Vanessa here! As many of us know, controlling diabetes, whether T1 or T2, is not always a walk in the park, whereby blood glucose levels can easily resemble a rollercoaster at Alton Towers! Let’s face it, we are attempting to do the job of an organ and face many challenges that so many people without diabetes take for granted, such as:
- Not having to think about how many carbohydrates are in food
- Not having to think about injecting and working out how much insulin is required
- Not having to change pump sites
- Not having to remember to check BG levels
- Not having to avoid certain foods
The list goes on……! The problem is though that the complications of uncontrolled diabetes, (especially consistently high BG levels) are long term, as opposed to short term consequences (apart from DKA course). Therefore, if we check our BG levels and it shows 19.2mmol for example, apart from the feelings of thirst, frustration and headaches (depending on the individual), sometimes many people are still able to live their day as normal. The fact that sometimes there are no instant consequences to high BG levels, this makes many people desensitized to the long term complications that high BG levels can have on our bodies. Take me for example, I had the tendency to become lazy with my diabetes control as a teenager, by not checking BG levels, eating poor quality food, not carb counting etc. As humans, we naturally get into routines and uptake a lot of habits, both good and bad. As I started to put less effort into my diabetes control, these behaviours then became habits, unhealthy habits, due to the fact that the short term consequences were non-existent…..maybe a bit of thirst. So, I then got into a routine of not controlling my diabetes, whilst ignoring the doctor’s warnings of possible long term complications. Then, when I turned 18, they detected maculopathy in the back of my eyes (retinopathy close the centre of the eyes), which was more than likely due to my poor habits and lack of control. If I could go back now, I would shake myself and attempt to control the condition a lot better than I did. BUT, there is no point getting myself worked up about it, what’s done is done. But what myself and Georgia (The Fit Diabetics) do want to do is to help other people with diabetes gain control over their condition, to decrease the likelihood of long term complications developing before it is too late.
So, based on our personal experience living with T1 diabetes and our experience of gaining better control over the condition ourselves (last Hba1c 5.3 woo!), we have come up with 10 tips for gaining better control, which can be turned into healthy habits:
- TEST, TEST, TEST CONSISTENTLY
I am sure we have all been there when we get tired of our parents/partner/friends saying “Have you checked your blood?” which based on personal experience, makes us want to not do it even more (strange I know!?). However, checking BG levels is THE most important thing we can do in order to understand, track and change our BG levels for the better. Without checking, we would be unaware of:
- What our BG levels are
- If we need to treat a hypo
- If we need to catch a high BG reading before it gets higher
- If we need to correct
- If we need to have extra carbs before training
- If we need to check for ketones
Now unless you have a CGM (constant glucose monitor), checking our BG levels with a traditional meter can be a nuisance at times. However, it is overcoming this and identifying how this will benefit us long term. Now…..many people recommend testing four times per day, but to be honest, myself and Georgia check 12-15 times per day, as we always want to know what our BG levels are, which is in no way a bad thing. I personally tend to test as soon as I wake, before every meal and 1 hour after every meal, before training, during training and after training, and whenever I don’t feel quite right, just so I can possibly catch a low or high before it gets worse. But, by testing consistently and frequently, I am able to understand what my BG levels are and the direction they are going, whilst it also allows me to understand how food and activity effect my BG levels.
But let’s be honest, 12-15 times a day may not be on everyone’s list. The important thing to do to increase a behaviour and make it a habit, is to take small steps at a time. So for example, if you test 1-2 times per day, set yourself a goal to test maybe 3-4 times per day, then the next week you may increase this to 4-5 times per day and so on. Once you start to get into a routine of checking BG levels, this will then become a healthy, maintainable habit.
