Spike in blood sugar


Help! My blood sugar is wacky!

It’s safe to say most people with diabetes have experienced occasions when their blood sugar has been high without missing their medication or eating poorly. Often the reason seems unclear and can be quite scary and frustrating, leaving them puzzled as to why it’s happening.

Well, we’re here to help. Below are a few of the most common reasons that may cause blood sugars to go wacky.

Any illness, even a minor one, can raise your blood sugar. In fact, unexplained high blood sugars may be the first clue that you may be getting sick. Sometimes during an illness, you will need to use more insulin. However, if you are vomiting, have diarrhea and are unable to eat, your blood sugar can drop low and you may need to decrease your insulin or hold your oral medication. Certain medications used during times of illness may also contribute to a rise in sugar levels; the most common culprits are steroids.

Outdated Insulin
Using insulin that has expired can also cause your blood sugar to go up. It’s important to make sure that you check the expiration date on your insulin vial. If it’s expired, call your doctor or go to your pharmacy as they may be able to help.

Improper Insulin Storage
It’s important that your insulin is stored and used correctly. Always refrigerate unused insulin vials and pens. Keep in mind, once you use insulin, it’s only good for 30 days, after which you must dispose of it.

Stress /Poor Sleep
Lifestyle changes such as poor sleep or stress – which are often related – can cause your blood sugar to run high. When you don’t sleep, you may end up eating more and your stress hormones may increase, which in turn can increase blood sugar.

Incorrect Injection Technique
Another reason for high sugar levels is incorrect injection technique. If a person forgets to rotate injection sites and injects insulin into the same area/s over and over again, it results in a lot of scarring and fat build-up, which prevent insulin from getting properly absorbed. That’s why your doctor will remind you to rotate the insulin injection sites around the abdomen, flanks, thighs and back of the upper arms (unless there is a specific reason not to use a certain area).

Changes in Physical Activity
Changes in physical activity can certainly affect blood sugars. If a person suddenly becomes hospitalized or bedridden, their sugars may be higher than before, not only because of the stress of the illness, but simply because they are no longer doing their activities of daily living. The contrary is also true. If a person exerts him/herself more than usual, a low sugar event (hypoglycemia) may occur. For this reason, your doctor will remind you to lower the meal-time shortacting insulin dose if you are planning to exercise soon after a certain meal, i.e., take a long walk, do chores around the house or go to the gym. Depending on their vulnerability to low sugars, patients using insulin pumps may find it helpful to either set up a lower temporary basal rate for the duration of physical activity or altogether suspend the pump for that interim to avoid a low sugar.

Types of Food
Another important factor that may make your postprandial (after-meal) sugars fluctuate is the type of food you are eating. Simple carbohydrates are usually more quickly digested and absorbed, which means they need all of the bolus food correction upfront. Meals containing complex carbohydrates, proteins and fats – burgers, pizza, Chinese food – will take longer to get digested and to raise the sugar. This may mean dividing up the meal-time injection into two separate injections. Patients on the insulin pump are typically advised to make use of the dual-wave bolus feature when having a fatty meal or to try increasing their basal rate temporarily for a few hours after such a meal. Talk to your doctor for advice.

It’s also important to pay attention to how many carbohydrates you are eating in each sitting as the number of units for your meal-time short-acting insulin dose would need to be adjusted accordingly. Patients with type 1 diabetes are often taught carbohydrate-counting skills for this reason. Alcohol may also make your sugar level go awry. Diabetics have to be especially cautious with mixed drinks made with sweetened beverages. One must also remember that alcohol typically falls under the carbohydrate umbrella and can cause blood sugar levels to rise on their own, not to mention impairing one’s judgment in terms of food choices/insulin injections/ pump use. When not taken together with food, excessive alcohol can actually cause sugars to go low.

People who travel to areas with extreme heat or cold (or live in such areas) also have to remember that insulin is a protein molecule which works just right only at certain temperatures. Therefore, if going snow skiing, you may need to place your insulin vial/ pen in an inside pocket of your jacket. Alternatively, if spending a lot of time in the heat in a tropical climate, you may need to bring a cooling pack for your insulin supplies.

Dr. Aarti Ravikumar is in her second year fellowship in Endocrinology, Metabolism and Diabetes at the Icahn School of Medicine at Mount Sinai in New York City. She completed her medical degree at SUNY Downstate Medical School and residency at Albert Einstein College of Medicine Montefiore Medical Center. After graduation from fellowship, Dr. Ravikumar plans to practice general endocrinology in Westchester, NY.

Dr. Elina Trofimovsky is a senior Ffellow at the Mount Sinai Hospital Division of Endocrinology, Diabetes and Bone Diseases. She is a graduate of SUNY Downstate medical school, after which she completed her internal medicine residency training at Hofstra-NSLIJ. Dr. Trofimovsky plans to practice general endocrinology in Connecticut after graduating from fellowship.

Nondiabetic Hyperglycemia

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  • Care Notes

What is nondiabetic hyperglycemia?

Nondiabetic hyperglycemia means your blood glucose (sugar) level is high even though you do not have diabetes. Hyperglycemia may happen suddenly during a major illness or injury. Instead, hyperglycemia may happen over a longer period of time and be caused by a chronic disease.

Why is it important to manage hyperglycemia?

Hyperglycemia can increase your risk for infections, prevent healing, and it make it hard to manage your condition. It is important to treat hyperglycemia to prevent these problems. Hyperglycemia that is not treated can damage your nerves, blood vessels, tissues, and organs. Damage to arteries may increase your risk for heart attack and stroke. Nerve damage may also lead to other heart, stomach, and nerve problems.

What increases my risk for nondiabetic hyperglycemia?

  • A medical condition such as Cushing syndrome or polycystic ovarian syndrome
  • Surgery or trauma, such as a burn or injury
  • Infections, such as pneumonia or a urinary tract infection
  • Certain medicines, such as steroids or diuretics
  • Nutrition given through a feeding tube or IV
  • A family history of diabetes or gestational diabetes
  • Obesity or a lack of physical activity

What are the signs and symptoms of hyperglycemia?

