Wednesday, March 18, 2009

Vegetables that help control blood sugar in Type 2 diabetes.

I have found that some vegetables are very helpful to me in my effort to control blood sugar after meals. Conversely, there are some that are very harmful.

The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.

Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.

All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.

The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.

Tuesday, March 17, 2009

What to do when one strays from the strict plan for controlling blood sugars.

When controlling blood sugar with diet and exercise, willpower plays a strong part. And the willpower has to be applied not just on one day or for a specific period of time. It has to become permanent. One is not on a "diet" plan when trying to manage Type 2 diabetes without medication. One is on a "lifelong" course.

For me, use of willpower to do my daily exercise is much more manageable than applying willpower to resist eating desserts or food items that are not allowed.

I can do my workouts anywhere anytime. Whether I am traveling on business or enjoying a vacation in a tropical paradise, I will find time and create the opportunity to get in some walking time, tread milling and lifting weights. It does not appear like it is a chore to me. So I have that base covered.

Ever since I have had my glucose readings and my A1C in the normal range I have felt good. But over time, I have become a little more relaxed in my restrictions related to sweet dishes and how much of a particular dessert I consume at one time.

This can be dangerous. Fortunately, I have been through these types of situations enough times that now I have a pretty set way of dealing with the deviation. In other words, i have a system for getting back to good control when I have fallen off the wagon.

Luckily, this happens generally for no more than 1 or 2 meals. And that also around the holiday time. Here's my process for course correction.

First, after every meal in which I know I have eaten more carbs or higher glycemic index food, I always check my blood sugar multiple times until the "clearing" takes place. If the peak is high, like 147 for example, I get concerned. So first step is to get a wee bit scared. And the fear comes from looking at a high reading. And that happens from an established habit of checking blood sugar frequently. I am quite data-driven so that also helps.

Second step is a follow-on from the first one. Fear from the high reading puts me in a fighting mood. Combat status to quell the rising glucose blood sugar number and get back to normal as quickly as possible. I take action the next day right from breakfast. I watch what I eat and do my exercise attentively. And I test. Blood sugar returns to my usual levels. Leads to relief and satisfaction. Good feelings to have.

Monday, March 16, 2009

Blood sugar after exercise ............reply to reader's comment.

Adnan's second question was about blood sugar after exercise. Some people say that their blood sugar rises immediately after exercise. And then there are others who claim that their glucose level actually drops after exercise.

In my own case, I have experienced both. Let me explain.

When I go for a walk for 30 minutes - the brisk, arm moving, spring in the step kind of walk - and come back and check my blood sugar, it invariably is in the 90s. I have not tested the effect of shorter walks because in my opinion, those walks do not provide much exercise.

After a vigorous 30 minute treadmill workout, my blood sugar tends to also be in the 90s. And then it may slip back to the high 80s.

The only time I have seen an increase is after lifting weights. There is definitely something about a workout involving muscle action that stresses specific muscles to the point of no return. Meaning I just could not do one more rep if my life depended on it. Which is how muscle building exercises tend to be....they work you to exhaustion. The glucose meter definitely shows an increase after such a workout for me. But not by much and not for long. Maybe in the low 100s and then within half an hour, it comes back to the 80-90 mark.

I am sure everyone sees a glucose response to exercise that is unique unto themselves.

Sunday, March 15, 2009

Blood sugar upon awakening ......reply to reader's comment

Adnan from Phoenix raised a great question.

About testing blood sugar first thing in the morning. And the answer is yes, absolutely. No matter where I am, I make it a point to do so. In fact, I can't recall even one single day since diagnosis when I might have missed testing my fasting blood glucose.

I have done it both ways. I test the blood sugar after waking up and then after I get ready just before breakfast. Most days the time lapse between these two readings is about an hour. Both readings are fasting sugar numbers. I have not found any significant pattern between the two readings. In other words, the second reading is not consistently higher or lower than the first reading. Actually, most of the time, they are pretty close, within plus or minus 10 mg/dl.

Sometimes I double-check my readings with a second meter. This morning my blood glucose was 74 taken at 10 AM. It was a late night last night. I was watching a movie, Linewatch on Bluray disc. Good movie.

In Adnan's case, a reading consistently between 102 and 110 is interesting in that there is so little variability from day to day. Each reading can vary by at leas 5 per cent on the basis of differences in strips and because of the inherent tolerance in the accuracy of the meter itself.

There is also this thing called the "dawn phenomenon" which increases the fasting glucose number in some people to 30-40 mg/dl more than the bedtime reading in spite of the fact that these people may not have had anything to eat after going to bed. Apparently it is caused by an overactive liver that dumps a lot of glucose into the bloodstream in the morning to prepare body for the day's activities.

