Diabetes is a very complex chronic illness and besides food and physical activity there are many other factors that affect blood glucose levels. In this weeks’ new blog post I will be sharing all 42 factors and I will provide brief comments on some of these.
This list is from the book “Bright spots & Landmines” by Adam Brown. This is a very practical and useful guide that I read and has helped me over the years to have better control over my blood sugar levels.
Based on Adam’s personal experience and the help of other experts, he created this list and did a great job in assigning these factors into different categories. These categories include: food, medication, activity, biological, environmental and behavior & decisions.
Below I will share the complete list and will assign arrows which represent the effect of each factor on blood glucose levels. Upward arrow ⬆ raises blood sugars, downward arrow ⬇ lowers blood sugars and sideway arrow ➜ which indicates a neutral effect.
It is important to mention that the effect of these factors on every individual could be different and this is just a general idea. Diabetes is unique and different for everybody. The only way to find out how these factors affect your specific blood glucose levels is through your own personal experience and continuous glucose monitoring.
This list starts with the food category and guess what? If you’ve been reading my other blog posts I do make a lot of emphasis on the importance of healthy eating and exercise in order to control glucose levels. This list will start with the number 1 factor which is carbohydrate quantity.
FOOD FACTORS:
1) Carbohydrate quantity ⬆ ⬆ : I covered this in the what I eat as a type 1 diabetic post and explained that all carbs turn into sugar so they will definitely raise glucose levels. Be careful with the amount and the type of carbs you eat. For more information on this you can check the glycemic index of foods post here.
2) Carbohydrate Type ➜ ⬆ : Not all carbs are the same. I did explain this in The glycemic index of foods post that explains which carbs will raise your sugars faster and which carbs will raise sugars slower. Always try to eat carbs from the list of foods with low glycemic index.
3) Fat ➜ ⬆ : Fat can also raise sugar levels so it is important for some people to dose and inject insulin for fats too. Meals with high fat and high carb content might require more insulin. This depends on each individual’s insulin requirements.
4) Protein ➜ ⬆ : Again, protein might raise glucose levels but not as much as carbs do. This also depends on each individual’s insulin requirements. I personally only calculate insulin for carbs.
5) Caffeine ➜ ⬆ : For some people caffeine will raise sugar levels. In my case this doesn’t happen. Oh and I don’t add any bullshit to my coffee. I drink it black, no cream, no sugar, no bullshit. The more things you add to your coffee the more it will probably raise your sugars. So keep this in mind for next time.
6) Alcohol ⬇ ⬆ : When you drink alcohol, your liver is busy breaking down the alcohol and stops releasing glucose into the bloodstream which might cause low blood sugar levels. Now imagine drinking a cocktail with a bunch of fucking sugar? You are right … your glucose levels will definitely skyrocket. If you are diabetic and you are drinking piña coladas or sugary cocktails, let me ask you; what the fuck is wrong with you ???
7) Meal Timing ⬇ ⬆ : Eating too late at night or just eating at random hours will make it harder to control glucose levels, why ? because insulin stays in our blood for a few hours depending on the type of insulin we use. Following a meal schedule will make it easier in order to give yourself enough time to inject insulin and for this insulin to have its full effect after a meal.
8) Dehydration ⬆ : Dehydration can raise sugar levels. Please keep yourself hydrated all the time. This is very important. Just DRINK WATER!!! Less sodas, less sugary drinks, less juices… Just DRINK WATER.
9) Personal Microbiome ? : There’s still some research on this subject on how gut bacteria can impact glucose levels and insulin sensitivity.
MEDICATION FACTORS:
10) Medication Dose ➜ ⬇ : If you take pills or insulin, the dose is very important in order to control glucose levels. Your doctor will help you figure out your exact dose for your specific needs and treatment plan.
11) Medication Timing ⬇ ⬆ : This is different for everybody. Some people need to inject insulin and wait 15-20 min before eating. Some people use ultra rapid acting insulin and don’t have to wait. Some people split their insulin doses before and after the meal. Timing will definitely affect glucose levels.