You may not have any signs or symptoms, or you may have any of the following:

  • More thirst than usual
  • Frequent urination
  • Blurred vision
  • Nausea and vomiting
  • Abdominal pain

How is nondiabetic hyperglycemia diagnosed and treated?

Your healthcare provider will measure your blood sugar level with a blood test. You may be given insulin or other medicines to decrease your blood sugar level.

How can I help prevent hyperglycemia?

  • Exercise can help lower your blood sugar when it is high. It also can keep your blood sugar levels steady over time. Exercise for at least 30 minutes, 5 days a week. Work with your healthcare provider to create an exercise plan. Children should get at least 60 minutes of physical activity each day.
  • Maintain a healthy weight. Ask your healthcare provider how much you should weigh. A healthy weight can help you lower your blood sugar levels. Ask your provider to help you create a weight loss plan if you are overweight. Together you can set manageable weight loss goals.
  • Follow your meal plan. A dietitian will help you make a meal plan to help lower your blood sugar level. You may need to decrease the amount of carbohydrates that you eat.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung damage. They can also make your blood sugar levels harder to control. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Limit or do not drink alcohol. Alcohol can increase your blood sugar level. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor. Ask your healthcare provider if it is safe for you to drink alcohol. Also ask how much is safe for you to drink each day.

Do I need to check my blood sugar level?

Your healthcare provider will tell you if you need to check your blood sugar level. He or she will also tell you how often to check it. Ask your healthcare provider what your blood sugar level should be. Write down your results, and show them to your healthcare provider. Your provider may use the results to make changes to your medicine, food, and exercise plan.

Call 911 or have someone else call for any of the following:

  • You have a seizure.
  • You have trouble breathing or are short of breath.
  • You become weak and confused.

When should I seek immediate care?

  • Your blood sugar level is higher or lower than your healthcare provider said it should be.
  • Your breath smells fruity.
  • You have nausea and vomiting.
  • You have symptoms of dehydration, such as dark yellow urine, dry mouth and lips, and dry skin.

When should I contact my healthcare provider?

  • You continue to have higher blood sugar levels than your healthcare provider recommends.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Learn more about Nondiabetic Hyperglycemia

Associated drugs

  • Abnormal Glucose Tolerance

IBM Watson Micromedex

  • Diabetic Hyperglycemia
  • Prediabetes

Blood Sugar: Hidden Causes of High Blood Sugar Levels in the Morning

What causes high blood sugar levels in the morning?

Commonly known reasons why your blood sugar may be high in the morning include high-carb bedtime snacks and not enough diabetes medications.

Yet two lesser-known reasons may be causing your morning blood sugar woes: the dawn phenomenon and the Somogyi effect. These causes of high morning blood sugar levels are a result of body changes and reactions that happen while you are sleeping.

What is the dawn phenomenon?

Your body uses glucose (sugar) for energy and it is important to have enough extra energy to be able to wake up in the morning. So for a period of time in the early morning hours, usually between 3 a.m. and 8 a.m., your body starts churning out stored glucose to prepare for the upcoming day.

At the same time, your body releases hormones that reduce your sensitivity to insulin. In addition, these events may be happening while your diabetes medication doses taken the day before are wearing off.

These events cause your body’s blood sugar levels to rise in the morning (at “dawn”).

What is the Somogyi effect?

A second possible cause of high blood sugar levels in the morning is the Somogyi effect, sometimes also called rebound hyperglycemia. It was named after the doctor who first wrote about it.

If your blood sugar drops too low in the middle of the night while you are sleeping, your body will release hormones in an attempt to “rescue” you from the dangerously low blood sugar. The hormones do this by prompting your liver to release stored glucose in larger amounts than usual. But this system isn’t perfect in a person with diabetes, so the liver releases more sugar than needed which leads to a high blood sugar level in the morning. This is the Somogyi effect.

How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sugar levels?

Your doctor will likely ask you to check your blood sugar levels between 2 a.m. and 3 a.m. for several nights in a row. If your blood sugar is consistently low during this time, the Somogyi effect is suspected. If the blood sugar is normal during this time period, the dawn phenomenon is more likely to be the cause.

Some additional clues that the Somogyi effect may be the cause include nightmares, restless sleep and overnight sweating as these are all signs of low blood sugar levels.

How can high blood sugar levels in the morning be controlled?

Once you and your doctor determine how your blood sugar levels are behaving at night, he or she can advise you about the changes you need to make to better control them. Options that your doctor may discuss depend on the cause of the morning high blood sugars.

For dawn phenomenon:

  • Changing the timing or type of your diabetes medications
  • Eating a lighter breakfast
  • Increasing your morning dose of diabetes medication
  • If you take insulin, switching to an insulin pump and programming it to release additional insulin in the morning

For Somogyi effect:

  • Decreasing the dose of diabetes medications that are causing overnight lows
  • Adding a bedtime snack that includes carbs
  • Doing evening exercise earlier
  • If you take insulin, switching to an insulin pump and programming it to release less insulin overnight

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Do your BGs bounce from very low to very high?

Question: My blood sugars bouce from very high to very low. For example, I can experience a low blood glucose (BG) level of 60, 50, or 43 mg/dl and then two to four hours later my BG skyrockets to 200 to 400 mg/dl?

This is called the Somogyi effect or “rebound hypoglycemia”. This condition results in high BG levels, and is actually is triggered by low BG levels. It is a natural defense mechanism of the body to regulate itself and counteract episodes of severe hypoglycemia. To keep it simple, we understand that the pancreas produces and regulates insulin and other hormones in response to BG fluctuations from food, activity and stress levels in the body that occur in everyday life. Every action in the body causes a reaction. Insulin is used in the body to metabolize carbohydrate content from food, which is broken down into energy units (glucose/sugars), which is used and stored as fuel. Insulin keeps the BG from rising too high. Other hormones keep us from getting too low. Some of the glucose in our bodies is stored in the liver as glycogen (a form of body glucose). In most people, whenever BG gets too low, certain hormones called counterregulatory hormones kick in and cause the BG level to rise. For example, the liver kicks in stored glycogen as a counterregulatory defense tp keep us from sinking into dangerous levels of hypoglycemia.

