for travel case options.)
Irregular Sleep
Sleeping isn’t just something we do to pass the time at night and during afternoon history classes.
Sleep is also a powerful regulator of appetite, energy use, and weight.
Lack of sleep can cause an increase in stress hormone production, which may result in elevated blood sugar levels.
It also tends to increase appetite and can lead to insulin resistance and weight gain, particularly when normal sleep hours are spent in a sedentary state (watching TV, and so on).
Conversely, if normal sleep hours are spent working or engaging in physical activity, blood sugars can run lower than usual.
The Adjustment: Be prepared to increase your basal and bolus insulin doses if you are having difficulty sleeping, particularly if you are sleeping less than six hours per night. However, if you are forced (or choose) to work late into the night, you may need to reduce basal insulin temporarily by 20 to 40 percent or have periodic snacks to prevent hypoglycemia.
Just about everyone benefits from maintaining a fairly consistent sleep/wake schedule.
If you are having difficulty maintaining a normal sleep pattern, you may benefit from avoiding caffeine, naps, and nighttime exercise (although daytime exercise can be beneficial).
Have a comfortable sleep area that you only use for sleeping.
Engaging in a relaxing activity thirty minutes prior to bedtime can also help.
In some cases, sleep disturbances can be attributed to stress, sleep apnea, or an underlying illness.
If this is the case, your physician may be able to prescribe appropriate medication or refer you to a sleep center for counseling.
Menopause
Natural menopause is caused by reduced estrogen production by the ovaries. Surgical menopause occurs when the ovaries are removed, resulting in a sudden decrease in estrogen. Weight gain often accompanies menopause. Hot flashes, mood swings, and fatigue may occur as levels of estrogen ebb and flow. Because estrogen makes the body more sensitive to insulin, blood sugar control during menopause can become more challenging.
The Adjustment: Many report more frequent and severe low blood sugars during early menopause, especially during the night.
Most find that in the later stages, as estrogen levels decrease permanently, their bodies are more resistant to insulin and that they require higher insulin doses.
However, changes in blood sugar levels during menopause are varied and highly individualized.
I would hesitate to make permanent changes to your program until a pattern of high or low readings is established over a period of several consecutive days.
Since the effectiveness of both basal and bolus insulin are influenced by estrogen levels, all doses (basal, I:C ratios, correction doses) should be adjusted upward or downward when a pattern of highs or lows is present several days in a row.
Sports and Exercise
As discussed in the previous chapter, blood sugar levels usually fall during exercise. However, experiencing a blood sugar
rise with high-intensity and short-duration exercise and competitive sports is also common. This is caused by a surge of adrenaline that counteracts the effects of insulin and stimulates the liver to release extra glucose into the bloodstream. That’s why a two-hour practice or training session can produce a significant blood sugar drop, while a two-hour competition can produce a rise.
Exercises that often produce a short-term blood sugar rise include
• weight lifting, particularly when using high weight and low reps
• sports that involve intermittent bursts of activity, like baseball, cricket, or golf
• sprints in events such as running, swimming, rowing, or skating
• activities that are being judged, such as gymnastics or figure skating
• sports where winning is the primary objective
• almost any form of exercise performed in the early morning
Ironically, the same high-intensity, strenuous sports that produce a short-term blood sugar rise can also produce a delayed blood sugar drop several hours after the activity (as was discussed earlier in this chapter).
Adjustments for Sports and Exercise
Given that sports performance hinges on having adequate control of one’s blood sugar, it is essential that everyone who exercises or competes in sports makes sound adjustments. We discussed prevention of hypoglycemia through mealtime insulin adjustment in