It's no big secret that there's plenty to feel down about when it comes to living with diabetes, unfortunately. But airing and sharing your concerns can be empowering, rather than facing them all alone. So today at our weekly diabetes advice column Ask D'Mine, veteran type 1 and diabetes educator Wil Dubois does what he can to address some cries for help that have come our way.Ask-DMine_button

This is the first of two parts, so be sure to stay tuned for next week's follow-up column.

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Cassi, pre-diabetic from California, writes: I have been posting all over the place trying get someone to answer a few questions for me. I have just been diagnosed with "pre-diabetes." After much research, I am monitoring my food intake and my blood sugar. I'm terrified of suffering from the side effects associated with the mismanagement of diabetes. I am also a multiple amputee. I got the flesh-eating bacteria 15 years ago and lost my right leg below the knee, 1/2 of my left foot and all my fingers but my left thumb. I am struggling. I do not want to lose anything else. I've spoken to my doc but he wasn't any help. So here I am. I am having trouble getting blood for testing. I have tried the palm and the inner forearm. I have only one finger to prick. My other "digits" are just too short (I've tried). I changed the setting on my lancet....turning it up to the highest setting and still no luck....and man my palms and forearms hurt. So does my only thumb. I need alternative sites for testing. (I did a Google search and found lots of conflicting info). Second question, I eat the same thing each day for breakfast (at the same time) but 2 hours after the meal my blood sugar can vary widely. Here are some test scores on consecutive days:

Before Breakfast: 95 / 2hrs after meal: 122

Before Breakfast: 80 / 2hrs after meal: 143

Before Breakfast: 83 / 2hrs after meal: 121

Before Breakfast: 97 / 2hrs after meal: 114

Before Breakfast: 98 / 2hrs after meal: 138

I measure exactly so I know it's the same each day. Why would today (138) be so much higher than yesterday (114)? I am new to all this....any help will be appreciated. (BTW: my doctor has been NO help!)

Wil@Ask D'Mine answers: Wow, what a horrible experience. Both the whole flesh-eating thing, and the way your pre-diabetes diagnosis was handled. I'm so glad you found us, and I think we can help you out. I honestly have no idea why good info on diabetes is so hard to find; it's not like diabetes is a secret society or anything.

But it probably comes from the fact that no two people are the same and the disease affects all of us a little bit differently. Or from the fact that none of the big doctors' outfits can even agree on blood sugar targets, much less treatment approaches. But still, you're having a hard time getting answers to the most basic of diabetes questions, and that's horrible! Let me tackle the question on those numbers first, then we'll get into the whole where-the-hell-to-get-a-blood-drop-from problem, and then I want to talk about your terror.

Your fasting numbers, the ones before the meal, are enviable, especially for someone with pre-diabetes. Your highest after-meal reading is Missing The Targetpretty much right at our tightest set of guidelines for blood sugar targets, the ones advocated for by the conservative American Association of Clinical Endocrinologists (AACE). The take-home message here? By controlling your meals you've already achieved a level of control that takes most people a medicine cabinet full of goodies to achieve. In fact, all the numbers you are seeing are the same types of numbers we see in people without pre-diabetes at all. So good for you!

But why are those numbers so vexingly variable? Because you're a human being, Cassi. You're not a machine. Look, blood sugar is never the same. Just like blood pressure, your body strives to keep sugar in a general range, but there will always be variation. On top of that, there's more to blood sugar than just food. Dozens, if not hundreds of other things can cause variation in blood sugar from day to day, hour to hour, minute to minute.

As you are a girl, you have a monthly ebb and flow of hormones that will affect your blood sugar. As you have survived a catastrophic illness and have just been diagnosed with a chronic progressive illness on top of it, you are suffering stress (I can so feel it in your words that I'm confident diagnosing you with stress without even meeting you). Stress releases hormones that drive blood sugar upwards, so if you are under more stress one morning than another, your BG level will be higher after the stressed-out breakfast. Pain can cause fluctuations in blood sugar. Sleep patterns can cause fluctuations in blood sugar. Hell, even changes in barometric pressure can cause fluctuations in blood sugar!

Basically, life causes your blood sugar to wander. But that's OK, Cassi, because you're only human.

So even though you're eating the same thing every day, it's more than just the breakfast that's driving the after-breakfast blood sugar numbers. That said, I'm worried about your breakfast. I understand why you're eating the same thing daily: You're trying to understand what's going on in your body. But you can't eat the same breakfast every day for the rest of your life! If you do, you'll die of boredom long before the diabetes will get a chance to do you in.

Now back to your variable numbers in the morning, there's also another major factor to consider, and that's the machine you are using to harshly judge your humanity by. That machine isn't as accurate as you think it is. Most blood sugar testing machines in the USA are only accurate to plus-or-minus 15%, and some are probably worse. Let's see what that means for your personal numbers. I added up your after meal numbers and averaged them:

122 + 143 + 121 + 114 + 138 = (638 ÷ 5) = 127.6

(If you weren't good at math before, now that you've joined the diabetes family, you're about to become a pro. We use a lot of math.)

For simplicity's sake, let's round that average off to 128. If your blood sugar were really, honest-to-God 128, what would your meter actually read? Well, if it's typical, it will feed you numbers plus-or-minus 15% of the Gospel Truth. In this case, as low as 109 and as high as 147. Actually, if you tested one big ol' drop of blood with five strips, you'd likely get readings ranging between 109 and 147, BloodGlucoseTargetsmuch less when you test different drops of blood on different days.

Why do we put up with crap equipment like this? Actually, we don't. We're fighting for change. But in the meantime, it's better than what we had in the past, which was peeing on a strip to see what the glucose in the blood had been hours before; or peeing on an anthill, which is what we did before the more high-tech pee strips came along.

Anyway, I hope that clarifies the numbers for you. You numbers look great (I'm jealous) and the variability you are seeing day-to-day is normal, normal, normal. Some of it could be from your gear, but likely most of it is just from the fact that variable blood sugar is normal blood sugar.

Just like no two people with diabetes (or pre-diabetes) are alike, neither are any two days for the same person alike. We just have to embrace that chaos and move forward!


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

* Stay tuned for our column next week, in which Wil gives Cassi some tips to help her extract blood for testing, and addresses her terror issues.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.