In people without diabetes, this effect is quickly counteracted by an increase in insulin production, which lowers the glucose released by the liver, and the body self-regulates when the BG is normalized once again. In people with diabetes, when the BG dips too low due to the effects of too much insulin, or glucose depletion from moderate to vigorous exercise, or not enough glucose derived from food metabolism, the liver kicks in stored glycogen reserves to bring up our BG fast. The counterregulatory function of the liver to release stored sugar in the form of glycogen during hypoglycemia continues to happen in people with diabetes. However in diabetes, due to the lack of insulin production, the liver doesn’t know when to shut down the release of stored glycogen and just keeps pumping it into the bloodstream in order to regulate an extremely low BG. Thus the BG can jump from 54 mg/dl to 254 mg/dl in a matter of an hour or two due the body’s counterregulatory response.

What happens? When you experience the Somogyi effect, at first you may not notice or be aware that the episode of hypoglycemia triggers an episode of hyperglycemia. For example, you experience some of the classic symptoms of hypoglycemia – light-headedness, shakiness, dizziness, irritability, moodiness, sweating, chills, clamminess, pulsating vision, rapid heartbeat, ravenous hunger, numbness or tingling in your lips and tongue. You feel lousy and panicky, and thus aggressively over treat your hypoglycemia. Then you experience symptoms of hyperglycemia, such as parched dry mouth, extreme thirst, headache, tiredness, nausea, vomiting, or a wicked need to urinate. Over treating the hypoglycemia by eating or drinking too much food or beverage with a high sugar content causes an even greater rise in the BG levels, which often leads to the increased symptoms of hyperglycemia. You now have an overload of glucose from the stored glycogen release and all the juice, glucose products, and extra food with quick acting carbs that have just consumed to bring your BG back up. You may feel obliged to aggressively overcorrect the elevated BG by taking more insulin to bring down an extremely high BG, which can lead to a rapid drop in BG, causing another round of hypoglycemia. The bouncing Somogyi effect can occur during waking hours or during sleep at night.

What to do? Once the cycle is recognized and identified, it can be corrected. If you see that your BG levels are falling and rising from below 65 mg/dl to over 200 – 300 mg/dl within a couple of hours, then you may be experiencing the Somogyi effect. Careful self monitoring of your BG levels will tell you and your health care team if you are experiencing rebound hyperglycemia. Your insulin dosage and dosing schedule may need to be adjusted. If you wear a pump, your settings and ratios may need adjusting. You must also be self-disciplined to test before and after you exercise with the intention to prevent hypoglycemia from happening in the first place. You must also match your mealtime insulin with your carbohydrate intake to ensure you are not overdosing. For example you may not need as much rapid acting mealtime insulin if you are just eating a green vegetable and protein salad with a low carb entrée for lunch or dinner. And remember in diabetes, snacks are generally used at specific times to maintain a balanced BG to prevent hypoglycemia at various times of the day and night.

TIP: Think of snacks as acts of mindful and purposeful eating to maintain balanced health and well being, and not a free for all to eat anything you want because “it’s only a snack”. Choose and enjoy healthy snacks and remember in diabetes self-care, snacks are recommended and advised as energy replenishment to prevent hypoglycemia. They can be a very important part of your self-care regimen, and an important step in managing the Somogyi effect. As each of us lives with diabetes it is important to know what is going on with the body at all times. Self-managing your diabetes requires ongoing and vigilant self-monitoring of your BG and making balanced food choices in order to intervene as necessary to prevent extreme highs and extreme lows. There is always a reason behind BGs being too high or too low. If we had functioning beta cells, we wouldn’t be living th lives we lead as women with diabetes. Talk to your healthcare provider and diabetes education team if you suspect that you may be experiencing the bouncing BGs of the Somogyi effect.

IMPORTANT TIP: Always keep quick acting sources of glucose on hand. This means in your purse, in your pocket, at your desk, in your car, at the bedside. You never know when and where you will need to treat a low BG. It is as essential as keeping your “I have diabetes” ID, testing supplies, sources of insulin, medications, and healthy snacks with you throughout your day.

General Rule of 15

When feeling symptoms of low blood sugar, test your BG. If you are at or below 65 to 70 mg/dl treat for hypoglycemia. Drink or eat 15 grams/carbohydrate of a rapid acting source of glucose – 1 oz. packet or pouch of glucose gel; 15 Jelly Bellies; 3 or 4 glucose tablets; 4 oz juice pak; 4 oz regular fruit juice or sugared soda. Wait 15 minutes and test again to make sure your BG is rising. There is no need to over treat as long as your BG is rising. You will be okay. You may need to eat your next scheduled meal or a small carb/protein snack to hold you until the next meal. If you are still low and shaky (less than 65 mg/dl) and it seems as if you are not coming out of the low, take another 15 grams of the rapid acting carb, and continue to treat for severe low hypoglycemia. Test again in 15 minutes. If you are still extremely low, you may need to ask or call for help. In extreme cases prolonged low BG of less than 50 mg/dl you may lose consciousness if you do not get sufficient glucose into your cells. You may need an emergency injection of glucagon to bring you out of a severe low. The after effects of glucagon will raise your BG quite significantly in the hours after the injection is given. It can, however save your life. On a day-to-day basis, in the event of hypoglycemia, your goal is to bring your BG back into a normal range ASAP without going overboard.

Blood glucose control (blood sugar levels)

  • Introduction to blood sugar levels
  • Why is controlling blood sugar levels so important?
  • Who is blood sugar control important for?
  • Diabetic patients: How to test your blood sugar levels
  • What level should my blood sugar be?
  • When to contact the doctor
  • How to control blood sugar surges
  • Blood sugar control, diet and exercise
  • Diseases associated with poor sugar control
  • Medications and blood sugar control

Introduction to blood sugar levels

Our blood glucose level, or blood sugar level, is the amount of glucose (sugar) in the blood. The amount of glucose in the blood is measured in millimoles per litre (mmol/l). Glucose levels are measured most commonly to diagnose or to monitor diabetes. It is also important to keep an eye on blood glucose levels during certain situations – for example: during pregnancy, pancreatitis and with increasing age. Normally, blood sugar levels stay within a narrow range during the day. A good level is between 4 to 8mmol/l. After you consume food, your blood sugar level will rise and after you have had a night’s rest, they will usually be lowest in the morning.

