Diabetes is a complex disease that impacts how the body regulates blood sugar. As a doctor who has treated diabetic patients for over 20 years, I often get asked why blood sugar levels can fluctuate so much in people with diabetes, even when they are taking medications, watching their diet, and exercising. In this article, I will provide an overview of why this happens by sharing a case study of one of my long-time patients.
Introduction
My patient, let’s call him Mr. R, is a 65-year-old retired man who has had type 2 diabetes for 25 years. Despite faithfully taking his medications, checking his blood sugar twice a day, researching diets and exercise plans for diabetics, and trying many different lifestyles including various diets over the years, Mr. R still struggles to keep his blood sugars in check. They tend to spike and dip frequently. This frustrates him enormously, as he works so hard to manage his condition.
As a doctor, I have seen many cases like Mr. R’s. Diabetes management can be extremely difficult and blood sugar fluctuations are widespread, even in the most diligent patients. Below, I outline some of the key reasons this occurs.
Key Reasons Diabetic Blood Sugar Levels Fluctuate
Several key factors cause unstable blood sugar levels in diabetics
1. Insulin Resistance
Insulin is the hormone needed to transport glucose from the bloodstream into the body’s cells for energy. In diabetes, either not enough insulin is made (type 1 diabetes) or the body becomes resistant to the insulin it does produce (type 2 diabetes). This insulin resistance causes excess sugar to build up in the bloodstream rather than getting absorbed by cells. Stress has also been shown to elevate blood sugar levels by inducing insulin resistance.
As we age, insulin resistance tends to worsen over time, meaning more fluctuations in blood glucose levels. Mr. R. has likely experienced a gradual worsening of insulin sensitivity over the 25 years since his diagnosis. His blood sugars are harder to control now than when he was first diagnosed.
2. Inconsistent Diet & Exercise Routine
To manage diabetes effectively, following a regular exercise routine and eating a consistent carbohydrate diet with proper medication timing is crucial. But life often gets in the way. Illnesses, travel, holidays, stress at work, family emergencies, or general fatigue can interfere.
Mr. R. does try different diets in search of better blood sugar control. But frequently changing between low-carb and high-carb approaches disrupts consistent insulin dosing and activity levels, causing more fluctuation. Irregular exercise also impacts blood sugar balance.
3. Side Effects of Medications
Along with diet, medicines, and insulin shots, many diabetics also take additional medications. As with all allopathic medications, these drugs can cause side effects that negatively impact blood sugar levels.
For example, diuretics or “water pills” frequently prescribed for high blood pressure can trigger drops in glucose levels. Mr. R takes several medications so interactions may inadvertently affect his diabetes management. Stress and lack of sleep may also exacerbate medication side effects.
4. Dawn Phenomenon
Many diabetics experience spikes in blood sugar levels in the early morning hours between 2 and 8 am, even without eating food. This is caused by changes in hormone levels during sleep. Stress hormones like cortisol and growth hormones can become elevated to counteract drops in glucose while sleeping. When this occurs, the liver starts churning out extra glucose leading to very high morning blood sugar levels.
Mr. R’s fluctuating bedtime routine, from sleeping pills some nights to watching late-night YouTube videos other nights, probably intensifies these effects. Too little restful sleep likely contributes to his blood sugar instability upon waking.
Conclusion
Hopefully, this gives some insight into why keeping blood sugar level is so challenging for many diabetics like my patient Mr. R, despite their utmost efforts and dedication. Every diabetic patient is different, with varying lifestyle and health issues impacting their disease management. As doctors, we aim to provide individualized guidance, medication regimens, and lifestyle plans to help each patient gain better control of this complicated disease.
I strive to remind my patients to be patient with themselves on difficult days and celebrate even small management victories, as progress is often not linear. Consistency with food, activity, sleep, and stress management is key. I am here to support Mr. R and all my patients through the ups and downs of life with diabetes.
