Sometimes it is to "drive out of the skin". You go to bed at night with a normal blood glucose level – and when you wake up it is as high as if you had eaten bars of chocolate during the night. Or the trouble starts after breakfast: morning after morning you eat the same amount of cereal. And yet the blood glucose level drops so low that you have to add two glucose tablets after the sweat. The next time it increases as much as if you had mixed a bag of gummy bears into your cereal. And so on.
As a diabetic, you often have to live with the fact that the sugar values have a certain life of their own on some days. But what do you do when the meter shows almost nothing but "runaways"? shows whether upward or downward?
Type 1 diabetics in particular often suffer from strong fluctuations in their values, while type 2 diabetics are more likely to be spared from this. This is due to the fact that the body of people with type 2 diabetes still produces its own insulin and can therefore often intercept strong increases.
Nevertheless the values drive also with them sometimes roller coaster, without the reason being immediately obvious. With the following tips, we would like to make it easier for you to find the cause, if you are also wondering what is wrong with your sugar.
The nuts and bolts of diabetes therapy:
Blood sugar: This is important in diabetes
Good blood glucose control is the basis of diabetes therapy. Regular measurement helps to avoid values that are too high or too low and to prevent secondary diseases
1. Overestimated when eating
People with diabetes who calculate their own insulin doses for meals must be able to estimate the amount of carbohydrates well – otherwise blood sugar problems are inevitable. You can train your eye for this by temporarily weighing carbohydrate-containing foods such as potatoes, rice, pasta or bread with the kitchen scale and remembering the portion sizes – as at the beginning of the training course. It is also helpful to have tables with portion sizes that correspond to one BE or KE (preferably in kitchen measurements such as "one tablespoon") and with photos). Such tables are available from the doctor and as an app. Perhaps you can also attend a refresher course (evtl. online via video). You can find a BE/KE calculator for food here.
Particularly with type 1 diabetics a meal, which consists predominantly of fat and protein (for example steak, fish, omelet), can let the sugar rise with some hours delay. Among other things, because the body converts some of the protein into sugar, but this happens very slowly. If you inject insulin with a pen, you can try out whether the delayed rise in blood sugar can be intercepted by injecting a small dose of fast-acting insulin two or three hours after eating. Pump users can program a delayed bolus. Please discuss the procedure with the diabetes team beforehand.
Meals that are very high in fat and carbohydrates (typical: pizza) can cause hypoglycemia after the meal. Because fat delays transport from the stomach to the intestine. Insulin injected before eating then acts faster than the sugar from the carbohydrates enters the bloodstream. With meals that are very high in fat and carbohydrates, it can therefore make sense to administer part of the insulin after the meal. Pump users can program a delayed bolus for this purpose.
Whole grain products also delay the rise in blood sugar. You can take advantage of this if sugar often spikes after a meal: Switching to whole-grain pasta or whole-grain rice then often works (small) miracles.
The fat protein unit (FPE):
Adjust insulin for fat and protein? In type 1 diabetes sometimes worthwhile: the insulin dose also to the fat-. Adjusting the protein content of a meal. Here's how
2. Stress and worry
Constant stress can lead to a chaos of values, perhaps because one neglects the diabetes therapy and stress hormones drive up the sugar level. Stress can also drive blood glucose into the basement. "As far as that goes, everyone reacts differently.", says the Hamburg diabetologist Dr. Jens Kroeger. Many of his patients have higher levels on work days than on weekends. He advises you to adapt the therapy to the "stress situation" Adjust. For example, injecting a little more basal insulin on work days.
In the case of very irregular daily routines, an insulin pump can help to calm down the values. A system that constantly monitors sugar (CGM) is also useful. If you feel very stressed, confide this to your diabetes team. Diabetes training helps to manage the therapy better and to reduce fluctuations. If you feel you can't get out of the stress trap, psychological counseling can help. If the soul is better, the sugar levels often improve as well.
Blood glucose: How much fluctuation is normal??
At Non-diabetics Blood glucose rarely drops below 60 mg/dl (3.3 mmol/l) and usually rises to no more than 140 mg/dl (7.8 mmol/l) after eating, occasionally to over 160 mg/dl (8.9 mmol/l). Studies have shown this with continuous glucose monitoring.
At Diabetes everything is open upwards and downwards: In extreme hypoglycemia, blood glucose can drop below 20 mg/dl (1.1 mmol/l) and at the diabetic coma rise to the 1000 mg/dl (55.5 mmol/l) range – both life-threatening levels that must be avoided at all costs.