Diabetes is a common disease in our society, affecting 2-5% of the general population, with many more people unaware that they may be affected by this condition. Diabetes results from a lack of insulin, or insensitivity of the body towards the level of insulin present. Thus if you have diabetes, your blood sugar level may move outside the normal limits.

Why is controlling blood sugar levels so important?

Carbohydrate foods are the body’s main energy source. When they are digested, they break down to form glucose in the bloodstream. If you make sure you eat regular meals, spread evenly throughout the day, you will help maintain your energy levels without causing large rises in your blood sugar levels. It is also important to maintain a stable and balanced blood sugar level, as there is a limited range of blood sugar levels in which the brain can function normally. Regular testing of your blood sugar levels allows you to monitor your level of control and assists you in altering your diabetes management strategy if your levels aren’t within the expected/recommended range.

Long term complications, including eye disease, kidney problems, nerve problems, cerebrovascular disease such as strokes, and cardiovascular disease such as heart attacks, heart failure and high blood pressure, can be significantly reduced. Based on studies of people with type 1 diabetes (Diabetes Control and Complications Trial : DCCT) and type 2 diabetes (United Kingdom Prevention of Diabetes – UKPDS), maintaining near normal blood sugars and glycated haemoglobin levels significantly reduces the risks of complications arising from diabetes.

Who is blood sugar control important for?

Good blood sugar control is important for most people in the general population. However, if you have a condition such as diabetes, pancreatitis, hyperthyroidism / hypothyroidism or Cushing’s syndrome, it becomes even more important to achieve good sugar control. If you are pregnant or planning to become pregnant, it is also essential to maintain good sugar levels to ensure both your own and your baby’s wellbeing.

Stable blood sugar levels significantly reduces the risk of developing diabetic complications at a later date. Depending on the level of control achieved, these problems may start to appear 10 – 15 years after diagnosis with type 1 diabetes and often earlier in patients with type 2 diabetes.

Diabetic patients: How to test your blood sugar levels

Blood sugar levels are usually measured on a daily basis with a home blood sugar level testing kit. There are several brands and varieties available, but they will all consist of a measuring device and disposable paper strips. To check your blood sugar level, you are usually required to prick your finger tip with a lancet (a small, fine, sharp needle). Then you have to put a small amount of blood on the paper strip and place the strip into the measuring device. After about 15-30 seconds the blood sugar level will be displayed. These blood sugar measuring devices are available at most local pharmacies and also through Diabetes Australia.

There have been new meters that test alternative sites that have been released. These meters allow you to test alternative sites,such as the forearm, upper arm, base of the thumb and thigh. However, testing at different sites may give you results that are different from those obtained from the fingertip. It has been shown that blood sugar levels in the fingertips show changes more quickly than those in alternative testing sites.

People who have type 1 diabetes should measure their blood sugar levels at least once a day, either in the morning before breakfast or at bedtime. Those with type 2 diabetes and are on insulin treatment should also measure their blood sugar levels one – two times a day. For those type 2 diabetics who are on a special diet or oral tablets, blood sugar levels should be measured once or twice a week before mealtime or one to two hours after a meal.

What level should my blood sugar be?

The recommended range of blood sugar levels are:

  • 4 to 7 mmol/l before meals.
  • < 10 mmol/l one to two hours after meals.
  • About 8 mmol/l at bedtime.

When to contact the doctor

When your blood sugar levels are in the extreme ranges – either a fasting blood sugar greater than 15-20mmol/L or less than 3-4mmol/L, and especially if there are two or more abnormal readings, you should seek medical attention. However, you will find out the normal value of blood sugars for your own body and these levels provided are just arbitrary values – some people will feel no symptoms at a level of 20mmol/L whereas others may have symptoms of a high blood sugar such as thirst, urinating frequently, lethargy and vomiting. Regardless, you should contact your local doctor to see if better control of your blood sugar levels can be obtained.

How to control blood sugar surges

If your blood sugar reaches very high levels at any time, you will need to adjust your food intake or insulin dose. Blood sugar levels rise in the blood after breakdown of carbohydrates in the food we consume.

The Glycaemic Index (GI) is a measure of the effect that a carbohydrate containing food has on blood sugar levels, compared to the effect of the same amount of pure sugar, on blood sugar levels. Foods with a low GI (less than 55) means that they cause a slower and lower rise in blood sugar levels. These include types of bread such as mixed-grain and fruit and oat breads, barley, pasta, noodles, beans, sweet potatoes, green peas and milk. Foods with a high GI (greater than 70) means that they cause a faster and higher rise in blood sugar levels. High GI foods include white bread, brown rice, jasmine rice, French fries and coffee.

Limiting your intake of high GI foods will help bring down the average GI of your meal and prevent marked surges in blood sugar. If you are a diabetic, high blood sugar levels may need to be controlled by increased amounts of insulin, if you are already on insulin treatment. If you are only taking tablets to control the blood sugar levels, this may need to be reviewed, to optimize treatment of your diabetes. In any case, high sugar levels can make you feel unwell, with symptoms as described above and you should consult your doctor if this arises.

Blood sugar control, diet and exercise

Diet and exercise play a very important role in helping control blood sugar levels. Research has shown that by eating a diet with a lower GI and rich in healthy foods, people with diabetes can reduce their average blood sugar levels and reduce the risk of complications. There are various factors that affect the GI of a food. These include: the types of sugar in the food, the way it is prepared, the type of starch, and it’s fat and fibre content. Although you don’t have to avoid all high GI foods, you should try and combine them with low or intermediate GI foods when possible.

Some tips for maintaining a healthy diet and incorporating the GI index into your daily routine include:

  • Follow the dietary guidelines for Australians, trying to incorporate a variety of foods into your eating plan.
  • Try and use low GI foods instead of high GI foods when possible.
  • Try and have at least 3 low GI foods throughout the day, especially during mealtimes.

