Category: Blood sugar control

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Breakfast for diabetes – here are the three worst ones!

Is your healthy diabetic breakfast helping or hurting your blood sugar? Are you eating one of the three worst breakfasts for diabetes?

There are lots of foods that are supposed to be good for you.

Yes, generally speaking some of them may be for some people. But when you have high blood sugar you have to think differently.

They say that breakfast is the most important meal of the day…. no, not really. But I’m going to give you three of the worst possible breakfast foods for diabetes. I’ll also give you some much better alternatives you can use as a healthy breakfast for diabetes.

Unhealthy breakfast foods for diabetics

Wheat bread – a sugary breakfast for diabetes type 1 & type 2

Lots of diabetics know that white bread will raise your blood sugar and they avoid it. But somehow people have been given the idea that wheat bread is good for you.

Maybe because it’s brown and looks natural and earthy? 

There are several things to point out here:

  1.  Sometimes the manufacturers add food colouring to this bread to make it look more “wheaty”.
  2.  Another problem is that sometimes producers add sweeteners to the bread to make it more palatable because it really doesn’t taste very nice.

If you set aside these two issues, there’s another problem.

Wheat bread is made from finely ground wheat i.e. flour. Once you eat it in this form it will cause your blood sugar to go up. You will find that there is virtually no difference between your blood sugar when you eat wheat bread and when you eat white bread.

This is definitely one of the worst breakfasts for diabetes!

Instant oatmeal – this should not be part of your diabetes breakfast diet

This is one of the most popular breakfasts for diabetes. Yet anothe food that’s supposed to be super healthy for diabetics. It’s a true breakfast favourite.

But let me start by saying that if you’re eating instant oatmeal, the quick cooking 1, 2, 3, minutes variety, then you might as well eat white bread.

Once again, the same principle applies as for wheat bread. They chop up the oats into very small pieces, partially cooked, dried and packaged.

Once you eat them they are digested very fast, broken down into sugar and you absorb them very fast into your bloodstream. The blood sugar shoots up.

To make matters worse, you might decide to wash this down with skimmed / fat-free milk. Thereby adding even more sugar to your meal.

You might then decide to add insult to injury by throwing in some spoons of honey into that oatmeal. This is a disaster of a breakfast. There is no scenario in which this helps your blood sugar.

This is a very good example of a high glycemic index breakfast.

Breakfast cereal – not a healthy breakfast for diabetes

diabetes breakfast foods

The third type of food that you should avoid if you have breakfast high blood sugar is breakfast cereals. This includes the various pops, krispies, flakes and things of that variety.

They are just little balls and flakes of sugar. They are so highly processed that they bear no resemblance whatsoever to the plants that they came from.

The box might look appealing and colourful; various prestigious organisations may endorse the cereal. It may be fortified with vitamins and minerals.

But then one might argue that if they didn’t remove the natural vitamins and minerals from the food in the act of processing it, they wouldn’t need to add the artificial ones back in.

These are bad for your health and terrible for your blood sugar!

Now before you cry foul just hear me out, just hang on. Don’t take my word for it.

Use your blood sugar glucose metre and check for yourself. Record your blood sugar 30 minutes 1 hour and 2 hours after eating any of these processed foods that I just talked about.

Write down your numbers and keep them as a reference. Then compare them with the numbers that you get after eating the alternative foods that I’m going to mention.

Now onto some more blood sugar friendly foods that you can eat for breakfast.

Breakfast foods for diabetes that won’t raise your blood sugar!

What makes a good diabetic breakfast?

A good diabetic breakfast:

  • should not make your blood sugar shoot up,
  • should keep you satisfied for several hours so you don’t feel like nibbling all day,
  • it should be easy to put together, which means you’ll be more likely to prepare and eat it,
  • it should be a good source of minerals and vitamins and other essential nutrients.

Healthy breakfasts for diabetes are all around and include many of the types of food you’re already eating.

What can I eat for breakfast with diabetes?

Eggs – a complete healthy breakfast for diabetes

Over the years eggs have become controversial for some reason. And it’s difficult to actually figure out why, because we’ve been eating eggs for many generations.

