may not work for you. But gardening or swimming might.
Always be conscious of your feet. Check your feet before you exercise. If you see any signs of irritation, use mole foam, available at drug stores, to cushion the area. If you see any cuts, wash them with soap and water, treat them with an antibiotic ointment, and bandage them. During exercise, wear comfortable shoes and socks. After exercise, check your feet again.
Test your blood glucose twice before exercising--about an hour before and then 30 minutes before you begin your workout. Two tests allow you to see if your glucose is stable or dropping. Physical activity usually lowers blood glucose because the muscles use it during exercise.
For most people, the safe pre-exercise blood glucose range is from 100 to 250 mg/dl. If your glucose is less than 100 mg/dl, or if it's dropping down to close to 100, have a snack to raise it before exercising. If it's between 100 and 150 mg/dl, test during exercise, and be prepared to snack to keep your glucose up. For every hour of planned exercise, be ready to consume 10 to 15 grams of carbohydrate: one-half a bagel, one apple, four ounces of a nondiet soda, three cups of plain popcorn, seven dried apricot halves, or a handful of raisins. If your blood glucose is between 151 and 250, this is optimal range for safe exercise.
Do not exercise... if you have type I diabetes and your blood glucose level is greater than 250 mg/dl and you have moderate or high levels of ketones in your urine. Moderate to high urinary ketones mean than your insulin is too low and your body is breaking down fats for fuel.
Do not exercise... with either type of diabetes if your blood glucose is greater than 300 mg/dl. Consult your health care team immediately, and bring it down before you work out.
If you begin a new activity... or increase your workout intensity or duration, test your blood glucose every 30 minutes during exercise, especially if you have type I diabetes. It's hard to predict how new activities or intensified or extended exercise will affect your blood glucose level. Don't take chances. Test every half hour or so until you feel comfortable with how your activity affects your glucose. Have snacks with you and be prepared to eat them as you exercise. However, this advice is less important if you have type II diabetes. Type II diabetics rarely experience exercise-related hypoglycemic crises.
Test your blood glucose several times after you exercise. The more strenuous the workout, the longer afterward it can lower your blood glucose. Exercise draws on glucose stored as glycogen in the muscles and the liver. After exercise, the muscles and liver replenish spent glycogen stores by taking glucose out of the blood. Depending on the intensity and duration of your workout, it may take as long as 24 hours for your glycogen stores to be fully replaced. Until you understand how exercise affects you, test yourself every couple hours after a workout.
You may need to decrease your insulin dose or oral medication dosage. Exercise increases cellular insulin sensitivity, so you need less insulin to move glucose into your cells. Exercise draws glucose out of the blood as the muscles use it for energy. Finally, compared with resting, exercise makes insulin start to work sooner, and peak sooner. As you test yourself, consider reducing your insulin or medication dose, in consultation with your doctor. With regular exercise, many type II diabetics can eliminate insulin and medication altogether. Some type I's can lower their insulin dose.
Understand that exercise may raise blood glucose. Strenuous exercise may stimulate the liver to release glycogen into the blood as glucose. If your blood glucose level is already high, exercise might push it into the danger zone. That's why it's so important to test before, during, and after exercise until you're confident you know how your glucose level responds.
Plan to exercise after eating. It's best to work out one to three hours after a meal. That way you have recent food consumption to supply the glucose you need to exercise and to replenish glycogen stores in the liver and muscles. Exercising after eating also helps prevent hypoglycemia.
Don't exercise when your insulin is peaking. When insulin is at its strongest, it moves a great deal of glucose out of the blood. If you're exercising at the same time, you might develop serious hypoglycemia. In addition, an exercising muscle absorbs insulin faster than a muscle at rest, further increasing risk of hypoglycemia. Ideally, wait an hour after injecting insulin to exercise. If this isn't possible, inject at a site that won't be exerted during exercise. If you plan to walk, jog, dance, or bike, you might inject your abdomen.
Exercise can help type II diabetics get off insulin and drugs.
Information from www.diabetes.com