42+ Variables Can Affect Your Blood Glucose - How To Use Them To Your Advantage
If you’ve read some of my most recent articles, you might have seen mention of the 42 and more variables that affect our blood glucose levels at any time by way of acting on our insulin resistance and insulin sensitivity.
There’s a wide range of trivial and less trivial ones to consider: what food you eat, how much, whether you’re active or not, how much are you drinking, how much are you sleeping, whether you’re stressed, what’s the temperature outside, whether you’re at altitude or not, your microbiome, and on and on and on…
All of these factors do play a role in a successful “blood sugar equation”, the one we type 1 diabetics are expected to solve every day of our lives to achieve the almighty blood sugar stability and the highest time in range possible.
However, 42 (and more) is a big number, and sure enough trying to control all of them is an impossible task. Even more so because many of them are completely outside our control: as an example, periods like puberty cause hormonal changes that will alter our blood sugars. I still have to find someone who has been able to “avoid” or “control” puberty. It happens and we have to deal with it some how. You get what I mean.
However, knowing these factors and how they affect our blood sugar regulation is a tremendous help, because with some trial and errors we can develop the ability of turning them to our advantage.
Looking at the graph below (credits to Diatribe.org!) , you can see arrows on the left of each factor: arrows up mean that it causes spikes, arrows down mean that it causes lows. Let’s learn how can manipulate these arrows to our own advantage.
Understanding The Arrows
Knowing what variables can cause spikes and lows we can use them strategically to redirect blood sugar at any point in time. I’ve come across this “strategy” of approaching blood glucose thanks to Matt Vande Vegte, who is doing an excellent job at sharing his experience and coaching people with diabetes through his courses and his YouTube channel FTF Warrior.
We also need to learn to understand when we’re more insulin sensitive or more insulin resistant because this is going to determine our course of actions.
The general idea is that, for every known “arrow up (or down) factor” we want to introduce an equivalent and opposite arrow as a counter balance.
For instance, if you have a factor that causes insulin resistance and is likely to spike you during the day (you haven’t slept well, it’s warm outside, you’re going to lift weights), you can deploy tactics to balance it out with one factor that lowers you (you walk more on that day, you hydrate more, you allow a bit more time for your pre-bolus, etc).
Every “arrow up” is balanced with an “arrow down”, and depending on where your blood glucose is trending you can redirect it with confidence and stabilize it.
By doing this you’ll be able to make the right call given a specific situation. Here are some scenarios.
If your CGM signals a 102 with arrow pointing down, then you can consider some high intensity anaerobic activity (lift something heavy, weight training at the gym, doing a sprint, reducing the time between your pre-bolus and your meal).
If it’s early morning and you know the dawn phenomenon is about to kick, you can consider going for a walk or take one corrective unit as a precaution. This decision varies depending on the day or the activity: in my case, I always workout first thing in the morning. However, when I run I never give any insulin because aerobic effort of running is sufficient to take care of my dawn phenomenon (dawn phenomenon: one arrow up; running: one arrow down). If I am going for a strength training with some heavy weights, I am aware that this will further contribute to a rise in blood glucose so I will drink more water and take a few corrective units of insulin (dawn phenomenon and strenght training: two arrows up; water and insulin: two arrows down).
Getting A Flat Blood Glucose Line No Matter What: Our Responsibilities
Honing this “arrow compensation” thing is a great power, but with power comes responsibility.
The first responsibility is, of course, getting familiar with the arrows themselves: how many are they and what is their impact (up or down).
The second responsibility is to assess how strong is their impact on us. While there’s a general consensus on their expected degree of “violence” on our blood sugar (you might expect a long run or aerobic exercise to decrease your blood sugar), there are unique contingencies that can alter these predictions. In my case, a training run often has a “arrow slightly up” kind of effect, but a race such as an official marathon has a “triple arrows up” effect due to the adrenaline and the excitement. Thus, the same variable that causes people to go low is likely to send my blood glucose to the moon unless I take some countermeasures.