How did they suddenly become bad for us? Maybe it’s the rubbish that we’re eating with the egg, the processed junk that we eat for breakfast that’s actually causing the problem and not the eggs themselves.

Eggs are a super food.

They contain many important vitamins and minerals as well as antioxidants, high quality protein and healthy fats.

Fish – a low sugar breakfast for diabetes

People have very rigid ideas about what they should eat at certain times of the day. But there is no reason to restrict your foods in that way…. to decide that you can only certain things for breakfast, lunch or dinner.

So I’m going to suggest that you try fish for breakfast. You can try frozen fish, fresh fish, dry fish, sardines (minus the oil in the can).  You can eat all these types of fish in the morning. If you choose a naturally oily fish, then you’ll get the benefits of the Omega-3 fatty acids that are in these fish.

These help with brain function and depression. They help with thinking, they are beneficial in heart disease, for improving insulin resistance and so much more.

Plain unsweetened yoghurt

This is a great, healthy breakfast for diabetics. Yoghurt is made from milk. Milk contains lactose which is milk sugar. The process that converts milk into yoghurt uses of the lactose.

So you will find that if you drink yoghurt, it will not raise your blood sugar as much as the same quantity of milk would.

You can combine the yoghurt with nuts like peanuts, almonds or walnuts. This will help you to stay satisfied through the day.

Greek yoghurt is an even better breakfast for diabetes.

I know that it’s hard to ignore all the advertising and the marketing around some of these food because they do use psychology to get you to buy them.

But that is exactly what you have to do. If you want to bring down your blood sugar, forget the hype.

When it comes to your blood sugar let your metre be your guide. It’s not biased in any way. It doesn’t like you, it doesn’t hate you, is not trying to sell you anything. It is completely objective.

If you let your glucose metre guide you when making your food decisions, it’s hard to go wrong.

 

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What are normal A1c levels?

normal Hb A1c levels

Normal A1c levels can be difficult to achieve in long-standing diabetes. But using the HbA1c is not always the best way to measure success or failure of diabetic treatments.

The hemoglobin A1c test is a blood test used to diagnose diabetes mellitus. You can also use it to monitor the progress and success of treatment.

It gives an average of your blood sugar levels over the past 3 to 4 months.

What is hemoglobin (haemoglobin)

Hemoglobin is a protein found in your red blood cells. It carries oxygen from the lungs to the cells. It also takes carbon dioxide from the cells to the lungs to be breathed out into the atmosphere.

Sugar in the blood attaches to hemoglobin to form glycated hemoglobin, which is commonly known as HbA1c.

The higher the sugar levels in the blood, the more of it binds to the hemoglobin, the higher the HbA1c levels.

Once sugar attaches to the hemoglobin, you cannot remove it. 

The only way to get rid of this sugar is to destroy the red blood cell. The average lifespan of a red blood cell is 3 to 4 months. So once it is formed, the a1c (glycated hemoglobin) will remain in the blood to be measured for 3 to 4 months.

The HbA1c is often described as a percentage: 

glycated haemoglobin/ total haemoglobin x 100.

How is the HbA1c test done?

You must have a blood sample to check the HbA1c levels. You don’t need any special preparation. That means you can have your blood drawn any time, day or night.

Everybody has some a1c (glycated haemoglobin) circulating in their blood. Your blood sugar cannot be zero or else you’d be dead! In the same way, your HbA1c cannot be zero because you must always have some sugar circulating in your blood.

Normal A1c Levels

  • less than 5.7% is normal
  • 5.7 – 6.5 is the prediabetic level
  • more than 6.5 suggests a diagnosis of diabetes.

Estimated average glucose level (EAG) and abnormal A1c levels

Below is a table that gives the HbA1c equivalents in units you will be more familiar with.

A1cEAG (mg/dl) EAG (mmol/l)
61267
6.51407.8
71548.6
7.51699.4
818310.1
8.519710.9
921211.8
9.522612.6
1024013.4
The relationship between A1c and EAG (estimated average glucose levels)

eAG (estimated average glucose levels) = 28.7 X A1C – 46.7

If you don’t want to do the maths, here is a handy calculator you can use to calculate your estimated average glucose levels based on your HbA1c.

