Diabetes control: what if my sugars are too high?

So, having posted a few days ago on good blood sugar goals, an obvious good question is what about if they are higher than goal?

Pills are used to improve blood sugar control and to prevent eventual and inevitable failure of insulin production by your pancreas.

However, diet and exercise are 2-8 times more effective than pills in maintaining normal blood sugars and body weight. A major reason to use pills is that diet and exercise cannot keep your pancreas from eventually needing insulin, and pills can prevent this.

Insulins are used where your body has simply become unable to make insulin for itself.

If sugars first thing in the morning or before meals are over 125, it usually means the meal before this was high in carbohydrates and or that you were not very physically active (such as sleeping or sitting at a desk all day). If you take fast insulins (such as Humalog) before meals, it may mean that the amount you took was too small.

You can get lower sugars in these settings by eating less, being more active or exercising, or by increasing the dose of pills that help to maintain greater insulin responsiveness (such as metformin). If you use insulins and you fasting morning sugars are under 125, but later pre-meal sugars are higher, then increase your fast insulin dose by 1-2 units for the meal before this. For example if your pre-dinner sugar is 155 and you took 5 units of fast insulin before lunch, next time try 6-7 units before the same kind of lunch.

If you are seeing higher than goal sugars after your meals, then try reducing the size of your meals. You may need to increase the dose on pills that help your pancreas to put out more insulin (such as glimiperide, Glyburide, or Precose) or increase your before meal doses of fast insulins.

If you are using long-acting insulins (such as Lantus), then your fasting morning blood sugars are telling you how well your dose is working out for you. The sugar goals for this time are the same as everyone else's: 80-125 is good to go.

If they run over this for over 3 days in a row, then increase the Lantus dose by 2-3 units every 2-3 days until it falls back into this zone and then stay at that dose.

If they are under 80 for 3 days in a row, then go the other direction. Decrease the Lantus dose by 2-3 units every 2-3 days until your morning sugars come back up into the zone, and then stay at that dose.

Rules of thumb:

• Fasting AM sugars reflect overall steady basal insulin activity which maintains normal baseline sugars.
• Pre-meal sugars show how your body is doing with your last meal and activity level since then.
• After-meal sugars are telling you about how much and what you just ate and how well medicines that help with this are working for you.
• Feel free to call or see me if you are concerned about your blood sugar control, medicines, or what to do next!