Ideally, sugar levels in diabetes should be in a similar range to those in healthy individuals. But what is seldom to be realized in everyday life. In general type 2 diabetes Values of 100 to 125 mg/dl (5.6 to 6.9 mmol/l) before eating, one to two hours afterwards they should not exceed 140 to 199 mg/dl (7.8 to 11 mmol/l). This applies similarly to Type 1 diabetes, Although routine after-meal checks are not recommended here. "This also has to do with the fact that short-term sharp rises, which also occur in well-controlled diabetics, often lead to an 'overcorrection' with insulin, which results in hypoglycemia", says diabetologist Kroger.
Infections can derail blood glucose – fever increases it, vomiting and diarrhea threaten hypoglycemia. Ask your doctor how to adjust your therapy in case of infections.
Thyroid dysfunction, in which too little or too much thyroid hormone is produced, can also cause sugar levels to fluctuate. A measurement of the TSH level in the blood shows whether the thyroid gland is working normally. If the dysfunction is treated, blood glucose stabilizes.
Treatment with cortisone-containing drugs drives up blood sugar. Then it is important to adjust the diabetes therapy in consultation with the doctor. If you need cortisone because of an illness, such as rheumatism, you must never stop taking it or reduce the dose without talking to your doctor.
Stomach paralysis (gastroparesis) can cause sugar lows after eating during insulin therapy. Stomach paralysis is diagnosed by a gastroenterologist. To prevent lows after eating, it can help to inject insulin at a later time.
4. Tie changes
In diabetics who inject insulin, hardening and thickening under the skin (lipohypertrophy) is one of the most common causes of fluctuating blood glucose levels. These tie changes occur when insulin is repeatedly injected into the same area. Or the pump cannula is placed there again and again. Changing the pen needle too infrequently or leaving the pump cannula in place for too long also promotes the formation of lipohypertrophies. Insulin no longer enters the bloodstream evenly from these lipohypertrophies. Blood glucose can fluctuate widely. The need for insulin increase.
Have your injection levels checked by your doctor every three to six months – and always in the event of unexplained fluctuations. Regularly check the injection areas yourself for changes.
Please consistently avoid hardening and thickening as an injection site for at least six months or. Do not insert a pump cannula until the changes have subsided. Very large or long-standing lipohypertrophies usually do not regress completely. Caution: There is a risk of hypoglycemia when changing the injection site. Discuss dose with doctor!
To prevent lipohypertrophy, when injecting insulin or inserting the pump needle, the injection sites should be changed according to a pattern: for example, on the abdomen, row by row from right to left, always keeping a distance of one or two transverse fingers from the last site and two from the navel. Also use "more remote" areas Areas, such as the flanks of the abdomen. Also important: use a new needle for each injection; change pump needle as recommended by manufacturer.
Video: How to inject insulin correctly?
5. Puberty and periods
Puberty is a turbulent time, also with regard to diabetes. This is not only due to the fact that young people often neglect their diabetes during this phase. But also to hormones that counteract the insulin. This can lead, for example, to a sharp rise in sugar levels in the morning hours. In this case, switching from the pen to the pump may make sense. Pump users can adjust their device to deliver more insulin early in the morning.
In some women, values fluctuate especially on the days before menstruation. One reason: the changing level of female sex hormones probably influences insulin sensitivity. If you suspect a connection between sugar values and the cycle, you should document the beginning and end of the period for a while, in addition to the values. And then discuss with the diabetes team how to adjust therapy. Women on insulin therapy often need more insulin in the week before their period. However, the need can also fluctuate.
6. Insulin or medication
Sometimes the diabetes medication is to blame when the sugar rides a roller coaster. For example, tablets from the sulfonylurea group are more likely to cause hypoglycemia than other diabetes medications. Those who take a sulfonylurea preparation and often have too low values should talk to their doctor about switching to tablets that do not increase the risk of hypoglycemia.
If you inject insulin at mealtimes and your blood glucose levels are always too high afterwards, the interval between injections and meals may be too short. This is the time interval between insulin injection and the start of meals. "In this case, it can help to wait a few minutes after insulin administration before starting to eat", says diabetologist Kroger. Under no circumstances should you make the mistake of injecting insulin again immediately because of an increased value after a meal. Because the insulin injected before eating is still in the blood, this can lead to hypoglycemia. In most cases, it is sufficient to correct elevated levels before the main meals and at bedtime. Even if you inject insulin too long before eating, you risk hypoglycemia. Because then the hormone acts too early.
Determine your optimal spray-to-eat interval (SEA) in consultation with your doctor or diabetes educator. Your diabetes team will also help you find out whether the high or low values after eating are due to an insulin dose that is too low or too high.