The third responsibility, linked to the previous one, consists in understanding how our own bodies interplay with these arrows, and how the arrows balance themselves out in our case. Each and everyone of us has individual traits that are unique, and differences in lifestyle that must be considered. Taking the time to connect the dots goes a long way in terms of wellbeing and helps us avoid dangerous situations. The goal is always to pair opposing factors that counteract each others without generating more imbalances (I will provide personal examples at the end)
The fourth responsibility is to keep tracking them. It is very easy to nail the first few days, perhaps gain some immediate success, rest on lawrels and then be back at square zero in the blink of an eye. These pieces of the puzzle keep moving and we must move with them. As Bruce Lee’s would say, “Be water, my friend”.
While some of these variables, or “arrows” as we’ve called them, are easier to predict than others (the exact carb count, the exact duration of a workout, and so on), others are much harder to factor into the equation. How much more insulin should I take since I’ve only slept two hours last night? How much should I extend my pre bolus time considering how stressful a morning it’s been at work? These are difficult calls to make, and that’s why we ought to keep them under close scrutiny. Only with experience and through some intentional understanding of ourselves can we learn how to navigate troubled waters with success.
How I Play With The Arrows
As I said just a few minutes ago, each of us has unique nuances that could alter the direction and the strength of the arrows. What’s a double arrows up for me could be a one arrow down for you, depending on what’s going on in a specific day or period.
Let me offer you some examples to clarify what I mean.
I am sure there’s no need to say that this is not medical advice, and that you are going to take your time to investigate how it works for you.
Running, as most aerobic activities is, generally speaking, an “arrow down” factor. However, believe it or not, there are people who are prone to spikes when they go for a run, and I am one of them. I also like to run in the early morning straight out of bed, right when the dawn phenomenon (another “arrow up” factor”) is about to hit. How do I counter balance these? With two “arrow up” factors to counterbalance, the first thing I do when I wake up is drinking a big gulp of water to help blood and insulin circulate - ”arrow down” factor number one. The run itself should be ”arrow down” factor number two, but not for me in most cases at least. That’s why I am often going to take a very small amount of insulin (one corrective unit) right before going out of the door. This is something most of the diabetic people I know would not do, but in my case it helps keep the blood sugar just stable.
That’s for training runs. What about races? I get very excited and emotional when I am toeing the starting line of a marathon, surrounded by people and music. This - the “excitement”, the “stress” factor - has always caused a steep rise. So on race day I actually have three “arrow up” factors to juggle with! However, I don’t want to be injecting insulin before a race, other than the one required to deal with my pre race breakfast, running with insulin on board is too risky. That’s why my balancing arrow consists in either increasing my basal insulin a slight the night before and doing some meditation or guided breath work to calm the nervous system down - both in the evening and on the morning of the race.
Stress can also hit at work just like in any other moment or area of life. On those busy, hectic days it is fundamental to keep in mind that stress is a big arrow-up factor. Your body doesn’t know whether a lion is chasing you, or you just had a fight with your partner or a colleague, or the person in the car in front of you decided to go as slow as possible right when you need to be on the other side of town in the next thirty seconds. This is all stress, and as such will foster insulin resistance. The best way to deal with stress is to relax. I keep short meditations as a quick and easy fix to balance the hormones in the body and keep cortisol under control. Since I know I am more insulin resistant than normal days, other than staying hydrated and active with short walks throughout the day, when I am having a meal I always increase my pre-bolus time to allow insulin more time to get into circulation and I start my meals with fibers proteins and fats, leaving the carbs last.
Did I just have the worst and shortest night of sleep in years? The neighbor decided to practice drumming at 3AM. The building around the corner was on fire. Mosquitoes invaded my bedroom. Whatever the reason, I couldn’t sleep. Sleep deprivation is a primary source for insulin resistance, and when I wake up the next day, while I acknowledge my destroyed look on the mirror, I must recognize that and set the day to compensate for it. I’ll drink more, take more breaks to sit in silence or focus on my breath, take more walks, review my doses (perhaps increasing them a slight), eat slower, and so on. I am already prone to spikes, so the last thing I want to do is to contribute with wrong behaviors.
These are simple examples to show how I balance the arrows in my day to day. There are thousands more cases and situations that I could describe and breakdown, but I need to close this article at some point.
The take-home message is that we must understand the arrows at play in our day and learn how to manipulate them. One “arrow-up” factor? One “arrow-down” factor. Two “arrow-up” factors? Two “arrow-down” factors. And so on.
The more we practice, the easier it gets. And the better our blood glucose stability and life.