Physical activity is an important part of optimizing glucose / diabetic control. It has many benefits, including: helping lower blood sugar levels, reducing weight, improving blood pressure and cholesterol levels and also improving muscle strength and stability. It also helps the body decrease it’s insulin resistance and burn excess sugar. The National Physical Activity Guidelines for Australians recommends that at least 30 minutes of moderate intensity physical activity be performed on most days of the week.

If you are thinking about starting regular physical activity, it is important that you slowly build up achievable goals over the next few weeks, gradually increasing the intensity. It is essential to closely monitor your blood sugar levels during physical activity. When you first start exercising, it is recommended that you test your blood sugar levels before, during and after physical activity. This gives you an idea of the way your body responds to exercise. Some of the signs of a low blood sugar level include feeling light headed, faint, sweating and weak. If this occurs, you should stop what you are doing and take some quickly absorbed glucose such as jellybeans or glucose tablets. Everyone is different, so it is important to know how you respond to exercise.

Overall, the long term benefits of eating a good diet and exercising regularly far outweigh the short term excuses and effort that is needed to initiate these changes.

Diseases associated with poor sugar control

Glucose control has been shown to be very important in helping prevent particular diseases, especially if you have diabetes. Studies have been done, which show that in adults with diabetes, persistently elevated blood sugar levels is associated with an increased risk of peripheral arterial disease, (a condition affecting the arteries which results in reduced blood flow). There have also been studies which show that poor blood sugar control and an unhealthy diet is linked to cardiovascular disease (affecting the heart and major blood vessels). This is because the body’s ability to use sugar for energy is not optimized and the blood fats (triglycerides) are increased, leading to cardiovascular disease.

In the long term, poor control of blood sugar levels in diabetic patients leads to both heart and blood vessel disease, kidney failure, nerve damage, eye problems and heart disease. Gaining optimal control over blood sugar levels is therefore essential to ensure that these long term consequences are avoided.

Medications and blood sugar control

If you are affected by type 2 diabetes, medications may be used as an adjunct to manage your condition at a later stage. Factors such as diet, exercise and loss of weight are very important in managing blood sugars – if you have tried to make changes in all these areas and are still not successful in gaining good control of your blood sugars, there are many types of medications that can help you manage your diabetes. These medications are usually taken orally, to help lower blood sugar levels. There are different classes of medications, which work on different parts of the body, to try and alter the levels of insulin and sugar in the body.


Biguanides are becoming increasingly popular in helping patients with diabetes gain control over their blood sugars, especially in those who are overweight. For example: Glucophage, Diabex and Diaformin (Metformin) belong to this class. These medications work by helping the body use insulin more effectively. Some side effects include nausea, diarrhoea and on rare occasions – lactic acidosis, especially in patients who have kidney, liver or heart disease.


Sulfonylureas are one of the commonly prescribed medications to help control diabetes. This group of medication works by acting on cells, to help your body make insulin. Some examples of this group include: Daonil (Glibenclamide) and Diamicron (Glicazide). They have few side effects, such as bloating, weight gain, allergic skin rashes and gastrointestinal disturbances (ie nausea, diarrhoea) and should be avoided by people who are allergic to sulpha. Due to the fact that this class of drugs increases the release of insulin, an important side effect to be aware of is hypoglycaemia. You should learn to recognize the signs and symptoms that you experience when your blood sugar levels are low – light headedness, sweating, hunger, etc.

Alpha-glucosidase inhibitors

This group includes medications such as Glucobay (Acarbose), which work by blocking an enzyme called alpha glucosidase, resulting in a slower absorption of sugar in your digestive system. These medications are often used in combination with another diabetes medication, such as a biguanide or sulfonylurea. Alpha glucosidase inhibitors are often associated with side effects such as abdominal discomfort and flatulence.


Thiazolidinediones act to make cells more sensitive to insulin. Examples of this group of medication include: Avandia (Rosiglitazone) and Actos (Pioglitazone). Side effects which may be experienced with this group of medication include: swelling (retention of fluid), weight gain, and liver problems.


This is a newer group of oral agents developed to help control blood sugar levels. Novonorm / Prandin (Repaglinide) work by causing a rapid, transient increase in insulin secretion from the pancreas, helping control blood sugar especially after meals. It is usually taken with meals and adjusted according to the number and timing of meals eaten. Some side effects that may be experienced include: nausea, diarrhoea and blurred vision.


Insulin is the body chemical that is responsible for lowering blood sugar levels and in patients with type II diabetes the body becomes resistant to its effects and can eventually stop producing it at all. So if your blood sugar levels are not controlled well enough on antidiabetic tablets, then your doctor many consider using insulin injections, along with your tablets, to lower it.

You will usually start on a fairly small injected dose of long-acting insulin, or a mixture of long and short acting insulins, which will have an effect for up to 24 hours. These injections are often given in the morning, the evening, or both, but always at the same time. The dose starts at around 10 units per day (although this will vary from person to person) and is injected below the skin (not into the muscle) of the arm, belly or thigh. This can be extremely effective in lowering blood sugar levels, but precautions must be taken because if too much insulin is given there is the risk of your blood sugar going too low and causing a ‘hypoglycaemic’ episode. To avoid this, measurements of blood sugar level should be taken at least once every day and preferably more often. One reason for this is to make sure that the dose is as effective as possible, because it means adjustments to the dose can be made by the patient every few days.

Below is a table describing one system, although your doctor may prefer a different method and they should always be consulted if you are unsure about what dosage is correct for you.

Fasting blood sugar for the previous
3 consecutive days
Titration every 3 days;
managed by the patient
< 5.5 mmol/l No change or reduction of 2 units
(at the discretion of the investigator)
5.5–6.7 mmol/l No change or increase of 2 units
(at the discretion of the investigator)
> 6.7 mmol/l Increase of 2 units

It is important to know that this should always be concurrent with frequent blood glucose measurement and discussion with a physician.

More information

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.

