My husband has been a diabetic for seven years. Because his fasting level was so high (almost 300), when he was diagnosed, he was immediately put on Metformin and insulin both of which he took at night. At first, he tested four times a day while he figured out how much insulin he needed, but once his glucose levels become more-or- less normal he quite testing, even the occasional fasting test. He became complacent about his condition. He would skip breakfast at home and get an early lunch from a fast food joint as soon as they quit serving breakfast. This was usually a sandwich of some kind with a large order of fries and a large diet soft drink and maybe a cookie or brownie if they were available at the restaurant he chose. He would eat the lunch I packed (sandwich, fruit, veggies, and a small diabetic treat) in mid-afternoon. He would supplement this with M&Ms and Reeses Peanut Butter cups from the vending machines. At dinner, he would want extra helpings of rice, potatoes or bread, and always a dessert. I wasn’t into making low carb desserts then. I would have sugar free jello and pudding cups available, but he couldn’t say no to any other cookies or ice cream that were in the house. I bought single serve packages to make sure he wouldn’t eat too big of a serving, but finally quite buying them at all. During this time, he also had to start on a medication for his cholesterol and his A1C was stuck in the 7-8 range and would not go down further. Two other oral medications were added (Jardiance and Januvia) which he also took at bedtime. At his doctor’s urging he started choosing a salad for brunch at the fast food restaurants and cut back to small order of fries instead of a large.
Fast forward to March 2020 when the pandemic hit and we all got shut indoors. My husband was lucky that his employer would allow him (and any other employees in high risk categories) to work from home. Suddenly his access to daily fast food and vending machine treats disappeared. He ate only what I put in front of him. He started walking daily in our neighborhood not for the exercise, but just to get out of the house although he noticed that after a few weeks he could walk farther without getting winded and he felt better overall. He started to lose weight. I had to buy him new jeans that were two waist sizes smaller (from a 44 waist to a 40 waist).
At his last check up, his A1C was down to 5.9 and his doctor suggested that he cut his insulin dosage since he had lost weight and improved his diet. My husband resisted this for months. He didn’t want to be bothered with all the testing involved in finding a new dosage. I think hearing me scold my mom about her recent diabetes diagnosis finally made him bite the bullet and start testing.
The first morning he tested his fasting blood sugar was 65! My husband has always been a night person and somewhat of an insomniac. However, his morning tiredness, irritability, and inability to work productively until after he ate suddenly made a lot more sense. He was waking up hypoglycemic every morning. Since he didn’t regularly do a fasting test, he no idea how long this had been going on. Perhaps since before the pandemic started because he always took all his medications at bedtime and then fasted overnight – sometimes until mid-morning or later before the lockdown. This could have had serious consequences if he had continued to drive himself to work before eating with his blood sugar that low.
He has since started testing three or four times a day. After getting similarly low readings a few days in a row, he started taking some of his oral medications in the morning instead of at bedtime. His fasting levels came up some but were still in the 70-80 range which is fairly low. His post prandial levels have remained in the 120-170 range which he’s happy with but allows a little wiggle room to go upwards as he cuts back his insulin. He would like to get his fasting level up to the 85-100 range. He is going to cut back slowly on his insulin (his physician told him how to go about it at his last visit) and see if that helps any. He may end up starting to take all his oral medications and insulin in the morning. Now that he is testing regularly, he has the information he needs to proceed safely in adjusting his medications to maintain healthy fasting and post prandial blood sugar levels.
The point is testing is crucial. Do not get complacent about your diabetes management. My husband is lucky that he never crashed his car on the way to work due to his low blood sugar level or had any other serious problems. As a diabetic, you do science on your body everyday with your diet, medication, and exercise. You can’t know how your body is responding unless you test. Like my husband, you could be a serious hypoglycemic incident waiting to happen. However, it’s just as likely that your medication may have stopped working as effectively as it was. Your blood sugar could be out of control again even though you are taking all the medication you previously did, but without regular daily testing you would never know until months later when your doctor did a blood test. If your doctor isn’t insistent that you come in periodically for bloodwork and just refills your medication prescriptions whenever you request them, you could end up in the hospital with ketoacidosis.
Please, please, please. I can’t stress this enough. Test your blood sugar at least daily if not more. It’s the key to maintaining your health.
UPDATE: After getting fasting readings in the 70-80 range for several days after moving some of his oral medications to the morning instead of bedtime, my husband took the big step and moved his insulin to the morning. On the first morning his fasting level was 90. He will continue to check fasting and post prandials for a few days and then consider slowly cutting back on his daily insulin.
UPDATE 2: Just moving his insulin and most of his medication to the morning seems to have done the trick. His fasting levels have been in the 85-100 range and his post prandials have stayed on target as well. He says feels better when he wakes up and he is much more able to work effectively in the morning.