Blood Sugar

Q: Why is my fasting reading higher first thing in the morning?

A: This early morning rise in glucose, known as the “dawn phenomenon” is normal and happens when our bodies produce a surge of hormones to help us wake up. During the day, activity tends to keep sugars under control if following a healthy, active lifestyle. If using insulin, it may help to adjust your nighttime dosage.

Q: Why does my blood sugar level go up when I do yard work? I drink water all the time and eat my meals on time, but when I do yard work, like digging and planting and cutting the grass, my sugar levels rise. 

A: The first 30-60 minutes of exercise, especially in warmer weather, can raise levels. They should come down after that. Try checking right after your yard work, then again in around 90 minutes and see if you have a drop.

Q: What is the normal range that your blood sugar should be if you test it at home?

A: For a basically healthy person, a good fasting is under 100, and 80-90 is even better for most people. If you test two hours after a meal, under 120 is ideal.

Q: Why is my fasting reading around 110 in the morning but only around 90 two hours after lunch?

A: Fasting blood sugar levels are generally higher in the early morning due to the increase hormonal activity during the night, then tend to decrease to more normal levels during the day.

Q: Why does my blood sugar increase after exercise? I had a blood sugar reading of 135 first thing in the morning but after a 3 mile walk my reading was 155. I had nothing to eat or drink during this time. I repeated this test and got the same results a few days later.

A: Wait an hour after you exercise and see if you get the same results. Exercise is a stressor, so blood sugar will be higher immediately after your session. Also, blood sugars tend to be higher in the mornings because of hormonal activity during the night.

Q: I have lost a good amount of weight using intermittent fasting and low-carb eating but I can’t get my blood sugar levels lower. I seem to be stuck in the 130-140 range. It doesn't matter if I've been fasting for 16 hours, or two hours after eating, it is always between 130 and 140.

A: Good job! As you get closer to lower body fat levels, you can plateau for a time. The morning fasting levels are higher due to surge of nocturnal hormones that help you get up and join the day. With daytime activity, it is not uncommon to have normal levels with whole foods and regular activity. You still have a level of insulin resistance. Over time, as you continue to decrease visceral body fat, you may see levels drop further, with your pancreas's ability increasing to better handle glucose surges.  

Q: I am a type 1 diabetic and have been trying to lose weight by cutting back on what I eat. How come the less I eat, the higher my blood sugar readings?

A: If your diet now consists of less protein, that could be a reason for the spikes. Carbs will trigger that response, even if the total intake is lower. Try tracking your foods with levels for at least a week to see patterns and where changes may need to be made.  

Q: How can I reduce my A1C? I was diagnosed with Type 2 diabetes three years ago, and was prescribed 1000 mg Metformin in the morning and night. My A1C number was 8.0 (fasting glucose 180) before I started Metformin. Since then my doctor has asked me to check my A1C every six months. The A1C levels have been 6.0, 5.5, 5.9, 6.0, 5.8, 6.1. Is this the best that I can achieve with Metformin, low carb diet and exercise (6 days a week). My last A1C was 6.1 and fasting glucose was 100. 

A: First of all, congratulations on the fine results you have gotten! I cannot give you that answer as only time will tell. Your first goal would be to maintain the good lifestyle changes you have made. Ideally you would be able to reduce your medication needs. With continued practice and some discipline, you may not experience increasing elevations and may even reduce your levels further. If your daytime levels remain in the good range and fasting levels are only slightly elevated, the chances for complications are diminished down the road.

Q: My fasting blood sugar is normal, and 2 hours after meals are always high up to 380 sometimes. But my random blood sugar in the evening after 30 minutes of brisk walking goes down to 60 to 70 and feels hypo. What should I do to maintain a normal RBS?

A: This appears to be primarily food related. Carbs, especially simple carbs, will cause this kind of spike. If your food intake is not cushioned with some protein/healthy fat, a low dip can definitely occur. If you are on diabetes medication, some adjustment may also be needed. Small meals which include more fiber/protein can help prevent hypoglycemia.

Q: Can taking antibiotics increase blood sugar levels? 

A: Some antibiotics have been shown to cause elevated blood sugar levels, particularly for those who already have diabetes. You’d have to check about your particular antibiotic to see what the cautions may be. How high the elevation is will depend on the individual. In general, antibiotics can change the microbiome of the gut, interfering with insulin sensitivity and glucose delivery to the cells.

Q: I have finally gotten my A1C back in the normal range, do I still have diabetes or am I cured?

A: Congratulations! If you are not on medication for diabetes, then you now have it in control. However, it is important for you to continue with the lifestyle changes you made to achieve this. Reverting back to old habits would most likely result in elevating glucose levels once again.

Q: I have a normal A1C but recently, 4 hours after dinner I started sweating and my blood sugar was 74. But another time, 2 hours after dinner my blood sugar was 194. What is going on?

A: If your diet consists of more carbs and fruits, this would account for the highs after meals, followed by a low which is likely the reason for your sweating and other symptoms. A hypoglycemic diet would appear to be a good start for you: try eating 3-5 small meals with some source of protein. You may also request from your physician an Oral Glucose Tolerance Test, showing how your body processes carbs over a 2 hour period.

Q: I failed the one hour glucose screening scoring 197, however, I test myself a few times a day and my blood sugar is always within range, I even experiment with high carb meals and they have never gone over 140. Fasting is always at around 80-85. Is there any explanation for the high results on glucose screening? I am also anemic and wonder if that could be cause for a false positive?

A: There can be false positives. Given you were 7 points above the cut-off, a repeat may be considered, particularly if you did not follow the prep guidelines for the test. Another alternative would be taking a 3 hour glucose tolerance test to get a more complete picture of how you process your carbs. As with any of these tests, it is important to follow the prep guidelines. Anemia can increase an A1C otherwise it is usually more associated with hypoglycemia. With all these potential variables and the fact that you are diligently testing with good results, a second testing is certainly a reasonable request, assuming your anemia is being addressed.

Q: I tested my blood sugar 2 hours after eating fried food and stir-fried vegetables and the reading was 167. My dietician said the high reading was because of the oil used to fry the food. Should I be concerned? 

A: Fried foods and high carbs, especially refined grains and sweets will increase blood sugar levels. Sometimes you need to experience how other types of foods affect your levels so you have a clearer understanding of how to better control them going forward.  