Dealing With Unexplained Blood Sugar Spikes

Take steps to keep your blood sugar from rising. Martin Barraud/Getty Images

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You can do everything right to keep your diabetes under control — eat a smart diet, exercise, take medications as prescribed, and follow your doctor’s instructions for blood sugar monitoring — and still wake up in the morning with unexplained blood sugar spikes.

Even in people who don’t have diabetes, blood sugars fluctuate constantly, says Linda M. Siminerio, RD, PhD, director of the University of Pittsburgh’s Diabetes Institute. But when you have diabetes and wake up with an increase in blood sugar levels, you shouldn’t ignore it.

If high blood sugar happens once in a while and you’re able to get it under control quickly with insulin or exercise, it may be nothing serious. “Maybe you have high blood sugar in the morning because you went to a party last night and had a bigger piece of birthday cake,” Dr. Siminerio says. “Or it snowed, and you couldn’t go for your morning run the day before.” But if you consistently wake up with blood sugar spikes and don’t know why, you need to investigate the cause. You may need to adjust your diabetes treatment plan, possibly changing your medication.

You won’t feel right if you have high blood sugar, a condition known as hyperglycemia, says Anuj Bhargava, MD, president of the Iowa Diabetes and Endocrinology Research Center in Des Moines and founder of My Diabetes Home, an online platform that helps users track their blood sugar and manage their medication. When your blood sugar is too high for a few days or weeks, it can cause more frequent urination, increased thirst, weight loss, blurry vision, fatigue, and nausea. It also can make you more susceptible to infections. When you have high blood sugar for a long time, it can damage the vessels that supply blood to your heart, kidneys, nerves, and eyes, and cause serious health problems, says Dr. Bhargava.

Finding the Cause of Increased Blood Sugar Levels

A number of things can be responsible for high blood sugar:

  • If you have type 1 diabetes, you may not have taken enough insulin before bed or your insulin pump may have stopped working properly.
  • If you have type 2 diabetes, the insulin you take may not be as effective as it needs to be.
  • You might have a cold or the flu. When you’re sick, your body releases hormones that help you fight off the germs that are attacking you. These hormones can interfere with insulin’s ability to lower your blood sugar.
  • You’re stressed out from recent activities. If you’re under stress and not sleeping well, your body releases stress hormones, which again lower your ability to make insulin and process blood sugar.
  • You ate more carbohydrates the day before than you normally do.
  • You exercised less during the day than you normally do. When you exercise, your muscles take up glucose (sugar) much faster, resulting in lower blood sugar.
  • You could have what’s known as the “dawn phenomenon.” Experienced by everyone, even those who don’t have diabetes, the dawn phenomenon is part of your body’s natural biological rhythms. Pre-dawn, usually between 4 a.m. and 8 a.m., your pancreas releases a surge of hormones, including glucagon and cortisol, and temporarily slows down insulin secretion. In response, your liver releases more glucose into your bloodstream. When you have diabetes, your body doesn’t release enough insulin to adjust properly to this early morning surge of glucose, so you wake up with high blood sugar.
  • You could be experiencing “the Somogyi effect” and rebound hyperglycemia. This usually happens early in the morning. If you’ve skipped your dinner or bedtime snack, or had a lighter dinner without adjusting your insulin doses, your blood glucose levels can drop after you’ve been sleeping awhile. If this happens, your liver tries to return them to normal and releases glucose into the blood. Your liver can overcompensate for low blood sugar and cause it to become too high.

Emotions Can Spike, Too

People often feel guilty when they have high blood sugar and can become depressed, Siminerio says. Try not to let the numbers determine your mood. “People may think they caused their blood sugar to go too high or too low, but you need to understand it’s not your fault,” she says. “You don’t always have control over your blood sugars.”

Managing diabetes and blood sugars isn’t easy. “You have to monitor your food every minute of every day, exercise, test your blood sugar, and take injections or medications,” Siminerio says. “That’s not easy psychologically to deal with.”

Preventing Your Blood Sugar From Going Too High

To avoid increased blood sugar:

  • Monitor your blood glucose regularly. Put this at the top of your to-do list. Monitor regularly and keep track of your results. Discuss your blood glucose monitoring results with your healthcare provider at your regular visits. But if you’re having frequent unexplained blood sugar spikes, don’t wait for your next appointment; call your doctor.
  • Take your medication as prescribed. If your blood sugar fluctuates overnight, your doctor may need to adjust your dose or timing or may suggest that you try a different medication, Bhargava says. You may need to change your medication after a certain amount of time.
  • Watch your diet. You may need to eat less. Work with a nutritionist to find the best meal plan for you — one that helps you control your diabetes day and night.
  • Exercise. Exercise can lower your blood sugar because your muscles need to call on your stores of glucose for power. But, never exercise if you have ketones, a type of acid, in your urine. Exercising with ketones can be dangerous because it can cause your blood sugar to go even higher. Signs you have ketones: Your breath smells fruity, you’re short of breath, your mouth feels dry, and you’re nauseated and throwing up. You can also ask your doctor about testing for ketones in your urine at home with ketone strips.
  • Reduce stress levels. Try relaxation techniques and activities that help you de-stress, especially before going to bed, so that you’re able to sleep well.

“Maintaining a consistency in blood sugar will make a big difference in how you feel,” says Siminerio. Practice good diabetes management, including regular blood glucose monitoring, and keep an eye on your numbers. If you have several episodes of high blood sugar, don’t wait to talk to your doctor: If you treat hyperglycemia when you first notice it, you can avoid problems later on.

So You Went on a Sugar Bender — Now What?

So, what can you do when your blood sugar gets too high? Here are some natural (and medical) ways to get your sugar back into a safe zone.

1. Time to go om

Stress causes all kinds of problems (how many times has a bad day caused you to say something you regretted?). Beyond affecting your food choices and leaving you feeling generally run-down or unwell, stress can actually cause your blood sugar to rise.

Since stress is problematic for your blood sugar in a number of ways, it’s best to do anything you can to lower your anxiety levels.

A great way to reduce stress is to meditate. A small study found that mindfulness meditation reduced overall anxiety, even after only one session. When you take time to clear your mind, breathe deeply, and get away from the many annoying stimuli of the world, your body relaxes and stress is reduced.

