Troubleshooting Low and High Glucose While Taking Diabetes Medications

Low and high glucose levels can occur even when taking diabetes medications. Here are some common reasons why.

Why am I Having Low Blood Glucose?

Possible causes include:

Eating less carbohydrate than anticipated when taking insulin or insulin releasing pills

Sometimes we don’t eat what we plan to, or we miscount carbohydrates because we don’t know the carbohydrate content of the food. When this happens, low blood glucose may occur because the dose of insulin or insulin releasing pills (secretagogues) is based on eating a certain amount of carbohydrate at the different meals. The solution: If you eat less than expected, make up the “missing” grams of carbohydrate. For example, eat some fresh fruit or even take glucose tablets. If you are not sure of the carbohydrate content of the food, check you blood glucose more often and be prepared to take supplemental glucose .

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Delayed or missed meals when taking insulin or insulin releasing pills

Life is full of delays, so it’s not uncommon to anticipate eating a meal, and then have something happen that delays it. This is particularly true when going out to eat. Sometimes you get so busy, you miss the meal all together. The solution: Try to eat at regular times. And if you know a meal is going to be delayed, consider having a snack to tide you over until your meal is served. Also, speak with your healthcare provider about how to reduce the dose of your medications when you know you will not be eating as much as usual. 

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Increased activity or exercise while taking insulin or insulin releasing pills

Exercise generally makes the body more sensitive to the action of insulin. The solution: You may need to scale back the dose of insulin or insulin releasing pills, and increase carbohydrate consumption in order to prevent low blood glucose. Consult your diabetes medical team about dose adjustments.

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Increased insulin sensitivity

Losing weight can increase your sensitivity to insulin and thereby decrease your medication needs. Other less common causes of reduced medication requirements include kidney problems or low thyroid activity. The solution: Discuss with your diabetes team how your other medical diagnoses may affect your diabetes management and the dose of insulin or insulin releasing pills.

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Use of Incretin Based Therapy (DPP4 inhibitors, GLP-1 analogs) or an Amylin Analog (pramlintide)

Incretin based therapy (DPP4 inhibitors, GLP-1 analogs) or pramlintide will lower blood glucose after your meal. In combination with insulin or insulin releasing pills, their use may result in a low blood glucose. The solution: Decrease the insulin releasing pills dose and/or the incretin or pramlintide dose. Consult your medical provider for specific recommendations regarding dose adjustment.

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Fear of complications

For some individuals, the fear of complications from high blood glucose is so overwhelming that they prefer risking low blood glucose to the health consequences of chronic high glucose levels. This is a dangerous tradeoff. Low blood glucose can cause immediate, even life-threatening harm. The solution: Reduce the dose of insulin or insulin releasing pills until the low blood glucose are eliminated. Consult with your medical provider regarding specific dose adjustments.

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Drinking alcohol

Alcohol can reduce the amount of glucose produced by the liver, and can put you at risk for a low blood glucose. The solution: Drink alcohol in moderation. Eat carbohydrates when you drink alcohol. Check your blood glucose.

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Excessive medication

How do you know if your insulin or insulin releasing pill dose is incorrect? Look at the blood glucose overnight, and before and after meals. If your blood glucose is frequently low, your medication dose may be too high. The solution: Consult with your diabetes medical team about decreasing your medications to avoid hypoglycemia.

Why am I having high blood glucose?

Possible causes include:

Incorrect carbohydrate counting

If you underestimate the carbohydrate content of your meal, your blood glucose may become too high. This is particularly true when eating out or when eating foods that don’t have nutrition labels. The solution: Learn more about carbohydrate counting. Weigh and measure your food, especially if you take mealtime insulin. Eat foods with carbohydrate counts that you already know. Research nutrition information online for food options at restaurants and chain outlets.

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“Out-eating” the medication

It’s not always easy to anticipate how much you will actually eat during a meal. However, missing your mark has the same affect as if you miscounted carbohydrates. Moreover, there are individual limits on how much mealtime carbohydrate can realistically be covered. The solution: In general, it’s wise to limit your mealtime consumption of carbohydrate to whatever has been recommended by your nutritionist. If you have a special occasion coming up, be sure to discuss any special “party meal” or “banquet” medication dose adjustment with your medical provider.

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Inadequate medication dose

Insufficient medication doses can cause a high blood glucose reading. To be sure that this is the cause of your high blood glucose, you need to do some detective work. First, check your blood glucose readings overnight, and before and after meals. Second, check to make sure that a change in food, activity and stress aren’t causing the high blood glucose. The solution: Once you have eliminated these variables, if your readings are still high, consult with your diabetes medical team regarding a change in your medication doses.

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Not monitoring blood glucose levels

If you don’t check your blood glucose reglarly, you may be unaware of high blood glucose. The solution: Check your blood glucose at regular intervals, and at different times of the day. If your blood glucose is not on target, consult with your medical provider about a dose adjustment.

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Taking medications that cause insulin resistance

Occasionally, it may be necessary for you to take medications that lead to insulin resistance, such as steroids or niacin. The solution: Work with your diabetes team to adjust your insulin releasing pill doses to maintain glucose control.

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Inactivity

Any decrease in your usual activity can decrease your insulin sensitivity and increase medication requirements. The solution: Monitor your blood glucose levels closely, and adjust your medication doses as needed after consultation with your medical provider.

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Weight gain

Increased body fat can cause resistance to the action of insulin. The solution: Monitor your diet and your weight. If you find you are gaining weight cut back on how much you are eating and consult with your nutritionist.

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Increase in stress hormones

There are many reasons why your stress hormones might spike: Infections, physical and emotional stress, medical conditions like thyroid or liver disease, pregnancy or puberty. The solution: Work with your diabetes team to adjust your medication doses and maintain glucose control.