Treatment goals for diabetes using A1c

Generally speaking, the treatment goal in diabetes is an HbA1c below 7%. However, this depends on age and other coexisting health conditions. Younger people have lower goals, to help them avoid the complications of having high blood sugar over time.

  • less than 6.5% – young patients
  • less than 7% – general population
  • less than 7.5%-patients
  • less than 8.0%-very sick, elderly or frail patients.

For every drop of 1% in the HbA1c, the risk of diabetic complications reduces by about 30%.

Your aim should be to keep your HbA1c level as low as possible without having frequent blood sugar crashes (hypos). Hypos have their own set of complications and can lead to death. You must avoid very aggressive treatment of diabetes to bring the HbA1c level down to a particular number.

How accurate is the A1c test?

The HbA1c test is not a perfect one. Many things can affect the accuracy of this test one way or another.

Blood disorders:

  • Blood disorders like sickle-cell anaemia and haemolytic anaemia can lead to a very low HbA1c. They are conditions in which the blood cells are destroyed prematurely, so they don’t survive for up to 3 to 4 months. These result in an abnormally low A1c number.
  • Iron deficiency anaemia – In this kind of anaemia, the blood cells live for longer than 3 to 4 months which means that there are more blood cells in circulation at any given time. This leads to a markedly increased HbA1c. The same can be said for any condition where red blood cells live longer than 3 to 4 months.

Diseases of the major organs:

  • Kidney disease can affect HbA1c. 
  • Advanced liver disease can also influence the A1c.

Recent blood loss and recent blood transfusions can also skew the estimated A1c levels. 

Disadvantages of the HbA1c test to monitor progression and treatment of diabetes

Measured HbA1c levels can vary from lab to lab, even using the same blood sample. To make sure you have consistent results, you should get your HbA1c test done at the same lab each time.

Another problem is that anything that tampers with the haemoglobin in the red blood cells over the red blood cells themselves can affect the accuracy of the test.

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Why blood sugar is high in the morning and what you can do about it

Why blood sugar is high in the morning

Why is my blood sugar high in the morning even when I haven’t eaten anything? This is a question you may be asking yourself. Believe me, you are not alone. In diabetes or pre-diabetes it is common to wake up with blood sugar levels higher than the night before.

Fasting blood sugar

The fasting blood sugar (blood glucose) is the most common test used to assess the blood sugar levels. You would usually do this in the morning before breakfast. It is easy to do at home with a personal blood glucose monitor which most people with diabetes have.

You usually check your fasting blood sugar after fasting over night. This means you don’t eat or drink anything except water for at least 8 hours before you do the test.

Naturally you would expect the following pattern. You eat dinner, perhaps you check your blood sugar an hour or two after eating. Then you would fast overnight and check your blood sugar before breakfast.

You would expect your morning fasting blood sugar number to be lower than what you had before you slept.

It doesn’t always work that way!

Much to your frustration, you find that your blood sugar isn’t lower! In fact, it’s even higher. There are a couple of reasons why you may be having this problem. I’ll go through them all and explain what’s happening and what you can do about it.

If you have diabetes, you’ll find it more difficult to regulate the levels of sugar in your blood. In type 1 diabetes the body is not able to produce enough insulin. There is an absolute lack of insulin in the body.

In type 2 diabetes the body produces insulin and initially very large amounts. But the body cannot use the insulin effectively. This is insulin resistance. Insulin is the hormone that helps the body cells to take up sugar from the blood. The cells use this sugar for energy.

Normal blood sugar levels

The main symptom of all types of diabetes mellitus is high blood sugar. Diabetes is diagnosed with a fasting blood sugar over 125mg/dl or a random blood sugar above 200mg/dl. The aim of most diabetic treatment in non-pregnant adults is to maintain a fasting blood sugar within certain levels:

  • between 70 and 130 mg/dl and
  • 2-hour postprandial (2 hours after eating) blood sugar level under 180mg/dl.

In pregnant diabetic women:

  • the fasting blood sugar should not be above 90 mg/dl,
  • the 1 hour postprandial blood sugar should not be above 140mg/dl
  • the 2-hour postprandial blood sugar should be less than 120mg/dl.