According to a 2014 study, patients who did yoga regularly had a significant decrease in their blood glucose levels, so consider adding a few sun salutations to your week.

Regardless of whether you choose a guided audio meditation or an hour in a yoga studio, taking time to clear your mind and reduce stress will help your blood sugar.

2. Make like Popeye

You might not get super strength from spinach like Popeye does, but taking in some high-fiber foods can help bring down your blood sugar. A 1991 study found that fruits, legumes, and other foods rich in water-soluble fiber helped balance blood sugar.

Those fiber-y foods slow digestion, which means the sugar from your meal isn’t hastily thrown into your bloodstream. Instead, the fiber helps everything break down more slowly, and there’s more time for the sugar to be properly absorbed.

A major review of diabetic studies found that a high-fiber diet (especially including fiber from cereals) may reduce your chances of developing type 2 diabetes in the first place.

Unfortunately, that doesn’t mean you can go to town on Lucky Charms. “Cereal fiber” refers to non-sugary, unrefined cereal grains. Bran cereal, oatmeal, or other whole grains will provide the diabetes-busting fiber you’re looking for.

Outside of spinach and cereal, adding black beans, sweet potatoes, avocados, nectarines, and other fruits and vegetables high in soluble fiber to your diet will help bring your blood sugar down.

3. Don’t dry out

“Drink more water” isn’t cutting-edge nutritional advice, but avoiding dehydration is surprisingly helpful for balancing blood sugar. A 2017 study found that low daily water intake led to high blood sugar.

When your blood sugar gets high, your body tries to flush out that extra sweetness as quickly as possible. That means you might end up peeing a lot more than usual.

And if you don’t replenish your body’s water supply, you don’t have an easy way to get the sugar out of your system. So, low water equals high blood sugar.

While U.S. dietary guidelines don’t suggest a daily amount of water to drink, the United Kingdom’s National Health Service recommends aiming for about 1.2 liters, or 6 to 8 glasses of water, per day.

Try setting an alarm on your phone to remind yourself to get that H2O. If you’re in the middle of a blood sugar spike, drink water immediately and try to stay hydrated for the rest of the day.

4. Electrolyte it up

In general, elevated blood sugar can wreak havoc on your electrolytes, meaning you can easily get low on magnesium, potassium, and phosphates.

If you’re having a blood sugar spike and urinating more than usual, you’re losing water and electrolytes. And since electrolytes are essential for maintaining adequate hydration, you’re going to want to keep them replenished.

For quick relief, reach for a low-carb electrolyte drink like Propel, low-sugar sports drinks, or low-fat milk. Just make sure to check the labels.

You can also up your electrolyte count naturally with small changes to your diet. Foods like bananas, sweet potatoes, nuts, and seeds provide the key minerals your body needs to stay in balance.

Though all electrolytes are important, a study from the University of Palermo found that while many diabetic patients were specifically magnesium deficient, most achieved better glucose tolerance with magnesium supplements.

To restore magnesium balance, you can take over-the-counter supplements. Or, to increase your mineral intake naturally, eat more pumpkin seeds, almonds, cashews, plain yogurt, spinach, and other high-magnesium foods.

5. Take a pass on the bread bowl

It’s obvious that sugary stuff leads to an increase in blood sugar, but starchy foods can do the same thing. Your body processes simple carbs quickly and turns them into sugar, and it needs a lot of insulin to absorb them. That means a bag of Doritos is as likely as a candy bar to cause a spike.

If you’re in the middle of a blood sugar spike, it’s best to curtail your carb intake. Check the glycemic index if you’re not sure about a food.

Surprisingly, popcorn and white potatoes are worse than ice cream, according to the index. If you stick to low-carb/low-glycemic-index foods, your blood sugar will return to normal much more quickly.

Ultimately, it’s best to limit your carb intake. A 2004 study found that a diet of 20 percent carbs, 30 percent protein, and 50 percent fat lowered fasting blood sugar and kept blood sugar from spiking after meals.

This was a very small study, but the results suggest that lower carb intake can lead to generally lower blood glucose. In general, most people with diabetes eat 40 to 45 percent of their calories in the form of carbohydrates. Choosing nutrient-rich sources of carbs is best.

Another promising study found that after two years on a low-carb diet, many participants with type 2 diabetes were able to manage their condition without medication or resolve it entirely.

While this does suggest you should scale back on carbs, it doesn’t mean you need to break up with them entirely. Instead, try to eat lots of whole foods, including vegetables, fruits, grains, and proteins, if you have access to those foods.

The occasional baked potato isn’t a problem, but frequent trips to the drive-through are not a good idea. Find a few veggie-and-protein-heavy meals and make them your go-tos.

Then, even if you have a little bread or pasta, your diet is still full of the stuff you need and your blood sugar shouldn’t skyrocket.

6. Try glutamine (no, not that kind of glute)

Here’s a diabetes fun fact: People with diabetes often have lower levels of glutamine, according to a study from Tianjin Medical University.

Glutamine is an amino acid that helps your immunity and intestinal health, and it’s a general building block for the proteins in your body. Since glutamine tends to be low in people with diabetes, taking a supplement may help lower blood sugar.

The TMU study found that glutamine supplements made insulin even more effective, meaning blood sugar went down more easily (though it’s important to note that the study used rats).

A small study on humans had similar results. So while more research needs to be done before glutamine has a scientifically supported thumbs-up, we still think it has a promising start.

7. Get trendy with apple cider vinegar

If you do a quick Google search, you’ll see that apple cider vinegar (ACV, as the cool kids call it) is good for pretty much everything. You can use it to tone your skin, clean your pipes, and possibly lower your blood sugar!

A clinical review found that taking ACV daily could reduce blood glucose levels. Unfortunately, most of the trials were very small and some had mixed results.

But since you’ve probably got it in your house anyway, try taking a swig or two before meals, testing yourself, and seeing if a little ACV shot works for you (for bonus points, add a dash of cinnamon).

