The Diabetes BLAME Game

When your sugars are up, is it the medication or your diet?

By Gary Scheiner MS, CDE

Let’s be honest.  Not many of us follow our “prescribed diet” to the letter. 

For some, deviating from the meal plan means an occasional treat or carb-counting mistake.  For others, the meal plan is given less respect than Rodney Dangerfield, rarely adhered to or completely ignored.  And what happens when we eat with reckless abandon and blood glucose levels start to head in the wrong direction?  Being the responsible individuals we are, we usually place the blame squarely where it belongs: on our medication.

A wise physician once said, “You can out-eat any medication I can put you on.” 

How true.  Medications have a limited ability to improve our blood glucose control.  An appropriate diet is the foundation that lets your medications do their job.  Unlike medications, a healthy diet and weight loss gets to the root cause of Type-2 diabetes:  insulin resistance.  And whether you have Type-1 or Type 2 diabetes, following a proper meal plan can enhance your quality of life and reduce your risk for other long-term health problems.

So before placing blame on your medications, ask yourself:

1.Are my portion sizes appropriate? 

This is critical to both immediate blood glucose control and long-term weight management.  The dietary plan given to you by your physician or dietitian should specify portion sizes as well as the food types that will help you to manage your diabetes.  If you are having more than the prescribed amounts at most of your meals, you will have a hard ti me managing your weight and overcoming the insulin resistance that causes Type-2 diabetes.

2. Am I taking in too many carbohydrates? 

Both sugars (simple carbohydrates) and starches (complex carbohydrates) cause a rapid rise in blood glucose levels.  Managing the amount of carbohydrate in your meals and snacks is essential for controlling diabetes.  If your carbohydrate intake is not kept in check, your blood glucose levels are likely to go much too high after eating.

3. Am I eating too frequently?

Every meal and snack presents a challenge to your blood glucose regulation.  Even people without diabetes see a slight rise in their blood glucose levels right after eating.  Those with diabetes tend to see a higher and longer post-meal peak.  When meals or snacks are consumed too close together, the peaks start to run into one another, and the blood glucose level fails to return to a normal level before another rise kicks in.  Spacing meals and snacks several hours apart is essential to controlling blood glucose levels.

4. Am I getting enough physical activity?

Dieting alone may not be enough to produce sufficient weight loss and blood glucose control.    Physical activity burns calories, lowers blood glucose levels, and has a direct impact on the body’s sensitivity to insulin.  Physical activity includes both “exercise” and routine daily walking, chores and active hobbies.     

If the answer to any of the above questions is “no”, your first order of business should be to work on those specific areas. 

Keeping written records of your food and exercise habits is a good place to start.  That way, you can keep track of your progress and look for patterns or situations that cause you to sometimes get off track.  Record keeping also gives many people a sense of accountability for their actions.  If you need more help, talk to your physician or set up a meeting with your dietitian.

If the answer to all of the above questions is “yes” and your blood glucose levels remain elevated, then it probably is time to intensify your medication program. 

Remember, diabetes is a progressive disease.  Over time, as the pancreas gradually loses its ability to produce enough insulin, more aggressive measures must be taken in order to control blood glucose levels.

Many options exist for taking your medication program to the next level.  Your doctor may elect to start you on a new medication, increase the dosage of an existing one, or try a combination of medications at the same time.  Whatever change is made, don’t forget the basics:  A healthy diet, adequate exercise and a positive mental approach.  Your medications may change, but healthy behaviors should be a permanent part of your diabetes management plan!