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When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life with diabetes. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising!

Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too.

What to do:

• Be consistent. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. Simply eating about the same amount of food at about the same time every day can help you control your blood sugar level.
• Even out your carbs. Carbohydrates have a bigger impact on your blood sugar level than does protein or fat. Eating about the same amount of carbohydrates at each meal or snack will help keep your blood sugar level steady throughout the day.
• Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Your diabetes health care team can help you strike a balance.

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body's response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can lower your blood sugar level.

What to do:

• Get your doctor's OK to exercise. This is especially important if you've been inactive and plan to start exercising regularly.
• Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Or your doctor may suggest other changes to your diabetes treatment plan.
• Exercise good judgment. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that can cause low blood sugar. Drink plenty of fluids while you work out. Stop exercising if you experience any warning signs, such as severe shortness of breath, dizziness or chest pain.

Insulin and other diabetes medications are designed to lower your blood sugar level. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.

What to do:

• Store insulin properly. Insulin that's improperly stored or past its expiration date may not be effective.
• Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.
• Be cautious with new medications. If you're considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.

When you're sick, your body produces hormones to help fight the illness. These hormones raise your blood sugar level by preventing insulin from working effectively. This can help promote healing — and wreak havoc with your diabetes management plan.

What to do:

• Plan ahead. Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your insulin dosage, if you need insulin, and when to call your doctor.
• Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar level.
• Check the sugar content of over-the-counter medications. Many cough syrups and other cold preparations are high in sugar. Ask your doctor or pharmacist for advice.

The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is busy metabolizing alcohol, your blood sugar level may not get the boost it needs. If you take insulin or oral diabetes medications, even as little as 2 ounces of alcohol — the equivalent of two drinks — can cause low blood sugar.

What to do:

• Get your doctor's OK to drink alcohol. Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if your diabetes is under control and your doctor agrees, an occasional alcoholic drink with a meal is fine.
• Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, stick with sugar-free mixers — such as diet soda, diet tonic, club soda or seltzer.
• Tally your calories. Remember to include the calories from any alcohol you drink in your daily calorie count.

As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar levels — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

What to do:

• Look for patterns. Keep careful track of your blood sugar readings from month to month. Soon you may be able to predict fluctuations related to your menstrual cycle.
• Adjust your diabetes treatment plan as needed. Your doctor may recommend changes in your meal plan, activity level or diabetes medications to make up for monthly blood sugar swings.

If you're stressed, it's easy to abandon your usual diabetes management routine. You might exercise less, eat fewer healthy foods or test your blood sugar less often — and lose control of your blood sugar in the process. The hormones your body may produce in response to prolonged stress may even prevent insulin from working properly, which only makes matters worse.

What to do:

• Look for patterns. Log your stress level on a scale of one to 10 each time you log your blood sugar level. A pattern may soon emerge.
• Take control. Once you know how stress affects your blood sugar level, fight back. Learn relaxation techniques. Prioritize your tasks. Set limits. Most importantly, take good care of yourself.

The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations — and plan ahead accordingly. If you're having trouble keeping your blood sugar level in your target range, ask your diabetes health care team for help.