8. Go pro(biotic)

Probiotics aren’t just for keeping you regular. By reintroducing healthy bacteria in your intestines, probiotics may be able to help with inflammatory and metabolic issues. And there’s a chance those tiny bacteria can help bring your blood sugar down.

A clinical review found that daily probiotic use significantly decreased blood sugar. So if you’ve considered trying probiotics for digestion or inflammation issues, it just might help regulate your blood sugar along the way.

9. Get a little bitter (melon)

Another promising option (though it might not sound too appetizing): bitter melon.

We’re not talking about leftover cantaloupe at the salad bar. It’s a fruit mostly used as a natural remedy (in other words, you won’t find it in many smoothie recipes).

The melon contains a blood sugar-lowering substance called charantin as well as polypeptide-p, which has insulin-like effects.

In preliminary studies, bitter melon supplements helped reduce blood sugar in mice. Just make sure to talk to your doctor about this (or any) supplement before adding it to your diet.

10. Keep it cool

Remember all that stuff about staying hydrated? Well, when you get really hot, that hydration goes out the window, and your blood sugar could rise.

Extreme temperatures and high humidity aren’t fun for anyone, but they’re even more detrimental to people with diabetes. To avoid overheating and triggering a spike, do your best to stay cool when the temp is high.

You probably already do this during the day — not too many people think, “Oh, hey, let me just walk in the 100-degree sun for hours in my flip-flops and tank top. What fun!” — but it’s easy to get overheated at night while you sleep.

Be sure to wear breathable fabrics, get blackout curtains to keep the heat and light out of your room, and turn on the AC (or bust out the fan) to keep the temp comfortably low.

And by low, we mean a Goldilocks zone between 60 and 67 degrees, which will help you stay cool, sleep more soundly, and get more much-needed REM sleep.

11. Catch more Zzz’s

Speaking of sleep, not getting enough may directly relate to higher blood sugar. A 2015 study found that patients who got four hours of sleep or less for three nights in a row had higher fatty acid levels in their blood.

Usually, fatty acid levels naturally recede at night. But when people didn’t get enough sleep, the acids remained in their blood. That’s bad news since those acids make insulin less effective, which means your blood sugar goes up.

Also, a lack of sleep tends to increase stress and cravings for sugary foods — both of which are bad for blood sugar. So if you’ve had too much candy or just want to get your blood sugar down, go to bed!

Getting at least seven hours a night will help regulate your hormones, fatty acids, and stress. Try going to bed at the same time every night and putting screens away an hour before snooze time.

12. Dance the high away

Physical activity is one of the best ways to regulate your blood sugar and prevent spikes, but that doesn’t mean you have to stick to walking.

A 2013 study found that dancing helped decrease blood glucose levels more effectively than walking or using conditioning machines.

Translation: Boogying down to Lizzo is good for your health. (We knew it!)

To be fair, the study found cycling and running to be slightly more effective than dancing in lowering blood sugar. Though walking was the least effective, it did still reduce blood glucose. Just be careful not to do intense exercise midspike, which can be dangerous.

Bottom line: If you’re feeling the symptoms of high blood sugar and you have someone who can go with you, take a short walk. To prevent future spikes, make time in your schedule to shake it to your favorite song or ride your bike. Any kind of movement will help keep your blood sugar in a safe zone, so pick whatever is most enjoyable and get moving.

13. Follow doctor’s orders

If you take insulin and you are experiencing a blood sugar spike, you may need additional short-acting insulin. Make sure you’re following your doctor’s orders.

You don’t want to give yourself unnecessary doses, but you also don’t want to let your blood sugar get too high when an extra dose could easily put you back in the safety zone.

It’s important to check your blood sugar regularly, take your medication regularly, and see your doctor — you guessed it— regularly. Staying on top of your numbers can help you avoid a spike or take care of one before it gets dangerous.

What Does It Mean If Your Blood Sugar Spikes — and How Can You Prevent It from Happening Again?

Fortunately, a blood sugar spike doesn’t always mean a trip to the hospital. There are some ways you can try to lower your blood sugar.

Of course, it all depends on the person, and you should talk to your doctor about any major changes or if you think something is seriously wrong.

Chug, chug, chug… water

Drinking water can help remove the excess glucose from your bloodstream because it basically makes you pee it out. Start chugging!

Get moving

Exercising can increase insulin sensitivity, which can help your cells better absorb the glucose in your bloodstream. It can also help your muscles use blood sugar for energy, which can lower your levels.

Take a chill pill

If stress can cause high blood sugar, then it makes sense that pausing and relaxing for a bit can help lower it. You could try working out, meditating, or doing breathing exercises to calm down. A regular yoga practice isn’t a bad idea either.

Eat some fenugreek seeds

While the research on this is older, fenugreek seeds may actually work to lower blood sugar and improve glucose intolerance. You can add them to baked goods or brew them into tea.

Inject insulin

If you have diabetes, you’re probably used to injecting insulin to manage your blood sugar. But it never hurts to check with your doc to make sure you’re doing it correctly. If you’re not, you could end up with really low blood sugar, which you also don’t want.

Opt for electrolytes

When your blood sugar is high, your electrolytes are low. Electrolytes help your body maintain a good level of hydration, so you don’t want those levels to drop.

Drink a low carb electrolyte drink or a low sugar sports drink (read the labels) or eat foods high in electrolytes, like bananas, sweet potatoes, nuts, and seeds. Be careful, though, because some of these foods can increase your blood sugar even more.

Take a shot… of ACV

Apple cider vinegar might actually be a miracle worker. Some research suggests it could help lower blood sugar levels and improve insulin sensitivity.

You can mix a couple of tablespoons of ACV into a tall glass of water or go the safer (and tastier) route by making it into a salad dressing.

Stay as cool as a cucumber

Feeling really overheated and sweaty can easily lead to dehydration, which, again, can raise your blood sugar levels. When it’s super steamy outside, stay in the air conditioning and make sure you wear breathable clothes. And, of course, drink extra water.

Sprinkle some cinnamon on top

Add cinnamon to whatever you’re eating or drinking. Studies have shown that it may actually lower your blood sugar levels considerably. It can slow down the breakdown of carbs, which can help keep glucose lower.

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