The dawn phenomenon (and extended dawn phenomenon)

By far, the most common cause of very high morning fasting blood sugar levels is the dawn phenomenon.

The dawn phenomenon refers to recurring high blood sugar occurring in the early morning before breakfast. Sometimes it may extend into the late morning after breakfast. This is an extended dawn phenomenon.

The body has a circadian rhythm. During this daily cycle the body is programmed to do certain things at certain times of the day. For example in the evening your body starts to wind down. This prepares you to gradually become less active and eventually to go to sleep.

In the early morning, changes take place in your body. These changes prepare you to tackle a day of activity and challenges. This happens in every normal human being.

Insulin secretion goes down in the early hours of the morning. This allows for secretion of insulin antagonist hormones which raise the blood sugar.

Hormones that work to raise the blood sugar

From around 4 a.m. to 8 a.m. the body starts to release certain hormones. They tell it to wake up and be alert. These are the hormones that help you to get out of bed in the morning.

Hormones are chemicals which travel around the body telling different cells and organs what to do. These hormones that are released in the morning include;

  • cortisol which is a stress hormone 
  • growth hormone 
  • glucagon 
  • thyroid hormone
  • adrenaline or epinephrine

Under the influence of these hormones, in the early morning hours the liver starts to break down stored glycogen. This releases glucose into the blood. The liver also increases production of glucose from other sources like stored fat.

This leads to a rise in blood sugar. If you don’t have diabetes the body responds by producing more insulin. So as the blood sugar goes up the insulin levels go up as well. This tells the liver to stop producing and releasing more glucose into the blood. It also tells the cells to take up glucose from the blood.

Some diabetics do not have this response to the early morning rise in blood sugar. The blood sugar continues to go up to abnormal levels. There is no increase in the production of insulin. The liver just keeps producing and dumping in glucose into the blood, even as the blood sugar levels are rising higher and higher.

Who has high blood sugars in the morning?

The dawn phenomenon occurs in both type 1 and type 2 diabetics and can also occur in pre-diabetics.

If you are a type 2 diabetics who have dawn phenomenon you may have problems with your pancreatic beta cells. When the liver is dumping glucose into the blood, the pancreas does not produce insulin. It cannot respond to the high blood sugar levels.

In type 1 diabetics, the dawn phenomenon occurs when the insulin you injected the previous day is not enough to compensate for the early morning rise in blood sugar. This means that:

  • basal insulin injections are too low or
  • the intermediate acting insulin dose injected the night before is not high enough to compensate for the morning rise in blood sugar. The effects of the injected insulin start to wear off at about the same time as the release of the hormones. This raises blood sugar and opposes the effects of insulin.

About 50% of people with type 1 and type 2 diabetes may experience the dawn phenomenon. Recurring morning hyperglycemia (very high blood sugar levels) can cause insulin resistance. This can lead to a worsening of glucose tolerance and make the disease worse.

The Extended Dawn Phenomenon

If the morning glucose remains high until mid-morning you may have the Extended Dawn Phenomenon.  

Possible causes of the extended dawn phenomenon include:

  • eating too many carbohydrates for breakfast and
  • abnormal growth hormone secretion.

Growth hormone is normally released into the blood which raises the blood sugar. The levels gradually come down as the morning progresses. But some people with diabetes have an abnormal pattern of growth hormone production. The growth hormone continues to be produced even when insulin has been secreted which keeps the blood sugar high. 

Insulin

Insulin acts as a kind of gatekeeper to many hormones. Hormones produced early in the morning that contribute to the dawn phenomenon cannot be released in the presence of high insulin levels. So the low insulin requirements during the night allows these hormones to be secreted.

When you eat, the insulin level rises and then comes down again. Seeing as you’re not eating during the night, the pancreas does not produce much insulin. During the night when you’re not eating the insulin level drops quite low. This reduction in insulin allows the other hormones like growth hormone, epinephrine, cortisol and thyroid hormone to be released into the blood. These hormones work as antagonist to insulin. They raise the blood sugar while insulin brings down the blood sugar.

Tests for the dawn phenomenon 

Both the dawn phenomenon and the Somogyi effect can be a reasons why blood sugar is high in the morning. So you need to be able to tell them apart because the treatment for them is different.

