Gettysburg Medical Center
The Clinical View
by P.E. Hoffsten, MD
28 November 2007

TIPS ON BLOOD SUGAR CONTROL

            I am sitting here the morning after Thanksgiving marveling at how so many things can go so wrong.  With a fasting blood sugar this morning of 141 milligrams % (my usual is below 100), I am probably not the one to be telling someone else how to control their sugar.  But that old phrase about, “Do as I say, not as I do.” does seem to have some application.  So with these reservations, here is some information and some tips that may help control blood sugar better in the next month.  With the holidays in full swing I can see more obstacles coming down the road.

            In the first place, diabetes seems to be a progressive problem.  It starts off with what we call “a little insulin resistance”, meaning that the pancreas has to make more insulin than normal to keep up with the person’s blood sugar control.  Insulin is the hormone that makes the blood sugar come down.  As a person passes “a little insulin resistance” and becomes diabetic, the insulin they have just doesn’t work as well and they need to make more and more of it in order to keep the blood sugar down.  Eventually, the poor pancreas that is making insulin is asked to do more than it can do.  That is when the blood sugar starts to really go up. 

            Point #1.  Recognize that diabetes is a progressive disease that gets worse with time.

            To make a second point, a recent publication measured blood sugars in a large number of people and then ran their glycosylated hemoglobin (A1C) every three months.  Up to this time, we thought that a normal A1C was 6%.  It turns out that on  average a person with a A1C of 6% has an average blood sugar of 126 milligrams % which is no place close to normal.  A normal fasting blood sugar is less then 110 mg% and probably best under 100.  By the time a person’s A1C gets to 7%, the average blood sugar that person has is 155 mg%.  Those that think they are better than that are hiding their “bad blood sugars” by checking fasting blood sugars.  Fasting blood sugars are their best sugars.  The ones that you want to know about are the ones two hours after eating because that is when blood sugars come out at 160 and 180, and 200 milligrams %.  But if you don’t check blood sugars after you have eaten, you’ll never know that those are there.  By the time a person’s A1C gets to 8%, their average sugar is 182 milligrams % which is associated with deterioration of eyes, kidneys, nerves and blood vessels.  An A1C of 8% borders on a medical emergency. 

            Point #2:  Where we thought that the A1C of 6% or less was a “normal” blood sugar, it turns out that an A1C of 6% is already somewhat high.

            On of the biggest frauds perpetrated on our society at this time, is the idea that the wonderful prepared breakfast cereals are good for you.  Cheerios advertises everything from keeping your cholesterol down to providing fiber for your diet and bragging about “whole grain” content.  In fact, those wonderful prepackaged breakfast cereals will raise a blood sugar 100 mg% in 20 minutes.  Breakfast cereals are so laced with sugar to make them taste better and make your kids eat them, that when an adult eats these things, their sugars just go crazy.  Now I am not taking about oatmeal or cream of wheat without added sugar.  But sugar coated this and honey coated that raise blood sugars something horrible.  Unfortunately, the same thing is true for eating an orange or any very sweet fresh fruit.  Grapefruits or even apples aren’t quite so bad  but those wonderful fresh juicy, fleshy fruits like watermelon, cantaloupe, tangerines, plums and grapes raise blood sugars right away.

            The next point to make is going to seem almost like blasphemy.  It has been known for a long time that caffeine briefly raises blood pressure and pulse and wakes somebody up.  At a recent meeting of the American Association of Diabetic Educators, researchers at Duke University showed that caffeine had the effect of raising blood sugars very substantially.  A cup of coffee this morning, is not going to raise blood sugars this afternoon or tonight; but the cup of coffee this morning with a sweet roll, will zoom blood sugars off the map.  The researchers at Duke University demonstrated that stopping caffeine intake dropped blood sugars by 20%.  Caffeine increased the amount of insulin that the person was asked to secrete by 48%.   Thus a diabetic pancreas which was already struggling gets whipped and beaten into putting out even more insulin in response to caffeine.  To put this in perspective, stopping caffeine can be the equivalent of taking one diabetic oral medication.  On average, most diabetic oral medications decrease blood sugars by about 20%.  Diabetic medications cost money; stopping caffeine costs nothing but to find a new way to try to stay awake.

            Unfortunately, the ugliest way of all to control blood sugar is to exercise more and eat less.  It is coming towards January 1 when everybody makes their wonderful New Years resolutions and people always promise that they are going lose weight and exercise more.  It usually lasts about 15 minutes before the couch potatoes are back in front of the idiot box and the whole program goes down the drain.  To keep things in perspective, eating less costs nothing.  It is a really cheap way to control diabetes.  Exercising more, adding a mile or two miles, or three miles a day to one’s walking program has a tremendous effective on blood sugar control.  With one-third of our population now way overweight, this is the most urgent and important step in diabetic control.

            Of course, if one doesn’t want to try all of the things mentioned above, there are now eight different kinds of pills one can take for diabetes ranging in cost from $4.00 a month for glyburide, glucotrol and metformin to $300.00 a month for some of the new injectables.  And of course, there is an alternative I unfortunately see a whole bunch of people use.  From the standpoint of money, the least expensive way of taking care of diabetes is not to do it and let all of the medical complications of blindness, kidney failure, and numb feet slowly, progressively and irreversibly progress.  Those are the real tragedies because once those events happen, it doesn’t help to say, “OK!! I am going try and control my blood sugar now.”  By then it is too late. 

This and other columns available at www.macpierre.com.