And then there is the matter of late night snack. I always have something at about 10 30 PM. The snack definitely contributes to the fasting reading but here again, the effect differs widely. Some can control the snack related increase by having a protein-based snack whereas in other people, it doesn't matter what kind of snack they have - it always raises the reading.

So far I have been lucky in not having a noticeable "dawn effect" and being able to snack without causing a big increase in my morning blood glucose. I am keeping my fingers crossed.

Saturday, March 14, 2009

The second part of optimal post-meal blood sugar.

Controlling the peak of post-meal blood sugar is the first part of my goal. And that is to keep the peak below 140 mg/dl. Just like in the case of non-diabetics. Big question then is: how does one determine the peak?

Here is how I figured out the peak. Medical literature states that post-meal blood sugar in Type 2 diabetics peak somewhere in between the first and second hour after the meal. So that is a good starting point. Over many meals I collected sugar readings at the 1 hour, 1.5 hours, 2 hours and 2.5 hours after the first bite. Another key point is to count the time from the first bite not when the meal is finished.

Based on those many post-meal measurements, I found that in my case 1.5 hours after the first bite is when the peak occurs. For me, this is quite consistent. So whenever I have a meal whose carb content I am unsure of, I will test the post-meal blood sugar at 1, 1,5 and 2 hour points to determine the peak. Generally, a single reading at the 90 minute mark gives me an excellent measure of my peak. And this is the number I try to keep below 140. This is the first part.

The second part has to do with when the blood sugar returns to the pre-meal level. This is the hard part. Non-diabetics go back to their pre-meal levels within 2 hours of their first bite. For a Type 2 controlling with diet and exercise, this 2-hour goal can be quite challenging. There is even debate about the 2 hour normalizing observation. Some diabetes doctors I have spoken with consider a 3 to 3.5 hour clearing time.

Also the 2-hour clearing goal is difficult for Type 2s because of the delayed insulin response from the pancreas. Which is why we have this condition in the first place.

Normally, the pancreas releases insulin in response to food in two phases. Phase 1 insulin response is based on how much insulin the pancreas already has stored and Phase 2 response has to do with what it needs to make to handle the food load it faces.

For me, I have set my goal as follows: I must reach my pre-meal blood sugar within 3 hours or sooner. And that number has been consistently below 95 with my present diet and exercise routines.

Friday, March 13, 2009

What is the optimal post-meal blood sugar reading for me?

The optimal post-meal blood sugar reading for me is the lowest number possible. Yes, that is how I view this particular goal.

There are many "standard" targets.

The American Diabetes Association states that "Postprandial plasma glucose (after a meal)" should be less than 180 mg/dl.

The American Association of Clinical Endocrinologists cites "140 mg/dL as the 2-hr PPG". PPG here means post-prandial glucose.

In my opinion, the above two glucose goals are too generous. The ADA specifies a peak number. The AACE does not mention a peak but instead talks about a 2-hour recovery goal.

Both targets are in stark contrast with the actual observed peak amongst non-diabetics. Which happens to be 140 mg/dl. No matter how many carbs a non-diabetic consumes, his perfectly functioning body will keep the maximum glucose level below 140.

So why should we, Type 2 diabetics who are controlling the disease with diet and exercise, not reach for the same thing? I do.

My post-meal sugar goal is below 140. Occasionally, I may drift into 145-150 but not very often. And over time, I have learned the impact of certain foods on my post-prandial readings so that I can adjust my carb and/or caloric content to stay within my self-imposed limit.

Thursday, March 12, 2009

What should be the morning blood sugar number for Type 2 diabetics?

I have a very specific set of blood sugar goals. These may not make sense for anyone else. As we all know, this is such a "unique to oneself" disease, that my glucose goals may have no relevance for someone else.

Let's begin with the morning fasting number. Frankly, for me, happiness is seeing a 75-85 on my monitor's diplay first thing in the morning. That really makes my day. I can live with below 90. But any number above 90 for me is a bit of a red flag.

It means one of two things. Or both. One that I ate too much the day before (and night too - dinner and late night snack). Two that the carbohydrate amount in my prior meals were too high.

There is a third possibility too but I have not been able to establish strong correlation yet. And that is, that I did not get my requisite amount of exercise. Be that the walking, treadmill or weights. My mitochondria just did not get sufficiently "awakened".

Don't know about the third factor but the first two are pretty straightforward. They happen to me all the time. Well, not totally all the time. But whenever I have a 95-110 reading I can trace it to something I ate. I have not had a reading above 110 in a very long time.

Calorie restricted meals are critical for me. Does not mean that I starve myself. It means that if I overeat it shows up on my glucose monitor next morning.

If I have more than my usual amount of carbohydrates, the strict sugar control gets somewhat compromised come daylight.

I can deal with it. I don't get frustrated or dejected. I am just glad that my body responds to some of the steps I take. Literally.

And that is a good feeling.