Q: I have Type 2 diabetes and have been trying to manage my BG through diet and exercise for the last 4 months. I am no longer taking any insulin supplements but still take 2000mg of metformin per day. I eat less than 50g of carbs per day and exercise regularly. My weight has gone from 158 to 142. My blood ketones average 1.5 indicating that I am in ketosis and probably have no glycogen stores left. My BG, however, averages 140. Why can't I get my BG down? The lowest fasting BG I have recorded was 103 and that was after going 2 days with zero carbs.

A: If your fasting levels tend to be the reason for your higher average, with daytime levels being < 140-150, you may want to review the timing of your metformin to better target your fasting levels. This is something you can revisit with your physician. Eating whole foods high in nutrients is important to support the reactions in your body that facilitate increased uptake of glucose from the bloodstream.  

Q: Any blood sugar level below 100 gives me headache and nausea. I seem to feel best when its in the 140-150 range. I also cant feel highs until it gets in the 200 and above range. How can this be?

A: If you have long standing diabetes with glucose levels that ran high for some time, your system can adapt to this level, causing symptoms of low blood sugar if you try to lower to a more normal range too quickly. If you are on medication, this may need adjustment. Perhaps your diet needs a better balance as well, slowing down the rate of food conversion to glucose. An Oral Glucose Tolerance Test can give you a picture of how your body is processing carbs. Discuss all these with your physician.

Q: Besides drinking water, what can I quickly do to reduce a high blood sugar test result (212)? 

A: A high test result does not mean there is a one quick fix. For the short-term, I suggest that you do not consume any carbs, and instead eat small amounts of healthy fat/protein. Exercise may raise blood sugar in the short run, but lower in the long run.    

Q: Do I have pre-diabetes? About five months ago I started checking my glucose levels after meals because I was consistently experiencing brain fog. I found that after an especially high carb, zero protein meal, my 1 hour glucose would be as high as 180. I immediately reduced my carb intake significantly, lost weight, and increased my exercise. I recently had labs drawn and my A1C was 4.7. However, even 2 tablespoons of barbecue sauce will raise my one hour glucose to 145, but it will be well below 120 at 2 hours. Am I pre-diabetic? My doctor told me to stop checking 1 hour glucoses and only worry about my 2 hour levels. I can’t stand the brain fog that comes with glucose levels above 120 though.

A: Elevated glucose levels aren’t the only reason for brain fog. Changes in hormonal levels could be another factor to consider. If you consistently notice brain fog after eating refined carbohydrates, try eating an unrefined diet with most of your carbs coming from veggies and legumes. Perhaps only check your glucose levels when you feel “foggy”. You may have the genetic tendency for diabetes, but are in control as you have taken charge of your lifestyle.

Q: Why do I sometimes feel extremely angry when my blood sugar level is high?

A: Anger can be an emotional response to high glucose levels, and perhaps more so if one has underlying feelings of anger (it is not uncommon to feel anger when dealing with diabetes management as well). It is positive that you recognize this in yourself, perhaps working to best of your ability to not get to those levels that push those buttons.  

Q: Can an anxiety attack or severe anxiety raise blood sugar levels?

A: It is possible. Anxiety is a stressor that can elevate hormones, especially cortisol, the fight or flight hormone. This rallies glucose to the bloodstream to prepare you to run or defend yourself. Hopefully, you are working with anti-anxiety techniques such as deep breathing being a good place to start.  

Q: I have been told that I have diabetes, or "pre-diabetes", or that I am in the "honeymoon period". My readings are all over the place: sometimes in the 120's, others in the 90's, sometimes, but rarely in the 150-170's. My doctor does not want to put me on medication yet. I exercise regularly and am not overweight though my diet is variable. I certainly like sweets, pizza, and pasta. What is the long term effect of these continued high blood sugar levels?

A: Firstly, kudos for your physician for giving diet/lifestyle changes a chance to work. Reduction of body fat often is the first best start. This may or may not be true in your case but certainly sweets, pizza, etc. are affecting your numbers. If you can discipline yourself at this time to eat unrefined foods and be more active, your beta cells that produce insulin may get the rest they need to become efficient again. Our diabetes management booklet has many referenced foods/supplements that may help to stabilize your glucose levels. In time, your favorite foods may be reintroduced in moderate amounts. You appear to be more in the pre-diabetes range at this time. Complications are a long process. If your daytime levels stay under 120-140, that is good. Fasting levels are higher due to hormonal activity nighttime; these levels are a much slower road towards any complications. Continue working on lifestyle/diet, as both can always be a bit better, and in time, you may start seeing continued improvement.

Q: What would cause my blood sugar to drop over 200 points over the course of a day? My morning sugar was 252 when I got up, an hour after breakfast (w/ 73 net. carbs) sugar hit 390. A 138 point spike. An hour later 306. At lunch I had a "cutie" orange, and I checked an hour later my sugar was still dropping, the cutie didn't raise it any. I've also drunk 48 ounces of water thus far today. 390 an hour after breakfast at 8:50AM, to 188 at 3:30PM. No meds either. I'm curious as to the 202 drop over 8 hours with no med and 73 net carbs that set the spike. 

A: Carbs certainly drive your glucose up faster. The first change I would suggest is to eat healthy protein/fat for breakfast. This creates a slower rise with a longer digestion time. An Oral Glucose Tolerance Test over a two hour period can help confirm where your spikes occur. Getting better control of your fasting levels will set the tone for lower levels during the day. Nocturnal hormonal activity is what can drive up our fasting levels. During daytime activity, these hormonal surges wind down until night/sleep cycle kicks in. Revamping your diet and keeping as active as can are your first lines of defense.  

Q: I'm taking insulin and Trulicity but my sugar keeps spiking all day and night long. This morning I started out at 190 but after coffee my blood spiked to over 300. I just can't get control of this and every diet I try to follow I get spikes.

A: You may want to only eat protein and lots of green veggies for several days to see if this helps you to stabilize your blood sugars and then slowly adjust once stabilized. This means no high carbohydrate foods such as grains, potatoes, or fruit. Your only carbs will come from low carb veggies. Use olive oil/coconut oil as fat source. There are many diet theories out there now but no one diet is good for all. If you can manage without coffee for this time, that may also have an impact as you may be super sensitive to it.

Q: hi, I'm 24 weeks pregnant, my blood sugar in the morning ranges from 97 to 106. I’ve been monitoring my blood sugar level for a couple of weeks now. I only eat half cup of rice every meal with snacks in between, of course. My blood sugar sometimes drop below 100, 2 hours after meal. is that normal? I’ve been on a low carb, high fiber and less sugar diet for a couple of weeks now.

