What factors matter most? Where do I focus effort? How do I use "ripple effects" and "IFTTT" (If This, Then That) thinking? How do I avoid getting frustrated? Following my last column - 42 Factors That Affect Blood Glyco Caresblood sugar wellness? "Wow - there are a lot of levers to pull if I want to do better! "Ugh - What’s the point of trying? This last point is what I want to address in this column: yes, 42 factors may affect blood glucose, but we can still do something about it. Here are five tips that have really helped me conquer the unpredictability, many of which are summarized in Bright Spots & Landmines - get the free PDF or GlycoCaresberberine blood sugar support find it for $2-$6 at Amazon. 1. Not all 42 factors are created equal. If we could only pick five to focus on… Controlling all 42 variables is impossible, but it’s doable to focus on a handful that have a disproportionately large impact for virtually everyone with diabetes, newly diagnosed to working on your 75-year Joslin medal.
2) are the biggest driver of my blood sugar spikes, as well as the spikes of so many others. Consequently, reducing carbs takes out one of the largest variables in diabetes, keeps me much safer when dosing medication, cuts my stress and worry, and lets me put diabetes in the background. As I’ve written before, I personally aim for less than 30 grams of carbs at one time, with most of those carbs from high-fiber, low-glycemic sources: nuts, seeds, vegetables, GlycoCares Blood Sugar Guideblood sugar wellness and berries. Chapter one of Bright Spots & Landmines has my complete eating toolkit. If this seems like a huge step, doing low-carb at breakfast is a terrific starting point. 39) is the best way to learn what works and to guide safer diabetes driving, especially with paired checks. For example, check glucose right before eating and then 2-3 hours later - what do you learn? Obtaining more frequent glucose data is like a supercharger for conquering the other 41 factors, as it helps find patterns, identify what’s working (Bright Spots) and what isn’t (Landmines), and guide real-time decisions.
Glucose monitoring questions to ask yourself: "When is my blood sugar in range - 70-180 mg/dl or 70-140 mg/dl, depending on your target - what behaviors and choices might be driving that, and how can I increase those Diabetes Bright Spots? When is my blood sugar consistently going high (over 180 mg/dl) or low (less than 70 mg/dl)? What might be driving those patterns, especially related to food choices and medication dose/timing? What experiments can I try, aiming to stumble on those landmines less often? For more complete questions to ask yourself, see the end of each chapter in Bright Spots & Landmines. 11) are variables within my control and make a big difference on daily blood sugars. There are still many people with diabetes who are (i) not on the optimal dose of medication (especially insulin); or (ii) might benefit from a different dosing schedule, depending on what the medicine is.
Insulin that is taken several times daily has more dosing flexibility than a once-weekly injectable for type 2.) Timing is an under-recognized piece of the puzzle, in my view - WHEN I take my medicine can matter just as much as WHAT and HOW MUCH is taken. For instance, taking mealtime insulin 20 minutes or more before eating can make a big difference on post-meal blood sugars, especially at breakfast or when eating more than 30 grams of carbs at once. The same can be true for injecting some of the older basal insulins, especially Lantus/Levemir - some people find that "splitting the daily dose" into morning/evening prevents unexpected highs and lows (see this article as one example). The best way to optimize your medication dose is to get more frequent glucose data - real-time or professional ("intermittent") CGM - and talk to your healthcare provider. Not all factors exist in isolation - some influence blood sugars directly AND indirectly, which can spill over into other factors.
20), which is a force multiplier for so many things in diabetes. When I get less than seven hours of sleep, I see higher next-day blood sugars, more insulin resistance, more hunger, more carb cravings, more stress, and less desire to exercise. Wow! Addressing this single factor has a big "ripple effect" on many other factors, which makes it worth prioritizing, even if I’m tempted not to. 22) is another factor with a "ripple effect," since it can easily cause repeat hypoglycemia, which can easily lead to a hypoglycemia binge, a rebound high blood sugar, and then a "rage bolus" followed by another low. Correcting hypoglycemia with an automatic, go-to, quantity-limited food has been a personal Bright Spot for me; read here for more. 3. Consistency: What can I put on auto-pilot to drive more predictability? The full list of 42 factors illustrates how complex diabetes is, but it also reveals an opportunity: if I can add more predictability to my diabetes routine, I can reduce the number of variables in play, and therefore, sources of error and frustration.