How do you bring down a blood sugar when it’s over 200 mg/dl? Sue Thom, RD, LD, CDE offer this timeless advice? Remember to always check in with your healthcare professional before making any changes to your diabetes self-care.
A: An excellent question, but a complicated one to answer. Your doctor or nurse educator should be contacted any time your blood sugar runs consistently higher than 250 mg/dl for more than two days. When a person with Type 2 diabetes encounters a high blood sugar, the strategy used in bringing it down will vary from individual to individual. This is because of the differences in treatment concerning diet, exercise, and medication. It will also depend upon the guidelines for glucose control that you and your doctor have mutually agreed upon.
When high blood sugars occur, several strategies can be employed to adjust the glucose level back down to a normal range. These might include:
1- Eating less food at the next meal, eliminating a snack, and or eating foods with a lower glycemic index.
A general rule of thumb to follow is decreasing 15 grams of carbohydrate (the amount found in one starch exchange, one fruit exchange, or one cup skim milk exchange) will lower blood glucose by 30 mg/dl. For example, if you test your blood sugar at 182 mg/dl before a meal or snack, then eliminate one starch and one cup of milk at the next meal to bring the glucose value as close to 120 mg/dl as a baseline. Although people with diabetes will respond differently to this adjustment, it provides a basic guideline to start with.
For persons with Type 2 diabetes who are overweight, the loss of only 5% to 10% of total weight loss can dramatically improve blood glucose values (so just cutting calories moderately can achieve better blood glucose control).
Lastly, choosing foods with a lower glycemic index, i.e., foods that do not raise blood sugar as quickly or dramatically, can help bring blood glucose back into a normal range. To test the glycemic effect of food on your system, you will need to do more frequent monitoring. For example, you may want to compare the effect of brown rice versus baked potato by eating equivalent carbohydrate amounts of these foods at dinner and comparing your blood glucose response two hours later. Some foods with a low glycemic index are dried beans and lentils. The exact effect will vary from person to person.
2- Increasing activity or incorporating more exercise.
Persons with Type 2 diabetes generally respond quite favorably to increased exercise with lower blood glucose values. Simple exercise, such as walking 20 minutes or more per day, can effectively improve glucose tolerance and induce weight loss. In addition, proper exercise can be effective enough to lower or completely eliminate the need for medication altogether.
3- Increasing, changing medications, and or administering them more frequently.
Although this is certainly an option, it makes more sense to address this problem of elevated blood glucose by exercise and cutting back on food. These are less costly measures and have fewer side effects, but if they aren’t effective, a medication change may be indicated. For example, if you are on the minimal dose of oral agents, your doctor might raise the dose or split it into morning and evening doses.
This could also be true of those using insulin. Taking more shots per day does not mean your diabetes is worse. It may even bring more flexibility into your lifestyle. A rule of thumb for those on insulin (check with your doctor first before making these adjustments) is to take one unit of regular insulin to lower blood glucose by 30 mg/dl. For example, if the blood sugar is 191 mg/dl before a meal, an extra three units of insulin will bring the glucose down to about 100 mg/dl. It is important to note that this rule may change for people who exercise regularly (it will take less insulin to achieve the desired effect) or for those who become ill (they are more insulin resistant and may need more insulin to achieve the desired effect). The effectiveness of insulin is dramatically decreased also by high blood sugar levels.
4- Relaxation techniques and behavioral management.
Relaxation exercises, including deep breathing and audio recordings that guide you through deep muscle relaxation, can reduce stress and help you deal more effectively with it. These are designed to create health images in people with diabetes and encourage visualization to improve glucose control. Behavioral management techniques also improve an overall sense of control of one’s life and self-efficacy so that diabetes becomes a state of “wellness in the midst of illness.” When relaxed and in control, blood glucose values can improve.
5- Treating identified illness and or infections.
Illness and infection cause a rise in adrenergic hormones, which increase glucose production in the body. This extra surge of glucose is part of the healing process but can upset glucose control. Thus, continuing to take medications despite poor appetite is vital. In addition, you may temporarily require more medication during periods of an extended illness. Ask your doctor for instructions on dealing with illness.
6- Monitoring on a more frequent basis and or monitoring other parameters.
When blood glucose values exceed the target ranges you and your doctor establish, monitoring should be done every two hours until the blood glucose returns to normal. This allows you to treat and adjust blood glucose as soon as possible, rather than waiting until your next doctor visit or next meal (which might be four or five hours later). It also tells you whether or not what you are doing is helping to bring the blood glucose down. Other parameters would include ketone checks (done by urine dipstick or via a fingerstick to measure beta-hydroxybutyrate, an acid) if your blood sugar is over 250 mg/dl. Testing ketones hourly until they disappear is recommended.
7- Increasing consumption of sugar-free fluids.
Often, the poor hydration of some individuals will account for the concentration of sugar in the blood. All people (with diabetes or not) should drink two to three quarts of sugar-free fluids daily. When glucose is elevated, drinking helps to dilute it. Also, drinking fluids is filling, decreasing the possibility of overeating.
People with heart disease who take diuretics and those with renal (kidney) complications may need to be on restricted fluids. Check with your doctor and or dietitian if you fall into these special categories.
To combat high blood sugars, the most important strategy is prevention. Prevention of high blood sugars is usually possible with frequent and consistent monitoring. In addition, if you are aware of your usual glucose response patterns to foods and exercise, it will be easier to plan out your day and prevent fluctuations in your blood sugar.