A: Getting enough fuel for both you and your growing child is important. It is typical for blood sugar to be higher in the morning, due to activity of hormones during the night. Rice is a “race horse” carb meaning it converts quickly to glucose with a quick spike and dip. If your lows are occurring more towards afternoon, focus on morning food being more protein/healthy fats because they take longer to convert to glucose and may help with sustaining a more normal glucose the rest of the day. Perhaps switch your grains to something with higher plant protein, like quinoa. Again, check that you have adequate caloric intake. If yogurt agrees with you, this may be a good addition for bringing levels up in better balance. And of course, never hesitate to pose these questions to your physician.

Q: My fasting blood sugar level is 155. After a 30 minute morning work out on an empty stomach it reaches 167. How to manage this? 

A: Your levels are higher in the morning anyway due to hormonal activity during the night. After exercising, you may have elevated blood sugar levels for one hour or more before lowering. Exercise in the short run is a stressor, which causes the liver to release glucose to blood stream to “fuel up” for the activity. A goal will be to have lower fasting levels, which often will be result of dietary and activity changes.  

Q: Can sunbathing and high temperatures increase blood sugar levels?

A: High heat can lead to dehydration, which in turn can cause high blood sugars. It takes 6 molecules of water to move one molecule of sugar from the blood stream, so the higher the sugar, the more water you need to drink. Extreme hot or cold temperatures can cause changes in the vascular system that can affect blood sugar and cause reactions.

Q: Do I have diabetes? My most recent A1C test was 5.4. But this last Sunday, four hours after dinner I started sweating and checked my blood sugar and it was 74. Yesterday my blood sugar was 167 two hours after eating.

A: You may want to get an Oral Glucose Tolerance Test that measures your levels over a 3 hour period after a drinking a prescribed sugar syrup. Decreasing carbs and increasing healthy fats and proteins while eating smaller, more frequent meals may help these swings if you are on the path of hypoglycemia which can in time become diabetes if left unchecked. It would be a good idea for you to track your food intake for week, checking your levels one hour after eating to see where the shifts are.

Q: I was diagnosed with type 2 diabetes at 13 after I fell into a diabetic coma with a 1200 blood sugar level but I lost 90 pounds and was pretty much diabetes free. I haven’t taken medication in 7 years or so. I’ve recently gained a lot of weight and am concerned that my blood sugar levels now range from 90-107 after fasting for 8+ hours. During the days and after meals they are in the normal range.

A: Regaining weight, if too much, may be a key factor here, as that can impair your body’s insulin to effectively take up sugar from your blood stream. Even though your blood sugar was under control for years, changes in your lifestyle are starting to manifest with elevated fasting levels. This would be a good sign for you to re-evaluate what you eat and your activity levels. You may have a decline in insulin production that is now manifesting. Hopefully, you are discussing this with your physician if you continue to see your levels elevating. He/she may want to conduct testing to see what your insulin output is.

Q: As a type II diabetic my normal blood sugar readings are between 120 and 160. Unusually low reading of
94 is that of any concern?

A: If your 94 is a fasting reading, that’s a good level if there are no contraindications such as cardiac issues. If this is the reading you are getting daytime, make note of any signs of hypoglycemia. Perhaps you ate less that day? If you begin to routinely get lower daytime readings, then visit with your physician about lowering your medication doses. That would be a good goal!

Q: Do I need to test every new container of test strips with the red liquid or can I match the code on my tester with what’s on the lid of a new container?

A: The recommendation from FDA is to use control solution with every new test vial, after codes are matched and discard after 90 days. This may be costly for many on a tight budget. One guideline to adhere to would be to test a strip from your vial if your numbers start to suddenly change. Use your best judgement; you can also cross reference with your physician.

Q: I took my blood sugar test and it was 182 and two minutes later it was 136. What would cause such a difference in testing levels for just 2 minutes apart?

A: Smaller variances are not uncommon. If you normally test towards the higher number, the lower number would appear off. Try some more tests close together for comparison and if you see this pattern repeat, contact the meter company for advice.

Q: My fingers are sore. Is there any other place on my body I can use to check my sugar?

A: Forearms are the next place you may be able to go. However, you may want to discuss this with both your meter company and your physician to see what the difference may be between finger/forearm. I trust you are testing the sides of your finger pads, and not directly on them.

Q: I have not been diagnosed with diabetes and my A1c is only 5.0. However, I am concerned that when I wake up my blood sugar is sometimes as high as 140. Do I have diabetes? If I do, why is my A1c normal?

A: An A1C reflects an average so it may be possible that you are experiencing lows throughout the day that would average out some of the highs. It would benefit you to get a 2 hour Glucose Tolerance Test done to see just where lows and highs are occurring. Two tests with a fasting glucose of 126 or greater is considered a diabetes diagnosis.

Q: My husband with type 2 diabetes is trying to get his blood sugar down by eating a low carbohydrate diet and skipping lunch. He is having problems with an increased evening reading. Should he eat regular meals? 

A: Skipping meals can send glucose levels on a bit of a roller coaster ride. The liver can actually release too much glucose into the bloodstream when no food has been eaten, perceiving a “hunger” situation. He may be better off eating smaller meals with lower carb/healthy foods that will convert to glucose at a more reasonable rate, generally resulting in better levels. 

Q: I was diagnosed as a pre-diabetic several years ago and I am taking Metformin 500mg one tab a day.
My fasting blood sugar is between 110 and 125. My friend said my fasting level should be under 100.  What fasting and A1C level should I maintain for the rest of my life to best prevent complications.

A: The “ideal” blood sugar level is around 80 fasting but the guidelines provide a wider range. The range you are in may, over many years, have an effect on your nerve endings but this is often dependent upon what other conditions you may have. Taking Metformin in the evening may target a lower faster blood sugar. The first best guideline is to maintain as healthy a lifestyle as you can with food, activity and lower stress levels. I always suggest focusing more on improving lifestyle before getting overly focused on the number.

Q: Why do I still have high blood sugar readings even after a super low carb dinner? I’m currently on 500mg metformin twice daily. I have already lost 30 pounds and now weigh 300 lbs. 

A: A set dose of medication doesn't guarantee good control, even with diet improvement. You have started a good path with losing body fat, but you still carry enough to contribute to insulin resistance. Other medical conditions and medications you may be taking can also be a factor. In addition, foods eaten at earlier meals may not fully metabolize until later in day. If you are diligent with lifestyle changes, you should continue to see improvements over time.