12) Medication Interactions ⬇ ⬆ : Any medication that is not diabetes related might increase/ decrease glucose levels. For example, cold and flu medicines can have sugar. Be careful and always ask and find out how these can affect your sugars.
13) Steroid Administration ⬆ ⬆ : Some steroids like prednisone can increase glucose levels. Be careful with this and do your own research.
14) Niacin (Vitamin B3) ⬆ : Niacin, which is prescribed to improve blood lipid levels (HDL cholesterol and triglycerides) increases blood glucose levels.
ACTIVITY FACTORS:
15) Light Exercise ➜ ⬇ : Light exercise/ activity can lower blood sugars. Some people like to walk after eating meals because this will help them prevent sugar spikes.
16) High intensity and moderate exercise ⬇ ⬆ : The type of exercise you do will affect glucose levels differently. Running or cycling for example can lower glucose levels. Other exercises like HIIT (high intensity interval training) and weight lifting might increase glucose levels due to the adrenaline response that releases glucose to the body. These last two types of exercise can improve glucose levels for at least 1 -3 days post exercise. I personally do weight lifting. Best way to find out what works for you is to check and monitor sugar levels before, during and after exercise activity.
17) Level of Fitness ➜ ⬇ : You can see big changes (drop) in glucose levels when starting a new type of exercise. Once you get used to it, you will see less change in glucose levels since your body has adapted to it.
18) Time of day ⬇ ⬆ : This is different for everybody, some people exercise in the morning and have less drop in glucose levels compared to other people who have more insulin sensitivity and therefore see a bigger drop in glucose levels. Again check and monitor sugars often to find out how this affects you individually.
19) Food and insulin timing ⬇ ⬆ : Very important to allow time between having a meal and exercising. Your insulin dose can affect this and lower glucose levels while exercising. Always make sure to check glucose level before starting physical activity in order to avoid low or high sugar levels.
BIOLOGICAL FACTORS:
20) Too little sleep ⬆ : Lack of sleep will result in higher glucose levels. Try to aim for 7 – 8 hours of sleep every night.
21) Stress and Illness ⬆ : When we are under stress our bodies produce adrenaline (epinephrine) and glucagon which will result in glucose release from the pancreas. This will cause a spike in glucose levels. Make sure to be aware when dealing with stress and when feeling sick.
22) Recent Hypoglycemia ⬇ : Having low blood sugars could lead to having another low or hypoglycemia in the next few hours. It is important to treat these and keep checking glucose levels.
23) During sleep blood sugars ➜ ⬆ : If you have in range blood sugars overnight, you will most likely have good control over blood sugars the next day. If you have high sugar levels at night you might be dealing with high numbers the next day. This is not always the case but it could happen to some people.
24) Dawn Phenomenon ⬆ : You have probably read about this phenomenon. This applies to diabetics and non-diabetics. Our bodies naturally produce hormones early in the morning. During these early hours, the body produces less insulin and more glucagon which raises glucose levels. It is important to check your sugars early in the morning and adjust any doses for basal or long acting insulin. I personally don’t get affected by this phenomenon.
25) Infusion set issues ⬆ : People who use insulin pumps might have high glucose levels sometimes due to the problems with their pumps. This could be due to the location of the infusion set on their bodies, an occluded cannula or bubbles in the tubing. Be careful when using pumps since these problems could happen. This is something I read a lot about in type 1 community groups and people need to know how to use pumps properly in order to take advantage of their benefits.
26) Scar tissue and lipodystrophy ⬆ : When injecting insulin and using infusion sets, we need to rotate and inject in different body parts. Injecting in the same spots will cause scar tissue buildup and will prevent the absorption of insulin into the bloodstream. This will lead to high blood sugars.
27) Intramuscular insulin delivery ⬇ ⬇ : When injecting insulin we need to be careful and avoid injecting directly into a muscular or low body fat area. Injecting in these sites might increase the risk of hypoglycemia because the insulin is absorbed faster into the bloodstream which will result in low blood glucose levels.
