Week Recap: Controlling Hyperglycemia, Eating too fast, Improving Insulin Sensitivity

More hyperglycemia than last week

A few weeks ago I documented how I stayed in range for 95% of the time over an entire week, with a 100% streak for three days. Great success! But living with diabetes is not such a straightforward journey, and there are so many factors at play and trying to control them all is impossible for the simple reason that some of them are outside of our control to begin with. So this week I will share the other side of the story. Let me offer you the recap of a less ideal week where I experienced some more ups and downs, trying to understand the reasons behind them.

First culprit: freezing temperatures

Let’s begin with one of those less obvious reasons: seasonal changes.

It is a period of oscillating temperatures here in northern Italy, there are times where you get 10 Celsius degrees one dat and -1 the day after. Severe cold is a stress factor and historically it has always hit me one way or another - just like extreme heat in the summer. The carb-to-insulin ratios that worked until a moment ago are suddenly not suited for the same meals anymore, and despite trying to be proactive and adjusting the dosages, I can only figure out the real impact on the blood glucose levels after having eaten. Sometimes it goes higher, other times it stays in range.

I still have to figure out the pattern, how the transitions between seasons affect me and how I should adjust to make lower their impact. Since I don’t have control on the hormonal changes produced in my body I just keep a sharp focus on the factors I can act on: eat slowly, eat the usual whole plant based foods that are known to promote insulin sensitivity, keep logging all I eat and inject, time my insulin appropriately, move after every meal. These are the small actions I know improve insulin sensitivity, and when I don’t know how to manage a situation, I just revert to those.

Second culprit: stress at work and eating too fast

One other factor has been an increase in business and rhythms at work. Stress has always been a problem for me because when I am stressed the first thing to go is my eating discipline. I eat more, more often and without thinking much. In two occasions this week I had to manage some stressful situations at work just before lunch time, and as per usual, I coped by eating. My norm is to calculate my dose, inject it, wait the appropriate time and then eat my lunch (potatoes and leafy greens lately) slowly. This always works to keep everything in range, even when I slam down 200 grams of carbs. But on these occasions, I would barely look at my ratios, take my dose and then eat the entire portion in 5-10 mins. The effects of my mindlessness and rush are clearly visible: the blood glucose spiked immediately after, only to return back to range a few hours later.

Stress management around a meal is something I am still working on. I find it helpful to take 10 deep breaths before attacking a meal, and to chew each bite for 20-30 times, putting down the spoon. Chewing properly not only improves digestion, but it also slows down the mealtime and allow the our diabetic organism to manage the carbohydrates at its best.

Time your insulin right, eat slow, eat mindfully and chew a lot. That’s how you keep your levels stable!

Third culprit: higher night time levels

The third factor to account for is my dinners. All my 600 grams of daily carbs are eaten throughout the day, when I am most active and need them the most, and I tend to stay light in the evening, preferring a big portion of greens and steamed vegetables with some legumes to garnish the plate. But as my running training block for my next marathon has started again, and I always run in the early morning, I have introduced some more carbs in my dinner to keep up the glycogen stores. Nothing big, just 40-50 grams of carbs mostly coming from potatoes, which I digest very well.

My errors here were two. The first, basic, one was forgetting to log the amount and calculate the exact bolus insulin to take. I increased it a bit but without putting too much attention to the math. The second one was, again, rushing through the meal. It even sounds funny to write it, but I simply ate my potato too fast. My norm is to take 20 mins to finish whatever meal I have in front of me, trying to take a pause half way through it. For instance, I usually eat half, take 5 minutes to stand up and do the dishes, then come back for the second half. But this time around I was too busy watching shows on my laptop, and I forgot the basic behaviors. Again, I forgot about mindfulness.

This produced some slow increases of my blood glucose over night, which reached the level of 210 by the time I opened my eyes again.

I also don’t move much after dinner. I don’t always feel like dressing up again and head outside in the evening, so I am going to fix that by walking around my living room or do some chores for 10-15 minutes after I am done eating. I know this works because it worked in the past, and I simply forgot the habit for a bit.

But Improved Insulin Sensitivity: sticking to the process

Despite these few episodes which I know I can correct by simply paying more attention to my behavior, my insulin sensitivity is trending up! I eat around 500-600 grams of carbohydrates a day, and I moved from 50 units one month ago to 40 units two weeks ago to the current 30 units of insulin a day (including 8 units of slow acting insulin).

That is the consequence of the same old three guys:

whole, plant based foods that are naturally rich in carbohydrates and low in fats (see the Mastering Diabetes Method articles about reducing insulin resistance)
daily movement, especially short walks after each meal. I also run and exercise every day, but it is non negotiable for me to move after eating, even when that means walking in circles in my 10 squared meters living room.
plenty of sleep. 8-9 hours of good sleep are the most prominent building block for everything else. Good quality sleep is secured by a good wind down evening routine, a good digestion and daily exercise. Get your hours in and you’ll be on your way to reduced insulin resistance and improved blood glucose control.

And of course logging and tracking everything. Sticking to the fundamentals always work, and while there are times when blood glucose control is harder, having a solid process and known path for decision making will ensure that we get through even the toughest times with success. The definition of success varies with time: some days it means 90% time in range, other times 80%, other times just accepting that our body is going through its own adaptations and that our control over blood glucose has to go for a while.

*No drama overall. 85% is still very good!*

And that’s ok! Missing one or two days will be nothing. Just know what works, take notes on what happens, stick to the process, be mindful and make sure you do things for a reason. When your system is set up for success, a few short term drawbacks will not affect the long term objective: good, solid health.