Q: I have been told that the older you are the higher the blood sugar readings can be. At 82 years of age my fasting reading is 140-152 with no medications. Is this cause for concern?

A: It is elevated enough for you to perhaps reexamine your carbohydrate intake, the timing of foods, as well as your overall lifestyle. Other health concerns may also be playing into elevated fasting levels. With advancing age, we can experience decreased efficiency of our organ systems, pancreas included. Perhaps more so, the liver - the major clearinghouse for so much of our digestion/absorption - goes on a decline. Increasing your phytonutrients through higher intake of greens is supportive, as are many other foods that more naturally help to detoxify the liver. Staying as active as possible is always key.

Q: Why does my blood sugar jump from 115 to 165 after eating breakfast?

A: All food turns into sugar and carbs turn the fastest. It is normal for everyone's blood sugar to rise after a meal though folks without diabetes don't go over 140 as a rule. If your blood sugars had been closer to 100 before your meal, you would have been closer to a normal range. Also, it may have been the types of foods you ate. A breakfast that includes protein, such as an egg, and whole grains, such as a higher fiber toast may help to keep your numbers down. Check your blood sugars 2 hours after eating for a while so that you see how you are the rest of the day. This will help your physician in adjusting any medications you might be on. Keeping a very healthy lifestyle is your best ally for keeping those numbers down.

Q: I was recently diagnosed with gestational diabetes and have been controlling it very well with diet. However, last night I had pizza for dinner, I know not the best choice! Two hours after eating, my blood sugar was 130. I know sugar should be under 120 after two hours, but is it acceptable since my sugar never went about 140?

A: With gestational diabetes, the goal is tighter control to help ensure better health to your child. Isolated instances will occur, but choosing foods to keep you closer to goal is a good target. I suggest you also visit this question with your medical team who has your entire health history to influence best answers.  

Q: Every two hours after I eat, I take my blood sugar reading. I assume that if two hours post-meal my reading is 120 or below, I have good control of my sugar. However, if I have a small snack 30-60 minutes before I test, will that affect my blood sugar when I take it at two hours post-meal? 

A: It may, depending on what you eat. Simple carbs will react pretty immediately and certainly within the 30-minute timeframe. Protein and fats take longer in the digestive process. You may want to check just before your snack. The highest peak blood sugar levels generally occur 1 hour after a meal if carbs were eaten. At 2 hours, protein begins to break down into blood sugar so one may begin to see some food effect. Test both before and after your snack and see what differences in readings you may notice.

Q: My morning and afternoon blood sugar readings are fine but the reading before my evening meal is still really high, even though I have only been drinking black coffee and water during the afternoon. I try to walk between two and four miles a day, so I am sure I am getting enough exercise. I do seem to be stressed most of the time, and wondered if this could have something to do with it. 

A: Stress can play a part; you may want to have your cortisol levels checked to see if they stay elevated later in the day. Caffeine can also elevate levels in the short run. If you exercise right before you take your reading that can also be a factor. Try waiting 1/2 - 1 hour and see if that makes a difference.

Q: I recently had a scary situation where my blood sugars dropped to a low number. An EMT was called and he measured my blood sugar with a meter at 46. He told me to eat some cookies. I ate four or five cookies and immediately had blood check again but it wasn’t going up yet, so was administered a tube of some type of glucose. Once again my blood sugars were measured within a minute or two and the level was now up to 125. The EMT left but within minutes I was experiencing extreme confusion, my legs were very shaky, and I finally fainted for a short time. I had nausea, and an extreme headache for hours. What could have been happening to me? 

A: Your blood sugar levels rose too quickly. 46 is very low, and it sounds as though within the space of 10 minutes or so you were back into the diabetes range. The protocol to follow for low blood sugar when that low would be to administer 15 grams of carbs, then re-measure. Starting with the tube would have brought you into a better range more immediately, wait 15 minutes, then retest. You would probably have been in a range where the next "food" would be a protein/carb combo: milk if you drink it, yogurt, nut butter on crackers, etc. Always stay well hydrated; this will help avoid some of those after-effects of low sugars. Better yet: be sure you are understanding how to eat for blood sugar control. This is even more important if also on medications. 

Q: I suffered what I believe was a low blood sugar attack with extreme dizziness and nausea. I take medication for type 2 diabetes. What should I do next time this happens?

A: It sounds like you did have a low blood sugar attack. It could be that you are not requiring as much medication, and/or you waited too long between meals. You should be checking your blood sugars and make sure that you know what ranges your physician wants you in. The idea is not to eat more to feed the medication, but to hopefully lower the medicine dose. Glucose tablets are good to carry with you in emergencies as the dose is then measured. Lifesaver candies can also work. The usual amount is 15 grams of carbs every 15 minutes until blood sugars come up.

Q: My friend's meter is giving me a different reading than my meter. I use the control solution BUT is that really accurate?

A: It is not uncommon to get some difference in readings between meters, but it should not be too broad a span. You might consider taking your meter to your physician's office at your next visit and see if you can test it against one of theirs. I suggest you also call your meter company and discuss your concerns. They do calibration studies and should be able to give you some solid answers.

Q: Why are blood sugar monitors so inconsistent. I thought my first one was broken because of the wide discrepancy in readings so I ordered another and calibrated it according to the instructions and it seems to be the same. I can get a reading of 160 and seconds later do another test and get a reading of 125. They call that accurate?! 

A: True, machines are never pinpointing the actual number, which is somewhat of a constant change. The current FDA ruling is 95% of time there is no more than 15% variance and 99% of the time there is no more than 20% variance. A meter value of 120 would reflect a range of 102-138. What “seasoned” testers start to see over time are more numbers closer together as long as lifestyle/management is consistent. Work out a testing schedule just to see where your greater discrepancies lie; discuss this with your physician as needed if adjusting medication based on numbers. 

Q: Can the hot weather have an effect on a persons blood sugar readings? 

A: High heat, particularly warm weather, does not directly affect your glucose levels, but it can lead to changes in your daily habits: eating less and not adjusting medication, being less active, and possibly over exerting yourself. These situations can lead to either higher or lower levels. Dehydration can set in more readily; don't wait for thirst to be your clue. Carry water at all times. Sunburn is stressful to the body and can elevate glucose, so plan your sun exposure and exercise for earlier or later in the day. Remember also that high heat can affect meter strips and medications, especially insulin. Be smart with the heat, and you will manage your glucose much better this summer.