28) Allergies ⬆ : There’s not a lot of research on this topic but some people have reported high blood sugars when they have allergies.
29) A higher BG level (glucotoxicity) ⬆ : Having high blood sugars for many hours might require more insulin amount in order to correct and this could lead to insulin resistance. The higher glucose levels and the more insulin dose you need in order to correct, the more your body could become insulin resistant.
30) Periods (Menstruation) ⬇ ⬆ : From reading in different communities, some women experience changes in their glucose levels the days before their period starts. This might not always be the case but it is possible that sugar levels are affected by this.
31) Puberty ⬆ ⬆ : Testosterone, estrogen, cortisol, and growth hormone; are all secreted by adolescents during puberty. This can cause insulin resistance which will require adolescents to use more insulin than adults.
32) Celiac disease ⬇ ⬆ : Celiac disease which damages the small intestine can lead to irregular glucose levels since the intestine can not absorb the nutrients properly. Very important for people with this disease to treat it properly so this will not affect their glucose levels.
33) Smoking ⬆ : Smoking is bad for everyone, period. Smoking can increase insulin resistance. Just don’t smoke.
ENVIRONMENTAL FACTORS:
34) Expired insulin ⬆ : Insulin needs to be stored at certain temperatures. If it is left in hot weather or if it freezes it will go bad. This will decrease its potency and will not be as effective when injecting. Always store insulin and keep it within the suggested temperatures. Unopened insulin should be stored in the refrigerator.
35) Inaccurate BG reading ⬇ ⬆ : Glucose meters and CGM (continuous glucose meters) are not 100 % accurate. It is important to always check if how you feel might not match the value in your meter or sensor. Important to always wash your hands before pricking your fingers and always having a second testing machine (glucometer) if you are using a CGM. I’ve read lots of comments on how someone using a CGM and then checking with finger pricks gets two very different values.
36) Outside Temperature ⬇ ⬆ : There is some research where people have experience a decrease in blood sugars when exposed to cold temperatures. There are also people who have experienced the same when exposed to heat, for example a hot shower. There is still research needed but outdoor temperature can be a factor that affects glucose levels.
37) Sunburn ⬆ : Produces stress in the body and this might increase blood glucose.
38) Altitude ? : Altitude can increase insulin resistance.
BEHAVIORAL & DECISION-MAKING FACTORS:
39) More frequent BG checks ⬇ : The more you check your glucose levels the better you will control and manage your diabetes. Very important to check frequently in order to maintain normal, in range glucose levels.
40) Default options and choices ⬇ ⬆ : To explain this factor; Adam suggests that eating in smaller plates will help us to eat less food. This is great in order to control portions and not overeat.
Also not having too many snacks at home will prevent us from overeating or just eating more than we should; for example when treating a low blood sugar. This is called a visual prompt. Personally, I try not to keep many snacks at home because I know I will eat them. I only buy snacks when I’m really craving some.
41) Decision-Making biases ⬇ ⬆ : The decisions I make today will have an impact in my overall blood glucose levels in the long term. This refers especially to the food choices I make and whether I choose to exercise or not. Very important to be aware of the decisions I make everyday and how these might affect my diabetes in the future.
42) Family relationships and social pressure ⬇ ⬆ : Family support is very important. A conflictive and stressful family relationship will definitely affect blood glucose levels. Support is crucial from the family and a healthy environment is essential.
I know this is a lot of information and many factors affect glucose levels. Like I mentioned earlier; it is very hard to control all of these. Be kind to yourself and do the best you can. In my own experience I know I can control what I eat, I can choose to workout and I can control my attitude and choose activities that will keep me out of stress and healthy.
Diabetes is hard and it requires a huge amount of effort from us. We all have good days and bad days, the most important thing is to try to do the best we can and adapt.
Diabetes is not constant and it will definitely change with time. Change is necessary and very important. Our main goal should always be to maintain normal, in range glucose levels.
To see Adam’s complete PDF list you can click here.
@dieabeast