Page 12 - Diabetes

Q

NEWS&
NOTES

Q: I am 61 years old and have Type 2 diabetes. is the opposite. My A1C is 6.9% while my fast-
I am in moderately good shape, but my blood ing blood sugars are in the high 100s and 200s.
sugar doesn’t seem to come down the way it What does this mean?
used to when I exercise. Do you have any sug-
gestions as to what I should be doing? A: I see these types of A1C/meter reading mis-
matches all the time. Remember, A1C reflects
A: First and foremost, nice job! Exercise is an average blood sugar over a two- to three-
perhaps the best way to keep Type 2 diabetes month period. That includes blood sugars
controlled. It helps with weight management, before, between and after meals, while we
improves sensitivity to insulin, burns glucose and sleep and exercise, and even when we’re doing
Our Expert does a world of good for mental health. absolutely nothing.
Gary Scheiner MS, CDE, is owner The fact is some forms of exercise are better If your fasting blood sugars represented
and clinical director of Integrated than others at producing an immediate drop in your entire day, your A1C would be somewhere
Diabetes Services (www.integrat- blood sugar levels. Aerobic activities like walk- in the mid-8s. So clearly, your fasting readings
eddiabetes.com, 610-642-6055), ing, cycling, swimming and dancing use lots of do not represent your entire day. It is very
a private practice specializing
in intensive insulin therapy for large muscles in a moderate-intensity, rhythmic possible that your glucose levels are rising
children and adults. He and his fashion. This usually results in a nice blood overnight or in the early morning and then
team of Certified Diabetes Educa- sugar drop. Anaerobic activities such as weight come down the rest of the day.
tors work with clients throughout lifting, high-intensity training and competitive As is the case with people whose A1C is higher
the world via phone and internet. sports tend to use isolated muscles for shorter than expected based on their fingerstick meter
Gary has lived with Type 1 diabe-
tes for 30 years and was named periods of time, and may involve a great deal of readings, it is necessary to collect data at times
Diabetes Educator of the Year in adrenaline production. This limits the ability of day other than just fasting (pre-breakfast).
2014 by the American Association to lower blood sugar levels and may even result Consider checking your blood sugar before
of Diabetes Educators. He has in a temporary rise. These types of activities are lunch, dinner and bedtime. If you don’t want
written six books, including Think not bad for you, but their immediate effect on to check four times a day, try checking before a
Like A Pancreas.
blood sugar isn’t always desirable. different meal each day. Also, check a few times
Workout timing is another variable. If you after each meal (about an hour after finishing
exercise soon after a meal when food is digest- eating) just to see how high your blood sugar
ing, your blood sugar is normally rising. Exer- peaks after eating. Throw in a few middle-of-the-
cising at this time produces less of a blood night readings and pre-/post-exercise checks and
glucose decline compared to exercising on you should have a portrait of what your blood
an empty stomach. If you didn’t exercise, your sugar looks like through the course of the day.
blood sugar would probably be much higher Another way to take a more complete look
than if you did. There is plenty to be gained at your blood sugar patterns is to wear a con-
from morning exercise: it’s a great way to start tinuous glucose monitor (CGM). If your insur-
the day, the risk of hypoglycemia is reduced ance won’t pay for one that you can use on an
and your blood sugar will likely be lower for ongoing basis, consider asking your doctor for
the rest of the day. But it’s important to under- a loaner. Most diabetes centers and endocrinol-
stand that morning exercise, when combined ogy practices have CGMs that you can wear for
with hormones that the body produces early in about a week and then return for evaluation.
the morning, may not lower the blood sugar The data generated by CGMs can be quite fasci-
as much as you might expect. nating. You’ll likely discover things about your
blood sugar levels that you had no idea about.
Q: You have discussed cases in which meter You can then work with your health-care team
readings are normal but A1C is high. My case to smooth out any rough edges. †
«Have a question about diabetes? Send it to Gary Scheiner MS, CDE, at gary@integrateddiabetes.com.

10 March/April 2018