Q: After 8 years of successfully controlling my type 2 diabetes, my fasting numbers are starting to creep up into the 200+ range and my doctor wants to put me on insulin. What am I doing wrong?

A: Many variables can cause this change. One factor is that as we age (I like to refer to this as "chronological maturity"), hormones change as well. Another very common variable is that we often eat the same way, not increasing our intake, but neither do we increase our activity levels. Taking insulin for a time may give the beta cells the rest they need, with perhaps returning to your lower levels. Conversely, many do experience a decline of insulin output over time, regardless of lifestyle management. Your gene pool may have you on this path. Do what you need to get back into good management. Managing one's stress levels is a "must"; yoga, Tai Chi, dance are just a few examples of very positive supports. Find what works for you.

Q: I have type 1 diabetes and whenever my blood sugar is low I feel as if my thinking process is different and I tend to feel anxious. Then once my sugar gets back up I don't feel that anxiety anymore. Does that have to do with blood sugar levels affecting my thinking? 

A: These are symptoms that occur with most people with low blood sugar. Remember, food is fuel for the body, and the form of our food is sugar, which you need to have enough of in your body for your brain to function normally. With low blood sugar levels, anxiety, lack of focus, gloom-to-doom thought patterns can manifest. This is very true with hormonal imbalances as well. Many kids begin to show signs of this with puberty and poor lifestyle/eating patterns that abound in today's society. The important thing here is that you know how to fix these symptoms. Better yet, keep yourself from getting to that point by always having something with you to elevate your blood sugar. Keeping a pack of glucose tabs with you at all times gives you a set dose of carbs to take when you first feel signs coming on. Dry roasted nuts also carry well to hold off hunger.

Q: I am an elementary school nurse. I have a 10 yr old student with type 1 diabetes. He typically comes in low before lunch (50-70), eats lunch, retakes his blood glucose 30 minutes later and it is up to 120-140. However, at that time the parent recommends the full compensation of insulin for carbs ingested at lunch. Invariably he comes back in less than an hour dropped back down to 50-70. My thought is they need to compensate for the low number that they are starting with before they give him a dose based on carb ingestion only. What are your thoughts? 

A: You are on the right track with seeing there is a deficit here in food/insulin. This is an active growing child. As with anyone with diabetes, it is important to have the right amount of protein/fat in place to create a more stable baseline for levels. Being around 110 pre-meal would be good unless his physician has established different numbers. The goal is not to keep feeding carbs to manage the insulin, but to reduce the insulin overall because the glucose levels are in better range. If he eats eggs for breakfast, they should provide a more stable morning. If the child begins to show fatigue and his performance is affected in school, this may be the documented route you need to have them revisit the protocol with their physician. Nobody wants him to suffer hypoglycemic episodes, which it sounds like he could be a candidate for. 

Q: I have had type 2 diabetes for 15 years. Although my fasting levels are generally higher in the morning, two weeks ago I noticed a few levels approaching 240 fasting before breakfast. For example, last week my morning level was 235. I ate a meal that had eggs and turkey sausage and coffee without sugar. My blood sugar dropped to 196 after one and a half hours. I took a walk for 20 minutes and my sugar level was 127. Then I had another coffee and an hour later my sugar was 190 again. Why would this happen?

A: Food intake is a most powerful player here. It is common for blood sugar levels to be elevated in the early morning due to hormonal activity during the night, then begin to drop during the day with usual daytime activity. Then, assuming eating is well-controlled, daytime levels can be in normal ranges. You should clarify with your physician what the target glucose goals are for you for both fasting and 1-2 hours post meals. The morning protein meal you ate converted into glucose at a far slower rate than if you had eaten a carbohydrate based meal, so it is not surprising that you saw a drop in levels as you did after that meal. Coffee is often listed as a "free food" that does not affect blood sugar levels but you can see this may not be the case. It does stimulate the central nervous system and can cause some short term rise in levels. 

Q: I was diagnosed with type 2 diabetes five months ago. I have been testing and trying to determine what is working and what is not. I've noticed recently I could have a double cheeseburger and fries and have a reading of roughly 140 two hours after. Yesterday I vigorously tested and found, 1.5 hrs post was 122, 2 hrs post was 142, 2.5 hrs post was 168, 3 hrs post was 189 and finally 3.5 hrs post was 85. A 104 pt drop in 30 minutes. Should I still be testing two hours after a meal when I was apparently at my highest three hours after?

A: This all depends on what you are eating. A double cheeseburger will show its greatest impact in that 3-4 hour time frame because proteins and fats start to peak into glucose 3-4 hours post meal. Most carbs peak by 1 hour after eating and are pretty much through the entire digestive process 2 hours after eating. If you eat few carbs and primarily meat and fats, then you will peak later. This is why in most structured meal planning, you will see meat intake to be about 3oz./serving, gradually increased for high calorie meal plans required by larger individuals. Get a good balance with your foods to where you include lots of veggies/higher fiber foods and smaller amounts of refined carbs/very low fiber starches (white breads ,etc). Testing after different times with different foods will give you a better idea of what raises your glucose levels more quickly.

Q: When my type 1 diabetic son goes low....under 70, if we give him 15 grams of carbs, how much does it bring his levels up by? 

A: 10-15 grams is targeted to elevate glucose levels 30-45 mg/dL. Assuming this is from quick acting choices such as 4 oz juice, 3 glucose tabs or 6 oz. of milk, his levels should come up quickly and be tested at 15 minute intervals until the target is reached. For those on insulin, it is especially suggested to treat once blood sugars drop below 72mg/dL. I suggest you enroll in diabetes management class if you have one in your area, or at least be very clear from your medical team what the basic targets and management skills are for your son.

Q: I just got a new glucose monitor and my numbers are lower than with my old monitor - as much as a 23 point difference. I am curious if you know why this would be? 

A: I'm assuming you have made sure your old strips are up to date and calibrated if necessary? I suggest you call both companies for an explanation, then perhaps assume the newer meter is giving more accurate readings. You can verify this by bringing your meter to your physician's office next time you go and test against their machine if they do this in the office. There is often some difference between meters, but that is a very wide range.

Q: I think I may have diabetes because my fasting glucose is 140 but my doctor said I do not have diabetes. I get light headed, dizzy, blurry eyed, and my hands shake if I don't eat a snack with sugar in it between meals. Please help, my doctor says Im fine. 

