You can have lows even with a high A1c

It’s often assumed that people with diabetes don’t have low blood sugars — especially if they are still struggling with a high A1c. But if you’re taking insulin and your doses haven’t been properly adjusted, you could be experiencing significant low blood sugars on a nearly daily basis.

The initial insulin doses your doctor prescribed are more of an estimate or educated guess.

You should expect this insulin dose to change.

Getting even just one or two units too much or too little can cause regular low blood sugars. And many things can change your insulin needs overtime, like weight-loss or gain, changes in activity level, stress, etc.

The necessary dosage adjustments could be with long-acting (background) insulin or the fast-acting insulin you take with meals. And the lows can occur an hour after you take it or 3 to 4 hours after you take it. Either way: you’re getting more than your body needs.

If you haven’t been taught what low blood sugars feel like and how to handle them, you can easily overtreat them with too much food and wind up high again. 

Here are a few tips to avoid low blood sugars:

• Symptoms of low blood sugar can include trembling, sweating, dizziness, hunger, feeling light-headed or weak.
• Use your glucose meter to check your blood sugar!
• When treating a low, use a “fast-acting” carbohydrate source — something that contains little or no fat and protein. Fat and protein will slow down the digestion of the carbs which means you’ll be low for longer. 
• Instead, use juice, a banana or apple, dried fruit, raw honey, etc. 
• You’ll need about 15 grams of carbohydrate for most lows. Then wait 15 minutes and check your blood sugar again. If you’re still low, consume another 15 grams of fast-acting carbohydrates.

And then schedule an appointment to your doctor or diabetes educator as soon as possible to make adjustments in your insulin dose! Bring this article with you if you need help getting them to understand that despite a high A1c, you are clearly getting too much insulin.

Adjust your dose based on what you’re eating

Too often, people with type 2 diabetes are prescribed insulin with a blanket number of units to use at every meal, regardless of what you are eating. And worse, type 2s are also told they should eat X grams of carbohydrate at breakfast, lunch, and dinner, and X grams of carbohydrate for snacks in order to match their insulin dose.

Today’s insulin allows us to choose how much and what we want to eat, and people with type 2 diabetes should be taught how to use this freedom just like a person with type 1.

When insulin is prescribed to a person with type 1 diabetes, meal-time insulin is carefully calculated at each and every meal based primarily on the number of carbohydrates in that meal.

A medium apple, for example, has about 20 grams of carbohydrates. But if you wanted to eat that apple along with a portion of carrots and hummus, you’re going to add another 15 to 20 grams of carbohydrate. Now you’ll need more insulin.

Similar to a person with Type 1 diabetes, you can work with a diabetes educator to determine your own insulin-to-carbohydrate ratio so that you get to decide what you eat and when. 

You are not a “bad diabetic” just because your body needs insulin

There’s a great deal of misunderstanding, shame, and fear that comes with being told you have to start taking insulin as a person with type 2 diabetes.

The misunderstands include beliefs that needing insulin means you’ve failed to manage your blood sugars in other ways and that taking insulin means you’re on your way to amputations and other terrifying complications that come with diabetes.

So, let’s clear things up:

First of all, roughly 50 percent of people with type 2 diabetes simply struggle to produce a normal amount of insulin. For these people, diabetes is a “progressive” disease rather than something they could improve through diet, weight-loss, and exercise. 

• The progressive aspect is the ongoing destruction of beta-cells in the pancreas. These cells are crucial to the production of insulin. 
• Some patients with type 2 diabetes taking insulin could lessen or eliminate their need for insulin through improving their overall level of insulin resistance through diet, weight-loss, and exercise.
• Some patients will always need to take insulin to keep blood sugar levels in a safe and healthy range.

Secondly, taking insulin to help get your blood sugars into a safer range is what will protect you from needing an amputation and protect you from the many other complications that result from chronically high blood sugar levels.

• Your body needs more insulin than it can produce on its own to keep you healthy and alive.
• Take your insulin while always striving to improve your health in other ways around food, activity, and weight management!