- Carbohydrate counting
Many of us may have received training on how to effectively count carbs to better understand how much insulin we require before eating. Even though this may seem a burden to many, these people are the ones facing highs and lows due to giving too much or too little insulin. Carb counting basically provides us with an individual carb/insulin ratio, whereby we learn to understand how many units of insulin are needed for the total grams of carbs we consume. So, for example, my carb/insulin ration is 5:1, meaning for every 5g of carbs, I take one unit of insulin. So, by calculating how many carbs are in my meal, I increase the likelihood of obtaining BG levels in a normal range and reduce the likelihood of highs and lows.
- Rotate injection sites
I think many of us can put our hands up and admit that we often tend to inject in the same place for convenience, especially the legs and stomach (guilty!). However, the problem with this is that excessive insulin administration in the same place can lead to diabetic lipohypertrophy, a build-up of fatty tissue under the skin that may appear lumpy, swollen or bruised. I have suffered from this myself in my stomach as a child, whereby I now attempt to rotate as much as I can. However, not only does it look sore, but from personal experience, I found that injecting in the same place also caused my BG levels to rise, which my doctor told me may be due to the fact that my insulin was not absorbing properly, due to the excess build-up of tissue. It was only when I started to rotate and try different places that I realised that my control improved, especially after meals, as my insulin started to absorb as it should. Not only that, my lypohypertrophy started to get better too. I do understand how annoying it can be when the doctor says “You need to rotate your sites!” which led to a “humph” and eye roll. But, take it from me, this made a HUGE difference to my overall control.
- Change lancets/needles consistently
Again, on the topic of convenience…… we can all become lazy when it comes to changing needles and lancets. I don’t think I have EVER come across a diabetic who changes their lancet every time they prick their finger! However, for those on injections, it is a lot more important to change needle heads consistently for a number of reasons:
- To avoid the pain from blunt needles
- To allow the insulin to flow through the needle more efficiently
- To avoid insulin becoming blocked
The photo of the used needle under a microscope is a good reason to be more mindful of changing needles consistently. From personal experience I did find that my BG levels after meals were slightly better following a fresh needle compared to a used needle. I will hold my hand up and say as a teenager, the longest I went until changing the needle was 2 weeks!
- Make healthier choices
I cannot emphasise enough the importance of making healthy, nutritious food choices when it comes to having diabetes. As we all know, unfortunately foods high in sugars can make it a lot more difficult to control the condition, even with the correct amount of insulin. From personal experience, I find eating foods high in sugar lead to big spikes and steep falls when the insulin kicks in. Throughout my teens I had a pretty bad diet, full of processed foods high in trans fats and sugar, which did not help at all controlling my diabetes. Since the age of 20, I signed up with a nutrition coach, who opened my eyes up to the world of nutrition and healthy eating, which is why I am sat here today as a qualified nutrition and fitness coach hoping to help other uptake a healthier diet and lifestyle, as nutrition has changed my life for the better. I started adding more vegetables into my diet and wholesome foods, which led to my insulin needs more than halving in a given day. My BG levels improved DRAMATICALLY and I went from having a Hba1c of 10.8 to 5.3. Making healthy swaps is so important when it comes to obtaining good results. So for example, if you fancy some chocolate, opt for dark chocolate as opposed to milk chocolate, as dark chocolate has very little carbs and sugar. I also increased my protein intake which satiated me a lot more, leading to less snacking. I even cut down on fruit and switched these for vegetables, which also had a dramatic effect. Overall, making healthier food choices may help people to better control their condition and avoid large spikes in BG levels.
- Be mindful of your behaviour
Being mindful about what we are doing and how certain behaviours effect our BG levels is really important, as this allows us to prepare for changes in BG levels and allows us to proactively stop BG levels from going high or low. Take the gym for example. I used to go to the gym without even thinking about how activity would affect my sugars, as it did not involve food. However, I would then leave the gym and my BG level would have risen from 7 to 15mmol, due to the effect exercise has on my body (adrenaline and cortisol). Sometimes, it is easy for us to participate in particular behaviours without even realising what we are doing or how certain behaviour effect our BG levels. Another example is coffee….. many of us drink coffee and forget that milk may cause BG levels to spike, followed by cordial, whereby products with ‘no added sugar’ do not mean ‘sugar free’ and still contain natural sugars. Being a little more mindful of what we are doing will allow us to effectively prepare for changes in BG levels and stop them in their tracks before they rise and drop. As I am writing this, I know I later have to do a talk at work, which I know sends my BG levels through the roof, so I will be taking action before I stand up in front of the crowd to avoid my BG levels rising, which is me being more mindful.
