More than any other health condition, living with diabetes requires you to take charge of your day-to-day health care yourself. Every hour of every day you will have to manage your blood sugars with activity, food, and medication without anyone to tell you what to do. The reality of diabetes is that simply following doctor’s orders is never enough to achieve an active lifestyle free from complications of this condition.
The good news is, however, that every diabetic can eventually bring blood sugars under control. Living with diabetes, and living well with this condition, just requires three basic areas of knowledge.
1. Every diabetic has to keep track of blood sugars:
If you don’t know your blood sugar levels, you won’t know how well your diet and medication are working and you can’t prevent dangerously high or dangerously low blood sugars.
And if there’s any single aspect of healthy lifestyle that diabetics resist, it’s doing finger sticks to take blood samples to measure blood sugars. That’s because most diabetes educators don’t actually have the condition, don’t take their own blood sugars, and don’t know how to draw that tiny drop of blood painlessly.
The secrets to pain-free sugar testing are:
- use a spring-activated lancing device. Never try to poke yourself with a bare needle
- test on the sides of your fingers and thumbs, never the fleshy part in the middle
- use test strips that require the smallest possible drop of blood
It’s also possible to use test strips designed to test blood from forearm punctures. The forearm has few nerve endings and drawing blood there is almost always painless. With the right setting of the spring-activated lancing device, fresh lancets, and testing on the sides of the fingers, however, there is no reason blood glucose testing should hurt.
2. Every diabetic needs to know what it means to have blood sugars ‘under control‘:
The problem with the concept of diabetic control is that most doctors don’t have a good grasp on it!
In various situations, diabetics might be told that getting sugars under 250mg/dL (14mmol/L) is good enough, or they might be told that any blood sugar under 60mg/dL (3.3mmol/L) could be deadly, or they might be told that the number 140mg/dL (7.8mmol/L) has “mystical significance.” The fact is, managing the numbers isn’t all there is to managing diabetes. Blood sugar levels are just a general guide to diabetes, but there are levels are definitely too high or definitely too low.
As a general rule, if your blood sugars go over 170mg/dL (9.4 mmol/L), even for a little while, your muscle and liver cells develop insulin resistance. This protects them from a flood of glucose that burns with the production of massive amounts of free radicals. Most of the science confirms that having your sugars go over 170mg/dL (9.4mmol/L) after you eat, slowly makes type 2 diabetes worse. You need to keep your after-meal (post-prandial) sugars in control, not just your fasting sugars. You probably won’t feel bad if your sugars are 170mg/dL (9.4mmol/L), but any sugar level this high at any time will gradually make the underlying insulin resistance worse.
Of course, keeping your post-prandial sugars to 90mg/dL (5mmol/L) or so is optimal, but most diabetics need a lot of practice to do this! Just be sure you always need to control the upper limit of your blood sugars. Any reading over 400mg/dL (22mmol/L), ever, requires immediate medical attention, and persistent blood sugars over 200mg/dL (11mmol/L) also require drastic changes in care.
It’s also true that diabetics need to avoid low blood sugars. It is actually very, very rare for diabetics to go into comas and die. It’s relatively common for diabetics to suffer diminished mental capacity and get into accidents, or make ruinous life decisions, when sugars get much below 60mg/dL (3.3mmol/L). Again, you won’t know for sure you have a low sugar reading unless you test. Don’t treat a problem you don’t have.
Test strips make diabetes much easier… but they aren’t perfect. The glucose concentration in the capillaries, where you actually draw your blood sample, is consistently 8 to 20% lower than the glucose level inside your body. And there are many situations in which blood sugar levels are spuriously high or low. There are so many of these situations that it helps to have a reference guide.