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Question: I am diabetic but I take my medication every day. Why is my blood sugar still high?

Answer: Diabetes is a very common ailment in our population today. It is also notoriously difficult to control, even with the wide array of medications available to treat the disease. To understand why it is so difficult to control, we have to look at what happens in the body when a person is diabetic.

There are two types of diabetes. Type 1 diabetes is an autoimmune disease where the body attacks the cells of the pancreas so they do not produce any insulin. You really have no control over this disease. You cannot do anything or eat anything to stop the disease from happening. The only treatment for Type 1 diabetes is insulin because the body cannot produce its own. Type 2 diabetes is the more common form of diabetes. In this case, the body might not produce enough insulin or the body may not be able to use the insulin well. Unlike Type 1 diabetes, Type 2 diabetes is a lifestyle disease. This means that decisions we make in our every day lives (such as what we eat and how much physical activity we do) contribute to the disease. Since Type 2 diabetes is the more common of the two, the rest of this article will address that particular type of diabetes.

Let us talk about what happens in the body when we eat food. When we eat, the carbohydrate component of the food is broken down into a simple sugar called glucose. The glucose is released into the blood and floats all around our bodies. As the food is broken down in the stomach, the pancreas is signalled to produce insulin. Insulin’s job is to facilitate the passage of glucose out of the blood and into the cells. The blood really does not need the glucose; it is the cells that need the glucose for energy. If there is too much glucose in the blood and not enough insulin to move it into the cells, we will have high blood sugar. If there is enough insulin but the cells are not responding to the insulin and not taking the glucose, we will also have high blood sugar. This reduction in insulin production or increase in insulin resistance of the cells is the basis of Type 2 diabetes.

I think we can all appreciate the fact that if we keep eating too many carbs we put a strain on our bodies, requiring them to produce more insulin to deal with the carbs. In a healthy person, the body normally can respond to the challenge and produce enough insulin. However, in a person with Type 2dDiabetes the insulin-producing cells in the pancreas are damaged and cannot produce enough insulin. Some of the diabetes medications — like Glyburide and Amaryl — work by stimulating the pancreatic cells to produce insulin, but production is just not the same once the cells have been damaged. The responsible thing to do if your pancreas is not producing enough insulin is to eat less carbs. This dietary change along with the medication will help to keep your blood sugar in the normal range.

Sometimes there is enough insulin circulating but the cells are resistant to the insulin. This happens a lot if persons are overweight or inactive. There are medicines that can help the cells to be more sensitive to insulin, such as Diavista. However, increased activity and weight loss are still necessary to help combat insulin resistance.

The fact of the matter is that Type 2 diabetes is a lifestyle disease and its control depends heavily on our everyday decisions. Medications will certainly help but oftentimes, it is not enough. I urge all diabetic patients to take your medications every day. In addition, though, you may need to adjust your diet by eating less carbs, increasing your activity level, and losing some weight. I know it is not easy, especially in this fast-paced world with unhealthy but convenient food options, and jobs that make us sit around the computers all day. However, everything that you value — including your health — must be fought for. You have to fight to keep your blood sugar under control.

Novia Jerry Stewart, MSc, RPh, is a pharmacist who specialises in diabetes care. She may be contacted for diabetes care coaching sessions at diabetescarepharmacist@gmail.com