Ask the Experts: When Your Body Stops Responding to Diabetes Treatments
Your body changes as the years pass by and so do your diabetic needs – even if you've made every effort to stay on track. In fact, over time, your diabetes treatment plan may become less effective.
We talked with Ann Brown, RN, CDE, a certified diabetes educator nurse at the Franciscan Healthy Living Center in Lafayette, Indiana, to learn why treatment needs change, and what you can do to make sure your sugar and insulin levels stay manageable.
What Causes Diabetes Treatments to Become Less Effective?
It's not that the medications lose their effectiveness. The problem is that your body changes over time. People with type 2 diabetes may have lost up to 50 percent of their beta cell function by the time they are diagnosed. The beta cells of the pancreas produce insulin, which helps move glucose, or sugar, from the blood into the body's cells where it is used for energy.
The remaining beta cells have to work harder to produce the amount of insulin the body needs. Over time, the remaining beta cells may even stop functioning. At that point, your medication may need to be increased, or you may need a new drug that works on the problem another way.
Another factor that can change during the course of the disease is called insulin resistance. This is when your cells become less responsive to insulin. As a result, glucose isn't moving efficiently into your cells and it builds up in your blood. Fortunately, lifestyle changes like increased activity and weight loss, as well as medications, can increase the sensitivity of cells to insulin.
If your diabetes treatment plan is no longer keeping your blood sugar levels within your target range, your plan (including lifestyle approaches and medications) needs to be re-evaluated by your diabetes care team. This team of professionals should include your primary diabetes care provider. It may also include a diabetes educator, registered dietitian and other professionals.
What Factors Can Increase Blood Sugar Levels?
People with diabetes should check their blood sugar levels regularly, and know what the numbers mean. If you notice that your numbers are running higher, you need to assess what could be causing the increase.
I always tell folks to review their treatment plan and ask themselves if they have been adhering to it. Think about questions like:
- Have you been following the meal plan?
- Has a recent surgery or illness prevented you from exercising?
- Are you taking every dose of your medication?
- Are you taking other medications, like steroids, that may affect blood sugar levels.
Most people don't realize that physical and emotional stress can also raise blood sugar levels. Physical stress can be from an infection or illness like a cold, an injury or controlled trauma like surgery, or chronic pain. It's important to evaluate if you're experiencing increased stress, because that can affect diabetes management.
Also, menstrual cycles can increase blood sugar, albeit temporarily, as can being dehydrated. So, there are a lot of factors that contribute to higher blood sugar numbers. Figuring out what is affecting you is crucial so you can take steps to address those issues.
When Should Your Doctor Reassess Your Diabetes Management Plan?
Your doctor should reassess your diabetes management plan at every visit, generally recommended every 3-4 months. These assessments provide an opportunity to discuss how you're doing and brainstorm ideas to address any problems you're having.
Don't wait for the annual review to get help if daily monitoring reveals higher numbers than usual. Reach out to your doctor or other diabetes care team member if you can't get your blood sugar back to the target range.
What's the Most Important Thing You Can Do to Stop the Progression of Diabetes?
You have to keep blood sugar levels within the target range because that's when the body is healthiest. Controlling your blood sugar is your best chance for halting or slowing the progression of the disease and reducing complications.
Checking your blood sugar isn't fun, but it can be a powerful tool to help you stay on top of the disease. For example, if your sugar is higher in the evening than it usually is, you can ask yourself what occurred that day to cause the change. Maybe you haven't exercised? Or you consumed more carbohydrates than usual? Whatever the case, you can use that information to come up with a strategy to bring your glucose back down to your target range.
Still struggling to get your blood sugar levels under control? Don't beat yourself and get discouraged. Ask for help. Diabetes is a disease with a lot of moving parts, and it can be very challenging to manage. Your diabetes care team can help you find answers and get a fresh perspective.
If you or a loved one needs help managing diabetes, contact a diabetes educator or your healthcare provider. They can work with you to minimize the impact of diabetes on your health.