There are two ways to do this:

  • Test the blood sugar between 3 and 4 a.m. for several days. In the dawn phenomenon the blood sugar should be normal or high at this time. In the presence of the Somogyi effect the blood sugar will be low.
  • Check the blood sugar levels with a continuous glucose monitor (CGM). This is a small machine that you attach to the skin to detect changes in blood sugar levels throughout the day. A computer processes and interprets the information. This will show whether the blood sugar is low normal or high between 3 and 4 a.m. This helps differentiate between the dawn phenomenon and the Somogyi effect.

Treatment and prevention of the dawn phenomenon

You can bring down high morning blood sugar levels over time in several ways.

Exercise

Engage in some physical activity after your evening meal. Go for a brisk walk or do something you find enjoyable but not too exciting (as this may stop you from falling asleep).

This activates your muscles so that they can take up glucose from the blood. Physical activity after your evening meal actually helps with blood glucose control throughout the whole of the next day. It is something that you should try.

Change what and when you eat

  • Eat a meal that’s high in protein and low in carbohydrates.
  • Have more fish, meat, eggs, chicken etc. with your meals.
  • Eat less starchy foods like pasta and bread. It’s also best to avoid processed and packaged food and to eat natural whole foods as much as possible.
  • Eat dinner earlier in the day. Instead of eating around 8 p.m., eat your dinner before 6 p.m.. You may find this difficult to pull off depending on how and where you work and how you structure your day. It may also not work for you if you have a family and you like to eat dinner together. But it is definitely something you should consider if you can make it work.
  • Take a tablespoon of apple cider vinegar in half a glass of water after your evening meal. It helps to reduce the absorption of carbohydrates into the blood from the intestines.

Medication

  • Increase your morning dose of diabetes medication
  • Switch to an insulin pump and program it to release more insulin in the morning

Why blood sugar is high in the morning – The Somogyi effect

Another way you can describe this is rebound hyperglycemia. This is another reason why blood sugar is high in the morning. The Somogyi effect is named after the doctor who first put forward the idea.

It occurs in type 1 diabetics and only in type 2 diabetics who are on insulin. The Somogyi effect refers to a situation in which there is very low blood sugar during the night followed by high blood sugar in the morning. This is your body trying to save you from the dangers of having a blood sugar that’s too low. In the body’s attempt to raise the blood sugar and prevent the complications of having a very low blood sugar, the blood sugar levels overshoot and become very high in the morning.

Your body tries to keep you alive by producing hormones that raise the blood sugar. These hormones tell the liver to release glucose into the blood. In a diabetic the system does not work efficiently and the liver releases more sugar than the body needs. This leads to a very high blood sugar in the morning.

Signs that you may be having very low blood sugar during the night

Signs that your blood sugar may be dropping very low during the night include:

  • waking up with a headache,
  • sweating profusely during the night,
  • having nightmares.

Why blood sugar is high in the morning – dawn phenomenon vs Somogyi

In both the dawn phenomenon and the Somogyi effect, the main symptom is very high blood sugar in the morning. So it’s important to be able to tell them apart to make sure the right kind of treatment is given. Once again the blood sugar should be measured between 3 and 4 a.m.. If it is very low repeatedly over several night this suggests that you’re suffering from the Somogyi effect.

How to prevent the Somogyi effect

You can prevent the Somogyi effect by making changes to what you eat. You can also adjust your medication.

  • Eat more protein and less carbohydrate with your evening meal.
  • Adjust your insulin regimen with your doctor’s help to make sure that you’re not having too much insulin or to reduce your insulin. Change your dosage to make sure that you don’t have hypoglycemia during the night.
  • Use an insulin pump to administer your insulin. Program it to give you a higher dose of insulin in the morning. 
  • Eat a carbohydrate snack before going to bed.
  • If you exercise in the evening do it earlier in the day.

Problems you may have when blood sugar is persistently high in the morning

You may start experiencing the dawn phenomenon early on when you develop diabetes. If it is not treated it can lead to a worsening of diabetes. It can also increase your chances of developing cardiovascular disease (problems with your heart and blood vessels) and problems with your nerves (neuropathy).