29.1 million or 9.3 percent of people in the US have diabetes and of those people, over 27% do not even know they have it. Another 86 million or one in three people have pre-diabetes, which without lifestyle changes can lead to Type 2 diabetes. If you have a parent with Type 2 diabetes or if you have diabetes then you should be checking your post meal blood sugars occasionally.
As a certified diabetes educator it has often surprised me to hear my patients say that their health care provider told them they did not have to check their blood sugars, let alone blood sugars after a meal. I also have heard the shock from my patients when they first were told they had diabetes. For those newly diagnosed with diabetes, looking back at their fasting basic metabolic panel which includes a blood glucose test, I often find that they have had pre-diabetes for years. With all that health care providers have to do today in a short office visit, it is no wonder these lab results are overlooked.
Why Check Your Blood Sugar
Checking your blood sugar is like checking the pulse of your pancreas. The pancreas is the organ that makes insulin. Insulin is the hormone that helps to bring the sugar from digested food into the cells for energy and lowers the blood sugars circulating in the blood vessels. Blood sugars are highest one to two hours after a meal depending on the food choice and combination. We also know that high blood sugars over time can lead to kidney, eye, nerve and cardiovascular damage. Think of your pancreas as the brake system for you blood sugars. Over time with repeated insults from high blood sugars the brake system weakens and eventually leads to permanent damage. Brakes can just be replaced, but for people with diabetes the only choice is to go on more medications and eventually insulin through injections or a pump.
There is a strong genetic link to the development of type 2 diabetes, much stronger than in type 1 diabetes. According to the American Diabetes Association, if you have a parent who developed diabetes before age 50 then you have a 1 in 7 chance of developing it. If your parent was diagnosed with type 2 diabetes after age 50 you have a 1 in 13 chance of developing it. So, if you have not been diagnosed with pre-diabetes then checking your blood sugars two hours after that pizza or Chinese buffet splurge will tell you how your pancreas is handling your indulgences and maybe convince you to keep those portions smaller and less frequent. Borrow your parents glucometer to check or heck, treat yourself to a meter from Walmart (the Reli-On is only about $30). And if you already have type 2 diabetes, occasionally checking your blood sugars two hours after a meal could help you navigate towards healthier food choices, slow down the diabetes process, and possibly keep you from ever needing insulin injections.
How Food Impacts Blood Sugars
Stress, infection and certain medications can cause hyperglycemia, or high blood sugars, but on a day-to-day basis it is the amount and types of carbohydrates we eat that cause blood sugars to rise. Carbohydrates are made up of starches and sugars and include things like cereals, pasta, soda and sweetened teas, grains, breads, milk, chips, ice cream, starchy veggies, sweets and even large servings of fruit. The more processed the starch, the more rapidly it can impact blood sugars. So eating a cereal like Cinnamon Toast Crunch or Rice Krispies that has been stripped of its fiber and has little protein or heart healthy fat, will cause a rapid rise in your blood sugar and less satiety than a breakfast with the right combination and amount of protein, fat and carbohydrates. Based on a 2000 calorie diet, the RDA for carbohydrates is no more than 300 grams a day. If someone has diabetes then the recommendation is between 45-60 grams per meal depending on activity level. I have worked with many people with pre-diabetes or diabetes who have tried to stock pile their carbohydrates by skipping or eating a very small breakfast and lunch and then eating a large amount of carbs in the course of an evening. This overworks and will eventually tire out the pancreas leading to diabetes or the need for insulin injections.
Blood Sugar Patterns
The first graph is a blood sugar pattern of someone with a healthy pancreas who has no pre-diabetes or diabetes. This strip shows three different days worth of blood sugars with each color representing a different day. The insulin in their body is able to do the work required to keep blood sugars in a normal range as evidenced by the fact that the blood sugars never went above 140 mg/dl. In pre-diabetes blood sugars can go as high as 199 mg/dl after a meal. If someone with pre-diabetes or diabetes has a meal with a lot of carbohydrates, especially ones stripped of their fiber (think donuts, juice, pasta, soda, rice) their blood sugar will rise rapidly and well above 140. An hour after their meal they might feel really tired or feel irritable or shaky due to a surge in insulin as their body tries to cope with the barrage of quickly digested carbs.
The next graph belongs to a person with long-standing Type 2 diabetes. You can see in this graph that the blood sugars are well above 200 and as high as 350 after eating. If this person was checking his blood sugars two hours from the first bite of food he would learn how his food choices were causing such a high blood sugar. This person was having cold cereal, milk, bananas and juice for breakfast which explains the sudden rise in blood sugar because all those foods are high carbohydrates when all combined, and low in protein and fiber. It would have been interesting to see how much lower his morning blood sugar would have been if he had tried a breakfast of 2 whole grain slices of bread with a half cup of low-fat cottage cheese or perhaps my smoothie recipe.
How To Avoid High Blood Sugars
The best way to avoid the sudden rises in blood sugars is to combine foods in a specific way to slow down digestion and lower the blood sugar rise. This eating strategy not only keeps blood sugars under better control, but it takes the work load off the pancreas, will keep you fuller longer, and will help you to lose weight.
The simplest way to learn about the way to combine foods is to use the Choosemyplate method. Breakfast might consist of a serving of whole grains, some lean protein coming from eggs, low-fat cheese, Greek yogurt or lean meats like Canadian bacon and some healthy fat from nuts or flax seed. Your lunch and dinner plate along with a glass of skim or low-fat milk, should consist of a smaller 9-10″ plate divided in four with each quarter containing:
- A non-starchy veggie like broccoli, salad or some other green
- A lean protein like chicken, lean pork, fish, Greek yogurt, low-fat cheese (can still be high in saturated fat so be aware of your serving size), eggs and nut butters
- A fruit
- Grains like brown rice, a slice of whole grain bread, whole grain pasta
Checking Your Blood Sugars After Eating
Healthcare is changing and gone are the days that your health care provider will be able to manage everything to keep you in good health. People need to learn to take responsibility for their own health by knowing their family history, by being proactive and informed, and willing to check-in with their own body. Borrow a meter, buy a cheap one at Walmart, but be informed and check the pulse of your own pancreas today if you have a family history of diabetes and certainly if you already have diabetes. Who knows, you might find checking your blood sugar might be just the impetus you need to eat better, feel better and live a longer, healthier life.