A: You clearly have blood sugar imbalances, going from some moderate highs to lows. The shakiness, etc. is hypoglycemia. Has your doctor done a glucose intolerance test on you yet? I suggest the one that shows your glucose levels at 4 intervals 2-3 hours apart. You may be higher in the morning and then going low daytime. Eating unrefined foods, lean protein, and more veggies than starches are really important for you right now. Eating 5-6 small meals/snacks should be your pattern. An apple and 1 oz. of cheese or 1 tbs. of nut butter is an idea for a snack. Learn where protein comes from and include it more. Beans have a good source of plant protein and fibers that stick with you longer and break down into sugar (as all food eventually does) in your blood stream more slowly. This is a good thing, as you won't get a low blood sugar nearly as quickly. Candy, juices, etc. are all turned into blood sugar very fast; they don't stick with you. Think of these simple sugars as very short term fuel. You may need a 2nd opinion. Eating correctly will help you straighten this out.

Q: My Dr. said my glucose number should be between 65-99. I am a 77 1/2 year old female who recently started experiencing low blood sugar episodes, especially at night. If my number when tested is 103 and lower, I shake, sweat and am generally miserable till I drink orange juice, etc. Is it possible that my count needs to be higher? 

A: I do think you need to revisit this with your physician, as clearly you seem to be requiring a higher blood sugar level. A textbook normal fasting glucose is closer to 80; 65 would be too low for many people. Keep close track of your intake, and be sure to eat protein at each meal.

Q: I was recently diagnosed with type 2 diabetes and manage with diet and medication. My primary care doctor told me when my blood sugar gets low and I get shaky I should take a pinch of table sugar. My question is, should I eat something like an orange or something other than table sugar to raise my blood sugar? It just seems counterproductive to watch what I eat all day, every day, then take some sugar to even out my blood.

A: Low blood sugars are better treated by drinking 4-6 ounces of milk if you are a dairy consumer, 4 ounces of juice, or some sugar equivalent to equal 15 grams. 3-5 Lifesaver candies often does the job. However, the goal is not to have to eat more, but to lower your medication requirements. As you continue to take charge of your lifestyle and how different foods affect your levels, episodes will be less frequent. When you are just beginning to show the signs of low blood sugar, milk is a good choice (this includes soy milk) because it has the right carbs to get into your bloodstream quickly, but also has some protein to digest at a slower rate. I suggest you try to find some diabetes classes in your area to learn all you can on how to manage, especially eating.

Q: I’m a type 1 diabetic and going though menopause. My blood sugars are consistently high whereas before they were on target. Does menopause cause my body to resist insulin? 

A: Hormonal changes can affect your glucose levels, as you are experiencing, which is not exactly insulin resistance. It is important during this time that you eat foods as unrefined as possible and stay active to reduce any potential symptoms like sweats and hot flashes. This will help to reduce glucose fluctuations as a result of less fluctuation at the nerve levels. You may want to eat the exact same diet every day to see what is due to hormones versus diet, etc. In addition, nutritional compounds for menopause may help with balance.

Q: I am on an 800-1000 calorie diet and my blood sugar readings are still 104-109. Shouldn't they be lower?

A: I would first suggest that you are eating too few calories; this is not effective fat loss. It will most likely serve to alter your metabolism more than give you any long lasting results. Fasting blood sugars of 100-125 constitute a diagnosis of pre-diabetes. You would fall into this range. A goal would be to be less than 100 fasting. I suggest you get some guidance with a healthy eating plan for yourself, be active, and target long term body fat loss at a gradual pace as the way to effectively achieve your goals.

Q: What finger should I use when testing? On two occasions I've had different readings from two different fingers.

A: It should not matter which finger you use as long as you test on the side of the finger. Do not milk the finger; hold it upside down to let the blood flow to the tip. Readings may vary slightly. If the spread is wide, be sure you tested correctly in both situations. If you still get discrepancies, I suggest you call the 800 number on your meter and ask their advice.

Q: What are the risks when blood sugar is 400 to 500?

A: The intensity of the symptoms will vary between individuals. If these high blood sugars persist, some symptoms that may be experienced include dizziness, nausea, headaches, frequent urination, and hunger. In some cases, one may even experience Diabetic Ketoacidosis, a condition that if left unchecked, can lead to coma. This is generally more associated with type one diabetes. High blood sugars over the long-term precipitate complications such as organ and nerve damage.

Q: I had a blood test but did not realize that I was supposed to fast beforehand. I had two cups of the coffee in the morning, and a sandwich and chips for lunch. My results came back at 293. Is this an accurate test? Do I have diabetes? My doctor wants to put me on medication.

A: 293 would still constitute a diagnosis of diabetes, since it is over 200 - the limit for a random blood sugar, even without fasting. In my experience working with endocrinologists, the next step after “discovering” the high blood sugar would be to order an A1C test to measure an average over the last 3 months. An Oral Glucose Tolerance test may also be order to see how the blood sugars go over the course of 3 hours after a high carb load. If you have no other symptoms or uncontrolled conditions, a course of 3 months of focused diet/lifestyle changes may be put in place to see how far your numbers come down before starting medications. It is most important for you to get educated on eating for diabetes management. Exercising and working towards reduced body fat is usually also at the top of the list.

Q: What is the normal blood sugar levels for a pregnant person fasting, immediately following a meal and 2 hours after? How many carbs can I eat?

A: The guidelines for gestational diabetes have gotten tighter. Those practitioners who manage their patients more tightly prefer a fasting glucose of less than 90 and 110 one-two hours post meal. The best rule of thumb for carbs is NOT to eat them in the morning if you do experience elevated blood sugars. This often means saving your fruit for lunch or later. How many carbs is dependent on your nutritional needs and caloric needs for your pregnancy. It would be helpful for you to have a consult with a nutritionist who understands gestational diabetes patterns. Once you and your physician have determined your blood sugar guidelines, a management plan should follow. Meanwhile, eat unrefined foods as much as possible, lean “flesh”, and minimize sweets and juices.

Q: Can having diabetes cause your blood alcohol levels to go up? 

