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Understanding Diabetes and Blood Sugar Control

Imagine this scene. Your doctor tells you that you have diabetes. You are afraid as you are not too sure what it all means. You start hearing new terms such as blood glucose, insulin, hemoglobin A1c, fasting blood glucose, fasting blood sugars and it seems overwhelming. So let’s take a minute to break it down. Understanding your disease is the first step in maintaining your health.

So what exactly does it mean to have diabetes? 

When a person eats, whether they have diabetes or not, the glucose level in their blood rises. The term “blood glucose level” is commonly referred to as “blood sugar”. A rise in blood glucose levels after eating is normal, and it’s how the body nourishes the cells. When a person does not have diabetes, the pancreas produces insulin, whose job it is to bring down glucose levels in the blood stream before it rises to a dangerous level. Insulin equalizes blood glucose levels to safe levels. But when a person has diabetes, their pancreas does not produce enough insulin, if any at all, or the insulin they produce is not working properly.  Therefore, when a person has diabetes, the blood glucose rises unimpeded, causing damage to the organs. If uncontrolled and levels rise dangerously high, it could cause coma or death.

Chances are you may have family members and friends who have diabetes. As a matter of fact, 6 percent of Americans have diabetes. November 14th is designated as World Diabetes Day.

What causes glucose levels to rise?

Blood sugars in our blood stream rise naturally when we eat, in order to feed our cells. But not all foods cause an equal rise in blood sugar. Foods containing carbohydrates make blood glucose levels rise sharply. When those levels go beyond safe levels, damage occurs to organs and nerve endings. Foods high in carbohydrates include, but are not limited to bread, pasta, crackers, cereals, starchy vegetables such as potatoes, peas, and corn, milk, soy milk, yogurt, fruits and fruit juices, grains and legumes, snack foods such as chips and pretzels, cakes, cookies, candy and table sugar. Proteins (meat, chicken, eggs, fish,) and non-starchy vegetables are low in carbohydrates and will not cause a sharp rise in glucose levels.

What is the goal for blood glucose levels?

According to the American Diabetes Association, a fasting blood glucose should be 80-130 mg/dl, and 2 hours after eating, blood glucose should be less than 180 mg/dl for a person who has diabetes.

How often should blood glucose be checked?

Blood glucose levels are constantly fluctuating due to what you ate, how much you ate and how long ago you ate. Although it seems tedious, checking your blood sugars before and after you eat is the best way to understand the relationship between what you are eating and how it affects your glucose levels.  It is important to check your blood glucose before you eat to know your starting off point.

Hidden Carbohydrates

There are foods that have “hidden” carbohydrates that are not so obvious to detect, so checking your blood sugars after a meal is important.  For example, it is well known that Chinese food may be high in sodium. But cornstarch, a carbohydrate source is often used as a thickener to thicken sauces in Chinese cuisine. Therefore, ordering beef and broccoli stir fry may seem like a healthy choice, but unless you check your blood glucose level, you may not be aware how a dish with sauce is affecting your level. Keeping a food log that you can share with your doctor or dietitian with the following information may be helpful.

Pre meal glucose Post meal glucose Time Food Quantity Hunger level 1-5 Mood (ie bored, stressed)

Identifying hunger level and mood is helpful if overeating is an issue. It can help you pinpoint situations that promote overeating.

What happens if blood glucose levels are consistently uncontrolled?

High blood glucose levels are harmful to the organs and most especially the kidneys, eyes and nerve endings. The effect of high blood glucose on the body is cumulative; meaning that, although your blood sugars eventually come down, the damage to your organs has been done and it is not reversible. Some of the side effects of consistently high blood glucose are cardiovascular disease, kidney disease, possibly leading to chronic kidney disease, dialysis, blindness, decreased wound healing as well as nerve damage leading to pain and amputation of limbs.

 

What is a hemoglobin A1c

A hemoglobin A1c level (A1c for short) is a blood test that indicates the average blood glucose level for the past 3 months. A single glucose level (like when you stick your finger and take a reading) looks at one level at one moment in time, but A1c looks at the average blood sugars for a 3 month period of time. This gives your healthcare team a better idea of the “story” of your glucose levels for a period of time. So the single blood glucose level is like a snapshot but an A1c level is like seeing the movie. See the chart below for the A1c levels and the corresponding average blood sugars.

A1c level Average glucose level (mg/dL)
6% 125
7% 154
8% 183
9% 212
10% 240
11% 269
12% 298

So if your doctor tells you your A1c level is at 10%, it means that your average glucose levels are at 240 mg/dl. This is cause for concern as this will have a negative effect on your health.

How can blood sugars be controlled?

It is possible to maintain your blood sugars within a healthy range and enjoy foods that you like, within moderation. Eating smaller, frequent meals helps to avoid blood sugar highs and lows. Replacing some carbohydrate foods with lean proteins or non-starchy vegetables helps you to avoid the undesirable peaks and valleys associated with uncontrolled blood glucose levels.  Make your plate about half non-starchy vegetables, a quarter lean protein and a quarter carbohydrate foods. Make sure to learn which foods contain carbohydrates so that you are aware of how your glucose levels are affected by what you eat.  Maintain a healthy weight. Regularly monitor your glucose levels. Visit your doctor regularly. Ask your doctor to refer you to a registered dietitian. Take your medications as prescribed and stay on top of your disease.

We’ve all heard the saying “your health is the most important thing.”  Why?  Because when you lose your health, you lose your freedom. So, maintain your health and maintain your independence.

For more information read “Maintaining Good Diabetes Control“.

Rasheeda Mustafa, MS, RD, CD-N

Rasheeda Mustafa, MS, RD, CD-N

Rasheeda Mustafa, MS, RD, CD-N has been a dietitian for 18 years, having worked predominantly with the geriatric population in long term care, short term rehab and home care. She has worked with DaVita almost 2 years, currently practicing in Bronx, NY. What she enjoys best about working in renal is the experience of learning a completely new aspect of nutrition as well as the camaraderie that she shares with her new colleagues and the interactions she has with her patients. Her previous background was in the food service industry, having attended The Culinary Institute of America and working in high end restaurants for such notable chefs as Emeril Lagasse. She enjoys travelling near and far and has been an avid practitioner of yoga for 12 years.