Are you diabetic? Is your blood sugar level too high?

In 20 years of seeing diabetic patients, one becomes familiar with certain patterns of disease and behavior. Any experienced doctor can list a dozen reasons why a patient’s blood sugar level may be out of control.

Here’s my list of the top 10 reasons your blood sugar may be too high.

1. Your total calorie intake is too high. For most type 2 diabetics, the body is still able to produce some insulin, but perhaps not enough to help it properly metabolize food. Cutting your calories by a third may be all you need to do.

2. You eat foods with a high glycemic index. When it comes to diabetes, not all foods are created equal. Simple carbohydrates (sugars, bread, cereal, rice, potatoes, pasta) are rapidly absorbed, rapidly raising blood glucose too quickly for the pancreas to respond adequately. Eating the same calories in the form of foods that are absorbed more slowly (protein, fat) will cause a smaller rise in blood sugar.

3. Your body mass index is too high. Having too much fat inside the body makes it harder for the body to use insulin. Once you’ve lost the extra weight, you’ll be able to eat the same number of calories, but you’ll have your diabetes under control.

4. You don’t take your medication as directed. Many patients not only ‘cheat’ by eating an occasional cookie, but they skip their medication more often than they admit. Lying to yourself will make it hard for you and your doctor to keep your diabetes under control.

5. You’re not taking enough diabetes medicine. Although your diabetes treatment probably started with a single medication, it is quite common for you to require additional medications as time goes on. This can be achieved by using a higher dose of the medication you are already taking or by taking a combination of two or more medications.

6. You don’t get enough exercise. Exercise not only helps lower blood sugar, but also builds muscle mass, which uses blood glucose more efficiently than fat tissue.

7. Your pancreas is wearing out and you need insulin. By the time you take three or even four oral diabetes medications, you’re getting to the point where your pancreas just can’t make enough insulin to counteract your blood sugar. If your pancreas is simply wearing out, there is no medicine that can make it “young” again.

8. You have an infection. Some infections are obvious, others less so. Urinary tract infections, for example, often raise blood sugar levels, but they can cause some other symptoms. Frequent urination associated with infection is also often confused by patients with that caused by diabetes. Any type of infection can raise blood sugar, from viral gastroenteritis to ear infection, the flu, or pneumonia.

9. You are taking medications that raise your blood sugar level. Steroids and diuretics are the two most common medications that raise blood sugar in both diabetics and non-diabetics. Anytime you start a new medication and notice your blood sugar rising, you have reason to ask your doctor if the medication might be to blame.

10. A combination of several of the above. This is actually the most common. Diabetics often eat too much or too much of the wrong foods, exercise too little, are already overweight, and take multiple medications.

If your blood sugar is too high, the list above is a place to start. Talk to your doctor about what you can do to change your lifestyle. Diabetic education classes are a good idea and can provide you with general information and specific guidance relevant to your particular situation. Once you’ve identified the cause, you’re well on your way to finding an answer.

Copyright 2010 Cynthia J. Koelker, MD