A: Yes, though generally this is more pronounced for those with insulin dependent diabetes. When the cells can’t suck in the blood sugar due to insufficient insulin, the body breaks down fat for fuel and produces ketones, which can cross-react with both blood and alcohol tests to produce a positive result, even without a drink. Lots of ketones can cause a fruity breath, mistaken for alcohol, and cause a person to have symptoms of being intoxicates such as slurred words and dizziness. ALWAYS HAVE ID ON YOU THAT IDENTIFIES YOU ARE DIABETIC TO AVOID UNNECESSARY HASSLE AND GET TREATMENT YOU MAY NEED IN A TIMELY FASHION!

Q: Is a 132 glucose level, after a ten hour fast, high enough to be concerned about? 

A: Two fasting levels of 126 or greater is a diagnosis of diabetes. If this was a lab test, your physician should order another fasting glucose to confirm, and an A1C to get your average level over a 3 month period. Meanwhile, start practicing a very healthy lifestyle, understanding what food choices to focus on. In a nutshell, focus on eating lots of veggies, some fruit, legumes, lower starch, and fish or smaller amounts lean meat. BE ACTIVE! That is the best key to control.

Q: My fasting blood glucose is normal, but the A1c was 6.5. What would you recommend?

A: I suggest to closely review what you eat the entire day, and increase your activity level if necessary. If your fasting is between 80-90, great! If higher, then lifestyle habits certainly are what need to be addressed first. You may also request an Oral Glucose Tolerance Test to see what your blood sugar response is post-meal.

Q: Why does my blood sugar get highest 3 hours after eating? One hour after eating my blood sugar is around 160-180, after 2 hours it is around 100-125. What's confusing is it goes up again after 3 hours post-meal to reach 140 then drops down again to 100, and stays at that level. Readings taken after fasting are between 90 to 110. Is this usual?

A: Most of what you describe is usual, particularly depending on what you are eating. Is the 3 hour rebound the same daily? Do you monitor that often? If you are exercising or particularly active before that 3 hour measurement, that could account for a slight rise, followed by the drop. That is a normal pattern for the immediate effect of exercise on blood sugar. Are you on insulin? It sounds as though you may need to revisit your eating habits and tweak your medication program to help you start with an even lower fasting blood sugar.

Q: I have type 2 diabetes and am having problems keeping my morning blood sugar to desired levels. My afternoon levels are usually in the normal range. I’m overweight, but I’ve lost about 27 pounds hoping to reduce my average blood sugar. However, this has not happened. What could this mean? Is my disease progressing?

A: There are several factors that affect morning blood sugars. Often, with reasonable control of diet and exercise resulting in weight loss as you indicate, you do experience a drop. Is your diet as "impeccable" as you can make it? Nutritional supplements also can be helpful when professionally guided. Don't give up; keep up with your good work. Insulin resistance can be just that: resistive! For some people, if they don't follow a disciplined program, blood sugars will keep rising. Sticking to a healthy lifestyle will only be a win-win situation for you in the long run.

Q: I sometimes experience a rise in blood sugar levels whenever I am under a great deal of stress or am ill. Even if I'm strict about my diet, is there any way of keeping the sugar levels down without having to take insulin? Will they return to "normal" levels without medication, or will I still require insulin shots?

A: In general, illness and stress do elevate blood sugar, and if you are already requiring insulin when you are otherwise healthy/unstressed, you may need more at these times. If your blood sugars fall into normal levels without needing medications, then triggers such as an illness may or may not raise them, and if so, may not raise them high enough or long enough to warrant medication. Be sure you understand the nature of the disease, and monitor yourself in all situations as closely as you can. No one will be able to manage this better than yourself.

Q: What is a good blood sugar reading after eating a meal?

A: In an entire day, we generally say your blood sugar should not go over 140 even after eating a large meal. Ideally it would not go over 120 two hours after eating. With diabetes, one's physician may have a higher goal, depending on the health of the person, in order to avoid hypoglycemia (low blood sugar).

Q: Does maintaining a level glucose mean that I should constantly keep my sugars the same, or will the numbers go up and down?

A: There are ranges to maintain your glucose within. Ideally, you will target to be under 100 before breakfast (fasting), and under 140 after meals. You are trying to avoid the extremes of high and low blood sugars. Ask your physician what his/her blood sugar goals are for you immediately and over the long term.

Q: Does high blood sugar cause your blood to get thick and sticky? 

A: Very high blood sugars can accelerate dehydration, which could contribute to "thick" blood. Other medications may also lend to dehydration. It takes six molecules of water to move one molecule of sugar through the blood stream. With all the emphasis on food and lifestyle changes, drinking enough water is basic to good management. Generally, 8 glasses per day is a good start for most people, realizing some will need more, some less. If your first morning urine is not reasonably pale, you are probably not getting enough water.

Q: Do I need to be concerned that my blood glucose runs about 106 fasting every morning? The rest of the day it is fine. I run and lift weights regularly, and my diet is good while watching my carbs. I do not drink. I am also careful with snacks at night.

A: It is good that you are normal during the daytime. The biggest wear and tear on the body seems to come from fluctuating daytime levels rather than a stable but slightly high fasting level. Yes, it would be good to get under 100, ideally between 80-90, but if you truly are most diligent in your lifestyle, you should be able to maintain good health. Certain hormones elevate nighttime levels, contributing to morning highs. Research is out there on many nutraceuticals that may lower fasting blood sugar levels. Water soluble cinnamon in capsule form is one of the most recent that is showing good results.

Q: What should my blood sugar be before meals and 90 minutes after a meal to be an acceptable level? I am pre-diabetic.

A: In general, you do not want to be over 140 post-meal at any time of day. Staying closer to 120 post-meal is an even tighter goal and mimics the non-diabetic state better. Pre-meal blood sugars will vary depending on the last time food was consumed; a goal is to stay between 80-120. Maintaining consistent exercise and monitoring carbs and food quantity will assist in keeping your 2 hour post meal blood sugars under 140.

Q: However, I can have a normal blood sugar reading of about 90 before breakfast and then after a moderate cereal-toast breakfast, my blood sugar will go over 200. I am not diabetic according to medical tests.

A: Have you had an Oral Glucose Tolerance Test? Newer research is placing more emphasis on the after meal glucose elevations as opposed to just monitoring fasting glucose. You are experiencing hyperglycemia, which as an initial diagnosis, generally manifests as slowly elevating fasting glucose. Ideally, your fasting glucose should be closer to 80. 100 is pre-diabetes. I would suggest that your breakfasts now consist of more protein and less carbs. Good choices include egg, yogurt, nut butter, cheese, meat, oatmeal, etc. Target for 20-30 grams of protein at each meal. Any carbs you eat should have fiber: whole grain toast, fresh fruit, etc. Breakfast cereals generally don't fit these criteria unless you search for a type with higher fiber. I suggest an overabundance of plant foods now, to clean out your system a bit, giving your liver a work break. This should help to fine tune your metabolism. Make sure you have essential fatty acids in your intake: fish/plant foods are main sources.

