A question was posted to me this week about why they had high glucose levels. This question is quite common for me especially when I ask if people have any questions on my Facebook page.
It’s a perfectly normal question to ask. Blood glucose levels are the name of the game with diabetes after all. So anyone with the slightest concern about the disease will have likely at one time or another had this question.
The answer isn’t so straight forward because there are a plethora of variables to contend with. What type of diabetes do you have. How long have you had it? What medications do you take? What is your diet like? How much do you weigh? The list goes on and on.
However, I thought I’d try my best to provide a general answer. It may be impossible to address everyones individual circumstances in such a post but hopefully it will give you some ideas.
The progression of the disease
Type 2 diabetes is a progressive disease. It gets worse over time. Particularly if you don’t manage it well. Over time your pancreas, which produces insulin, can become overworked and the end result is a reduction in your insulin production. Often it is at this stage someone with type 2 diabetes goes onto insulin.
Type 2 diabetes is a disease that exists on a scale. At one end of the scale you have someone who is diet controlled with a HbA1c of 48mmol/mol (the lowest it can be for a diagnosis of type 2 diabetes). At the other end of the spectrum you have someone on multiple tablets, multiple high dose insulin injections and a very high HbA1c. We then have everyone else in between.
Despite both these people being classified as someone with type 2 diabetes, they are worlds apart. Therefore, high glucose levels will be managed very differently.
The optimal management plan for anyone with type 2 diabetes comes from you. The underlying cause of the disease in 90% of patients is being overweight and/or unfit. Therefore, first line treatment is treating the cause and not the symptoms of diabetes which are high glucose levels. If you have high glucose levels and you are not eating healthy, getting active or losing weight, that’s mostly likely why.
Lets start with someone who is diet controlled only. If your glucose levels start to increase it means 2 things. One, the need for medication is near. Two, you need to make some serious lifestyle changes ASAP.
This involves eating much healthier, getting active and crucially losing weight. When I say eating healthier I mean 5 portions of fruit and vegetables per day MINIMUM (ideally more veg), smaller portions, limit sugar, only have modest portions of carbohydrates (fist size) and the list goes on.
Physical activity needs to become a major part of your lifestyle if you want to sustain your improved control. You don’t need me to tell you that fit people have better medical outcomes.
All the above principles apply to these individuals. Oral therapy does not mean it is too late to make a difference to your control. If you are managing on tablets alone it suggests your pancreas is still producing sufficient insulin but it isn’t working as well.
The more tablets that are added into your regimen, the further the diabetes has progressed. It then becomes harder to move in the other direction whereby you begin to reduce your medications through lifestyle changes.
Once insulin is commenced it still doesn’t mean it is too late per se. A lifestyle change at any time will be beneficial. However, I won’t lie, it starts to become more difficult to manage.
If your glucose levels are well controlled and you take multiple tablets and/or insulin it is likely more down to the medication. This means you remain on the conveyor belt before the next progression of the disease.
These people are the ones at the highest risk of complications from the disease. This is because their body is becoming more insufficient in it’s ability to control it’s glucose levels. Without any medications in these patients, their glucose levels would be very high.
I often see patients with foot disease taking multiple therapies and high dose insulin. These patients usually suffer with obesity too. It is very hard to do anything for these patients because we have maxed out our options medically. Therefore, their solution needs to come from lifestyle. The problem is these patients struggle to get active due to the foot disease. So their calorie requirement is very low. This makes it very easy to gain weight if they aren’t basing their diet around vegetables and low calorie foods.
These patient will not ever rid themselves of diabetes or the existing complications. What they can do however is prevent further problems and improve current symptoms.
Our vascular surgeon often asks patients to lose weight in order to improve circulation to the extremities and take weight of the feet.
So in essence we come full circle and see the solution comes down to lifestyle and weight management.
Lifestyle and weight management
Unfortunately, this is the hardest part. Particularly if you have lived your whole life in a particular way and then suddenly need to turn this 180 degrees on its head.
Often my patients don’t comprehend what is required in order to make a significant change. They will cut out sugar, which is great, but this doesn’t guarantee success. Making only one change may only slow down their weight gain because they are still eating too many calories elsewhere. Therefore, the diabetes continues to progress.
I’ve blogged about what is required many times in the type 2 diabetes section of this site. Here’s an example.
What each person needs to do will vary depending on their individual circumstances. One thing they will all have in common is it isn’t easy. Each person needs to make their health a priority. This will take time and effort. It means compromising on some things.
This doesn’t mean you still can’t enjoy yourself and have days out and treats. It just means 80-90% of the time you follow healthy living principles.
A healthy lifestyle can actually be very enjoyable. There are many healthy and great tasting foods. Getting outside and walking and becoming more active is great for the body and the mind. It is this lifestyle I am really passionate about and endorse to all my patients.
Granted I have just finished a pizza but we’ll write that off as the 10% of the time we can be naughty.
I hope this articles clears up why your glucose levels are high. I’ll try to expand on this in the future with a more comprehensive guide about how to manage your glucose levels.
Let me know your thoughts by joining the Facebook Group and community page.
Blog picture from: https://juvenon.com/when-your-blood-glucose-level-goes-too-high/