5 guerrilla tactics that really work.
If you have diabetes, you may think that you are taking all the right steps with your diet, medication and exercise habits.
But the truth is, virtually all people with this common disease make mistakes in managing their condition—and unknowingly increase their risk for diabetes complications, such as heart attack, stroke, kidney failure and blindness.
Small changes can give big results: Fortunately, you can correct these missteps if you understand some of the subtle aspects of diabetes that can easily derail one’s care. To learn more, Bottom Line/Health spoke to Richard K. Bernstein, MD, an outspoken diabetes specialist who gives his patients no-holds-barred advice on controlling their disease.
Guerrilla tactics that really work: Dr. Bernstein, who was diagnosed himself with type 1 diabetes at age 12, is vigorous and healthy at almost 80. He swears by the sometimes unconventional but highly effective approach that he has developed and adopted for himself and the thousands of patients with type 1 and type 2 diabetes he has treated.
Here’s where Dr. Bernstein thinks people with diabetes—and many mainstream medical authorities—have got it all wrong…
MISTAKE #1: Settling for blood sugar levels that are too high. Everyone agrees that elevated blood sugar is at the root of all long-term diabetic complications. But the blood sugar goals established by the American Diabetes Association (ADA) are much too high. The ADA has set a hemoglobin A1c (HbA1c) of 6.5% or above as the level that indicates diabetes. Most doctors accept these levels.
To virtually eliminate risk for complications: I advise that nearly all people with diabetes strive for an HbA1c of 4.5%—an average blood sugar level of 83 mg/dL. In fact, I often advise people with diabetes to ask their own doctors why their blood sugar shouldn’t be as low as that of someone without diabetes.
Also important: Your blood sugar shouldn’t vary by more than 10 mg/dL before and after meals. Many doctors are unconcerned if blood sugar spikes as high as 200 mg/dL after a meal, as long as it returns to an acceptable average level. But people with such blood sugar spikes tend to develop the same cardiovascular complications as those whose blood sugar levels are always high.
MISTAKE #2: Not recognizing hidden causes of elevated blood sugar. Acute stress—such as a fight with your boss or anxiety about a key presentation—can raise it. If your glucose reading is higher than expected when you’re stressed, an injection of rapid-acting insulin will bring it down if you have type 1 diabetes. If you have type 2, your own insulin secretions will likely lower blood sugar within 24 hours.
Infection raises blood sugar levels—and high blood sugar increases infection risk. Suspect infection if your glucose level is up and insulin isn’t working as well as usual. Get prompt treatment so that your blood sugar will go down and the infection will heal. Beware of dental infections and gum disease. What I do: I brush twice daily, floss after meals and get tartar and plaque scrapings from a periodontist every three months.
MISTAKE #3: Using the wrong glucose meter. Whether you inject insulin for type 1 diabetes or take oral drugs for type 2, or control your disease with diet and exercise alone, you must accurately track your blood sugar with home testing.
My advice: Test a meter you are considering buying in the store—take 10 readings in succession using the manufacturer’s “normal” control solution. A pharmacy with glucose meters on display will usually let you test them—ask the pharmacist. Readings should be within 6 mg/dL of the midpoint of that normal range.
Important: Make sure that you can return the device if you find it to be inaccurate later. If your insurance company won’t cover a meter you like, file an appeal.
My favorite glucose meter: Of the many glucose meters for home use that I have tried, the FreeStyle Freedom Lite by Abbott, available at most drugstores or on Amazon.com for about $13, has been the most accurate.
MISTAKE #4: Pricking your finger the wrong way. If you use a glucose meter, your doctor will probably tell you to wipe the site with alcohol before pricking it. I disagree.
First, it isn’t necessary to wipe your finger with alcohol—this dries out the skin and can lead to calluses, which makes it difficult to get a blood sample. Neither my patients nor I have ever developed an infection from not using alcohol.
However, you should wash your hands before drawing blood. This is especially true if you’ve been handling food or glucose tablets or applied hand cream—all of which can cause false high readings. Helpful: Rinse your finger with warm water to get the blood flowing, and prick the back of your finger between the joints—this area may produce more blood and cause less pain.
MISTAKE #5: Overdoing vitamin C. In excess, vitamin C raises blood sugar and inactivates the glucose-processing enzyme in the test strip, resulting in deceptively low glucose readings. You’ll probably get all the vitamin C you need from vegetables (you shouldn’t rely on fruit—it has too much natural sugar). If you must take supplements, 250 mg daily in a sustained-release form is tops. These formulations are less likely to cause blood sugar spikes.
HOW TO USE INSULIN THE RIGHT WAY
Insulin injections are crucial for type 1 diabetes and often needed for type 2 diabetes. To use effectively…
Change with the seasons. Most people need less insulin in summer than winter (or during a warm spell in colder months). Capillaries dilate when warm, and more blood containing insulin is delivered to peripheral tissues. Adjust your dose accordingly.
Prevent blood sugar spikes by correctly gauging how much insulin you need to cover each meal and when to inject it. With Regular (a type of short-acting insulin), that’s usually 30 to 45 minutes before the meal. To determine your best timing: Inject an insulin dose, and check blood sugar after 25 minutes, then at five-minute intervals. When it has dropped by 5 mg/dL, it’s time to eat. This may not work for people who have diabetic gastroparesis, which causes unpredictable stomach emptying.