Thoughts from a Doc: Why do my sugars DO that?!? (Part 2)

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director. 

This is Part 2 of 3 of this series from Dr. Chipkin. Last week we heard his thoughts on how exercise and food impact blood sugars - this week we get his perspective on some medications that can influence your numbers. 

Thoughts from a Doc: 
Why do my sugars DO that?!? (Part 2)

Insulin: (as my daughter would say- d’uh!).  Oral pills like glipizide [Glucatrol], glimepiride [Amaryl] or glyburide [Micronase] cause your pancreas to release insulin which can certainly lower glucose values over the course of many hours.  Other medications (repaglinide [Prandin] or nateglinide [Starlix]) act more rapidly and only cause insulin to be released for a few hours.  But the effectiveness of these pills is based on two things: (1) the ability of your pancreas to make and release insulin; and (2) the ability of your body to use the amount of insulin made by the pancreas.  If your pancreas “worn out”, then these medications won’t be very effective (the analogy is that you can’t squeeze anything out of a dry sponge).  Even if these pills help the pancreas to release insulin, if your body is very resistant to insulin, then it won’t be enough.  Resistance to insulin can occur for many reasons including excess weight, infections, and steroid medications such as prednisone, hydrocortisone or dexamethasone. 

Counter-insulin hormones: These can be thought of as “anti-insulin” hormones - fighting against the action of insulin.  The most common of these are steroid medications like prednisone, hydrocortisone or dexamethasone.  These medicines are sometimes used as pills for weeks at a time and can raise blood sugars a lot.  Sometimes, they are injected into joints or other locations and can raise glucose values for a few days.  Other counter-insulin hormones are stress hormones that are released when people are sick with other illnesses.

Next week's post will discuss a few other factors, including the "element of mystery" that anyone with diabetes knows all too well. Not as simple as it seems, sometimes!!

Guest Post - "I Know Better"

Today we are lucky enough to have another guest post from Seth, a VMG patient. Seth has type I diabetes and has completed our diabetes education program. Thanks Seth!

I hate vacations, not that this has ever stopped me from taking one. Maybe I should say that it's my diabetes that hates them. Truly, I'm not sure I can tell the difference between me and my diabetes. It’s the excess that usually does me in. Excessive lack of exercise and excessive eating push the bg bar line on my cgm up to Himalayan levels. I feel rotten about my poor self-control.

For the past week I’ve been on a staycation. This time was going to be different. In the end It was, too. Just not exactly what I wanted it to be. I told myself I was going to be very, very, good. O.k., I knew I’d be pretty good and, really, I have been. I’ve exercised and eaten right almost everyday. I relaxed. I watched the final two seasons of Borgen. I read magazines that had been piling up on my sofa. I finished a book I’m preparing for the book club I lead. I even lost a  few pounds. Heaven.

I still hate vacations. Most days started well. I managed to wake up with a bg around 100 and feel 100% proud of myself. I had the kind of super healthy breakfast certain internet sites say will prevent colds: a single portion of steel-cut oatmeal with half a banana and walnuts, soymilk and an egg on the side. When I’m working, I count that at 25 carbs—yes, I know that it’s actually more than that, but that’s what I bolus for if I don’t want to sink into the 70s two hours later—and, yes, I know there's a better of way to do that.

So there you have it. I’d wake up with a great, no, not just great, a perfect blood sugar. I’d eat a beautiful, healthy breakfast. I’d drink too much coffee, but I’m pretty sure that’s a good thing. Over the next 2 hours my blood sugar would rise a bit, just as it should. I'd get on the exercycle and peddle through half-an-hour of a Borgen episode. Post-exercise my bg is back to it’s near-hundred level. I’m in the groove. I’m throwing a no-hitter. I’m going to Harvard on these test scores.

Then it all goes wrong. For the rest of the morning my bg would rise until by lunch I’m around 140. This happened all week. I know 140mg isn’t that bad. But a lunch time bolus for 65 carbs—way more than I’m really eating—didn’t change anything. I'm  eating the kind of super healthy super foods that certain internet sites say cure colds, and in good portions, too. Still, my blood sugar was the same or worse at dinner, and even then, bolusing for way more carbs than I ate worked just as well as it did at lunch. I’d finish the day with a correction bolus.

Which is why I really hate vacations. As much as I need them, my diabetes needs special coaxing to behave itself when I change my schedule. I’m guessing that it missed the small, steady amounts of activity I get at work. I tried upping my basal. But that didn’t help, either. Probably I should have upped it more than I did, but for once I thought I’d better be cautious. I decided I didn’t want to bump it again because I’d be back at work in a few days, anyway. I have a suspicion that makes no sense, and I should have known better. At least I'll go to work tomorrow. Hope no one has left any cookies in the staff lounge.

P.S. Borgen is a great TV show.

Thoughts from a Doc: Why do my sugars DO that?!?

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director. 

This is only Part 1 - stay tuned in coming weeks for more. 

Thoughts from a Doc: 
Why do my sugars DO that?!? (Part 1)

I get asked this question several times a week. I usually take this as a chance to remind people how complicated blood sugar control is.

There are at least six factors that influence blood sugar (glucose) levels. Let's start with two: 

Food: obvious, and yet not so easy. “Simple” sugars cause rapid increases in blood sugar. More complex sugars (those from milk, grains, starches) cause glucose levels to rise more slowly and over a longer period of time.  We try and take advantage of that when we talk about eating more “complex” carbohydrates- either to let your body “catch up” to the carbohydrates that have been eaten or to be available over a longer period of time (after exercise or after a low blood sugar).  And it turns out that the way sugar is absorbed can be affected by other foods such as fiber or fat.  So sometimes foods make sugar levels go up fast and sometimes they go up more slowly.

Exercise: also obvious but also not so easy. Activity that uses a lot of muscles cause those muscle cells to absorb glucose (sugar) from the blood.  But your liver usually makes extra glucose for your muscle cells.  Very vigorous exercise (e.g., running longer distances) can cause your body to release adrenalin (also called epinephrine) which makes your blood glucose levels rise further.  But those muscle cells that absorbed the sugar during exercise continue to absorb it after exercise.  In addition to “soaking up” more sugar following exercise, muscle cells also become more sensitive to insulin.  In some cases, the increase in sensitivity can last over 12 hours!  So sometimes exercise can raise your blood sugars initially but sometimes exercise can make your glucose levels decrease after exercise and then, sometimes, your body may seem to overreact to insulin for many hours afterwards (not typically more than 18 hours).  

Next week's post will discuss other factors, including hormones, medications, not to mention the "element of mystery" that anyone with diabetes knows all too well. With all these different factors, and the ways that each of these factors can change blood sugar values, it’s pretty impressive we ever get things close to being on target!!  This is why each individual has to learn about their own personal diabetes and some of the “quirks” of how their body responds.