Q: My husband is on an insulin pump but after a severe low blood sugar, he will struggle for several weeks to get his blood sugars under control again. The blood sugars go low and then high for no reason, regardless of diet, exercise, insulin.

A: I suggest you work a bit more closely with the pump trainer on how to cut back on insulin depending on time of day, activity level, etc. With the abilities of today's pumps, there are many options for programming different dosages throughout a 24 hour cycle. In my experience, most pumpers need at least 2-3 different program rates. If you begin to notice a pattern of lows, that would be the time of day or activity relationship to begin cutting back with. This may mean both bolus and basal rates. If lows do occur, try to avoid over treating. Four ounces of juice may be enough if he is really low. Tablets may be a better choice to control the carb amounts, re-administering every 15 minutes until a desired blood sugar level is reached. With perseverance and lifestyle consistency, he should reach a more stable pattern.

Q: Do cold temperatures affect blood sugar? My blood sugar numbers have gone up since the building turned the air conditioning down. The cold air vent is directly above my desk, blowing cold air directly on me. 

A: Extreme temperature changes can create a stress reaction, elevating blood sugars. If you are cold, I'm sure you are "bundling up". Hopefully, you will adjust with time. And is it possible to shift your desk?

Q: How often should pen needles be used before discarding?

A: Pen needles technically are to be used once. In reality, most people who do more than one injection per day immediately cap their needles after use, discarding at the end of the day. Most pens are prefilled, so when finished, discard and start another pen.

Q: My wife is having problems with her blood sugar levels. She has been watching her carbohydrate intake but when she sleeps for at least 8 hours, her sugar levels are higher. Why?

A: It is good she is monitoring her carbs closely, but it is also about the total intake of food and her activity level. Glucose is generally higher in the early morning due to hormonal activity during the night. If she is also elevated during the day, it again may be the types and quantities of foods. Perhaps her medication needs reevaluating. I would suggest she pose these questions to her physician.

Q: I have had type 1 diabetes for about 16 years now. My A1C was 8.6 for a while but now I have it down to 7.6 and lower now. The problem is that now I feel like I am having low blood sugar even when I am in the good range.

A: For many who have adapted to functioning on higher sugars for many years, then in a reasonably short period drop into more normal ranges, low blood sugar symptoms may persist for a time. This means that your insulin is functioning far more efficiently in removing sugar from your bloodstream. At 7.6, you are still in a higher range, but certainly closer to numbers that are more protective for complications. If you are on other medications, particularly for CAD, these may also contribute to symptoms. Make sure you know from your physician what range you should be in. If the symptoms persist, perhaps something else would be the cause not directly related to glucose lowering in the bloodstream. Hormonal changes as part of the life cycle can also play a role.

Q: Do I use the first or the second drop of blood when testing my blood sugar?

A: With most strips now, you can touch them with the first drop. It takes far less blood than it used to to get a good sample. One drop is all that is needed.

Q: I've been taking my blood sugar readings for 2 years. The highest reading was 200 after a meal by 1 hour. Fasting blood sugar is almost between 80 to 100. With such readings, should I be concerned about being diabetic

A: You are showing readings of hyperglycemia. There is a greater movement among diabetes management practitioners to emphasize the importance of post meal control. This is because blood sugar excursions contribute to higher oxidative stress, which in turn may cause increased tissue damage leading to greater risk of complications. This seems to be more true than chronic sustained high blood sugars, such as only high fasting levels.

The ideal fasting blood glucose reading is less than 100. The ideal post-meal blood glucose reading is less than 140. 140-200 post meal/random reading is considered pre-diabetes. I suggest you carefully reevaluate your daytime eating, perhaps being more careful of carb intake and type and follow up with your health care practitioner.

Q: I am a 74 year old male whose glucose level has gone slightly but steadily up over the past year and a half: 99, 104 and today 106. My doctor seems not concerned as I have none of the usual diabetes symptoms, have loads of energy, exercise a great deal at recreational sports, and eat wisely. Given the glucose level and fact that many in my family have diabetes, I am concerned and wonder what I could do?

A: It sounds like you are on a good path geared towards a healthy lifestyle. You may want to seek professional nutritional counseling to fine tune if you are not already very aware of such issues as the impact of carbohydrates. You are still maintaining a low pre-diabetes status. There are nutritional supplements such as cinnamon that may also be helpful in keeping your blood sugars down. Be certain too that you stay well hydrated by drinking lots of water. If you maintain these numbers and don't go any higher, you should do well.

Q: My blood glucose runs about 106 fasting every morning. The rest of the day it is fine. I run and lift weights regularly, and my diet is good while watching my carbs. I do not drink. I am also careful with snacks at night. Is this morning level a reason for concern and why is it high in the morning?

A: It is good that you are normal during the daytime. The biggest wear and tear on the body seems to come from fluctuating daytime levels rather than a stable but slightly high fasting level. Yes, it would be good to get under 100, ideally between 80-90, but if you truly are most diligent in your lifestyle, you should be able to maintain good health. Certain hormones elevate nighttime levels, contributing to morning highs. Research is out there on many nutraceuticals that may lowering fasting blood sugar levels. Cinnulin PF, from cinnamon, is one of the most recent that is showing good results. It can be found in capsule form.

Q: I have been overweight for years and have been having my blood sugar checked at bi-annual doctor’s appointments, always to be told it was “fine” or “normal”. Five months ago the A1c was 6.3. Now it has gone to 10.1 with a fasting blood sugar of 329. While at my first diabetic management appointment, the nurse showing me how to test my blood sugar got a 428, stuck a needle of insulin in me, and sent me home with vials and needles. Is it normal for someone to go from fine to insulin diabetic so rapidly?

A: I would hope you had a bit more instruction than what you are conveying. With blood sugars over 300, it is now the thought of many endocrinologists to start a person on insulin to detox the beta cells of the pancreas. This may only be for a short period if lifestyle changes are diligently made. Sometimes, it is a shift to oral medication, or none at all. Over the years, one may need a return to insulin and/or other medications. Take charge of you lifestyle habits and get all the education you can on managing this disease.