Blood Glucose Is Affected By More Than Just Food
If you search for factors that affect blood glucose levels (BGLs) online, chances are you’ll find a heavy emphasis on food. What we eat does impact our BGLs; however, there are many other elements we can focus on when managing diabetes. BGLs are affected by things such as sleep, stress, medications, the menstrual cycle, hydration and temperature.
Hormones
When under stress, whether it’s due to lack of sleep, mental health or illness, it’s common for BGLs to rise because hormones such as cortisol are produced. Of course, cortisol can be elevated during exercise and even cause high BGLs when glucose is made by the liver.
Menstruation and menopause also cause fluctuations in hormones. The menstrual cycle, being divided into phases, can affect BGLs differently throughout the 28 days. For example, it’s common for BGLs and insulin needs to change before the Menstrual phase (days one through 7-10). The Follicular phase, days 8-10 until day 14, typically does not cause a big change in BGLs or insulin needs; neither does the Ovulation phase (days 15-20). The Luteal phase, days 21-28, can be associated with insulin resistance and insulin sensitivity, depending on the person. Of course, not everyone has a 28 day cycle so these fluctuations can vary by person too.
During menopause, changes in levels of progesterone and estrogen can lead to a difference in BGLs, and some people need to begin taking insulin for better diabetes management.
Medications
BGLs can increase or decrease depending on certain medications. Those that typically raise BGLs include:
- Corticosteroids (decrease inflammation)
- Beta blockers (treat heart attack, heart failure and arrhythmias)
- Diuretics (treat high blood pressure)
- Niacin (lower cholesterol and triglycerides)
- Statins (treat high cholesterol and prevent heart attack and stroke)
- Fluoroquinolones (a class of antibiotics that treat respiratory, urinary tract and abdominal infections)
- Birth control (though there is conflicting data about which types impact BGLs)
- Antipsychotics (treat certain types of mental health conditions)
The following medications have the opposite effect, in that they can cause low BGLs (though their purpose is to help keep BGLs in range).
- Metformin (decreases the amount of glucose made by the liver and makes muscle tissue more insulin sensitive)
- DPP-4 Inhibitors (such as Tradjenta, prevent hormones GLP-1 and GIP from breaking down)
- GLP-1 and Dual GLP-1/GIP Receptor Antagonists (including Januvia, help the body use GLP-1 and GIP hormones)
- SGLT2 Inhibitors (including Jardiance, cause extra glucose to leave the body through the urine)
- Sulfonylureas (such as Diabeta, stimulate the beta cells to make more insulin)
- Thiazolidinediones (including Actos, these help insulin work more efficiently and reduce glucose production in the liver)
Because medications can directly impact BGLs, it’s always important to discuss with a provider what to expect when changing or starting a new medication. Being mindful of medications and talking to your doctor about side effects and how they impact BGLs is another important part of diabetes management.
Temperature + diabetes
The heat can play a big role in diabetes management. People with diabetes are at higher risk of dehydration, which raises BGLs. In addition, higher temperatures impact how your body uses insulin, which can cause either high or low BGLs.
You’re also more vulnerable to heat exhaustion with diabetes because it can damage blood vessels and nerves, leading to the decreased ability to cool your body. The heat can also dilate blood vessels, which increases insulin absorption, possibly leading to low BGLs.
In addition, medications and supplies such as insulin, test strips and glucose meters are all sensitive to temperature. You can avoid problems by storing them in coolers and taking them inside with you instead of keeping them in the car.
The role of continuous glucose monitors (CGMs)
CGMs are small devices worn on the body to track BGLs continuously. These devices give even more insight into which factors impact blood sugar besides food. They also show data such as trends and time in range (TIR) so it’s easier to determine if changes to your diabetes management routine are working. CGMs are great tools to help you better understand how factors other than food impact your BGLs.
You can ask your doctor to go over your CGM data with you, like any trends or patterns, to make informed decisions on what changes you may want to take.
Routine changes
Knowing that elements such as sleep, stress, physical activity, medications and temperature affect BGLs, it might be a good idea to make changes in your daily routine. Perhaps prioritizing sleep and going to bed earlier is something that could improve your BGLs.
For others, stress management might be something to implement. If adding physical activity to your routine is a goal, make sure it’s manageable—not too much, too quickly. Also, try to find something you actually enjoy! There are resources available if access to medications and supplies are a burden and stressor for you.
As with any change, remember to take baby steps and not make too many modifications at once. Focusing on one thing at a time, getting comfortable with that process and then implementing another change is often the best way to have success with new habits.
If you are looking for support from people who understand what it’s like to live with type 2 diabetes, consider joining the Beyond Type 2 Community!
Editor’s Note: Educational content about health equity and access is made possible with support from Abbott, makers of the Freestyle Libre 3 system, a founding partner of Beyond Type 2. Editorial control rests solely with Beyond Type 2.
