While diet plays a key role in blood sugar levels, there are many other factors to consider. Below are the most important ones:
The diet- blood glucose connection is the most known one. Carbohydrate-rich meals have well-documented effects in increasing blood sugar levels. Another classification of foods based on their glycemic index can also be valuable to control diabetes. High glycemic foods like refined soda, cakes, cookies, white bread, white potatoes, and even natural fruits like watermelon and dates cause a quick significant spike in glucose levels. Individuals with diabetes should choose instead low or medium glycemic index foods like whole grain, sweet potatoes, berries, bananas, green leafy vegetables, mushrooms, and carrots.
Skipping breakfast can raise blood glucose levels after lunch and dinner. Eating randomly, at different times during the day can also have a negative impact on glycemia. However, intermittent fasting supervised by a doctor can offer long-term benefits in managing diabetes. Current scientific evidence suggests that intermittent fasting is an effective non-medicinal treatment for type 2 diabetes. Studies found that intermittent fasting decreases body weight, reduces fasting glucose and fasting insulin, and improves insulin resistance. Some individuals were able to no longer need insulin therapy when following medically supervised intermittent fasting. There are different forms of fasting from 16:8 (eating during an 8 hour period and fasting during 16 hours) to 5:2 (eating regular meals for 5 days, eating very little during the other 2 days) and other time-restricted feeding options.
Regular exercise is a key component of diabetes management and the best options for those with diabetes are low to moderate intensity workouts, aerobic or resistance training. This is because physical activity has beneficial effects on multiple factors related to diabetes and cardiovascular diseases. Not only improves insulin sensitivity and promotes a healthy weight, but exercise also helps maintain healthy blood sugar levels, blood lipid levels short and long term. It is important to check the blood glucose levels before workouts at the beginning of a fitness program, as low glucose levels may require some extra carbohydrate before working out.
Sleep is another key player in maintaining healthy blood glucose levels. Poor quality or quantity of sleep likely contributed to the rise of diabetes and obesity in recent decades. Even partial deprivation of sleep increases insulin resistance, increasing the risk of developing diabetes. On the other hand, maintaining good sleep hygiene helps promote weight loss and helps keep diabetes under control.
Emotional stress leads to poor control of diabetes. Emotional stress triggers the adrenal glands to release glucose in the bloodstream, to prepare the body for a “fight or flight response”. Instead of staying stored in organs, blood glucose becomes elevated in the blood. While these changes develop in everyone, those with diabetes will have a hard time regaining normal blood sugar levels after an episode of stress.
Infections, trauma, hospitalizations
Stress is not only the emotional problem behind worry, anxiety, and depression. Blood sugar levels spike in response to physical stress like trauma, injury, illness, after surgery, and hospital stay.
Time of the day
Blood glucose levels may be harder to manage later in the day. In the morning there is an increase in hormones like cortisol, glucagon, growth hormone, and adrenaline, causing the so-called Dawn phenomenon. It leads to a spike in blood sugar, usually between 2 am and 8 am in individuals with diabetes. In addition to hormonal changes, the blood sugar levels may be higher in the morning because diabetes medications were taken hours ago, before going to sleep. Doctors recommend taking blood sugar levels once per night, around 2 or 3 am in case blood sugar levels are too high in the morning on a regular basis. Adjusting the diabetes medication may be needed. Avoiding carbohydrate-rich foods before bedtime may also prevent early morning sugar spikes.
Gum diseases can be a complication of diabetes and also a risk factor for sugar spikes in individuals with diabetes. Glucose is present in the saliva, too and when the blood glucose levels are up, there are higher amounts of glucose in the mouth as well. Bacteria and fungi can overgrow and combine with food to form plaques. Plaques promote dental cavities, gum diseases, and bad breath.
Gum disease tends to be more severe and takes longer to heal in those with diabetes. Other mouth diseases associated with diabetes include dry mouth, Candida infections (oral thrush), and oral burning (a burning sensation in the mouth due to high levels of sugar in the mouth). Regular checkups with the dentist and dental cleaning are essential for mouth health and better control of blood sugar levels.