- Correct, correct, correct
Now I am not a medical professional so cannot give advice on insulin and this may not apply to many (so always speak to your doctor), but from my own personal experience, if I am very high, I correct to bring me back down to a normal level, based on the advice my nurse gives me. I know how easy it can be to ignore high BG levels and basically try to forget how high they are, but it is always better to be in a normal range. That’s all I am going to say about that…
- Prepare meals
Ever find that when you are travelling or having to buy lunch out on your lunch break, that it makes it harder to control BG levels? The problem is with many packaged foods, there are a lot of other chemicals and rubbish added to them, which may have an effect on our control. Even fresh food on the go, we cannot really control how big a pie is or how much rice we are going to have with our salad. Since myself and Georgia started to place a big emphasis on our nutrition, this also led us to prepping our meals for the day ahead. This involves bulk cooking and storing food away to be eaten in the home or out of the house. Not only was this convenient and saved us A LOT of money, but this also helped us to control our BG levels more efficiently. Why? Due to the fact that we knew exactly how much sugar, carbs, protein and fat was in the meals we were consuming, which made insulin administration much easier. Now, we aren’t saying people need to prep ALL their meals, as let’s be honest, this is not 100% achievable and even myself and Georgia still eat on the go every now and then, we are only human. However, why not try and start by prepping one meal a day maybe, and see how this effects BG levels? Small steps lead to big achievements. You can also be as creative as you want and not be left devastated when you realise there is only one small piece of chicken in your £5.00 chicken salad!
A lot of people in the 21st century are more sedentary than ever. For many of us who work in an office, we could be averaging at 2-3,000 steps per day, which is very poor. Even those of us who train, we could have a really good training session in the gym for 1 hour in the day, but what about the other 23 hours? Walking is incredibly important for overall health and fitness, whereby nowadays many of us have access to Fitbits and pedometers that allow us to track how many steps we take. From personal experience, walking really helps to stabilise my BG levels, whereby I give myself a daily goal of a minimum of 10,000 per day, which motivates me to meet this goal by having a visual prompt on my wrist. For example, if I go for a walk in the AM, I tend to find my BG levels are much more stable throughout the day. Why not set yourself an achievable step goal to reach on a day to day basis?
Stress is one of the most common experiences amongst a human being, whilst it can be one of the most lethal. Stress can be caused by environmental factors which cause physical changes to our bodies. For us diabetics, the excess release of cortisol can contribute to unexplained high BG levels, which can then become very hard to control. I have been through many periods of stress, which resulted in consistently high BG levels which ultimately caused more stress (a viscous circle I know!). So, my advice would be to try and knock stress on the head before it gets the better of us. Now this is definitely easier said than done, as we cannot always control the environment around us. However, there are ways to combat stress before it becomes worse:
- Breath – take deep breathes throughout the day
- Sleep – Ensure you are getting a good 8 hours of undisturbed sleep per night
- Talk – If you are worried about something, talk about it to someone
- Yoga/meditation – yoga has been shown to help individuals de-stress
I personally tend to take a few minutes throughout the day were I will focus on my breathing, which as daft as it sounds, did really help. Even taking a hot bath can really help me to de-stress, which has a better effect on my BG levels throughout the day.
Overall, I hope you have found this read useful, as this is what me and Georgia set out to do, help other diabetics take control over the condition, both physically and mentally. Remember, rule your diabetes, don’t let it rule you.