'But doctor I feel perfectly fine even though you say my sugars are running high. In fact I feel really lousy when they are within normal range. So this must be normal for my body'

I cannot tell you how many times I have heard that statement or a semblance thereof. No doubt one of the things I emphasize to all my patients is the importance of keeping their sugar levels within target range.

According to the American Diabetes Association, the target blood sugar range should be between 70-130 mg/dL for fasting blood glucose (3.9-7.2 mmol/L). And after meals it should be less than 180 mg/dL (10 mmol/L).

Some people with type 2 diabetes begin to act like they have hypoglycemia at the target range. In other words their body tricks them into feeling bad with all the symptoms of hypoglycemia. They eat to counteract the feelings. And their blood sugars rise outside of target range.

Eventually, this leads to poorly controlled diabetes. When the blood sugars remain outside of the target range then this can lead to complications.

So why do some people with diabetes feel 'bad' when their sugars are really within the target blood sugar range?

I like to explain it this way:

Everybody has a set thermostat so to speak. This thermostat is set to a range for each person.

For instance, as you may notice, the normal fasting sugar levels for a non-diabetic is a range 70-99 mg/dL. So as long as the sugar levels are in that range then it is normal.

This set level is called homeostasis. Everyone has a set level that his or her body systems function at.

When type 2 diabetes sets in, one of the first things that happens is that the body attempts to reset the thermostat. So that it can continue to function at a normal level. Instead of functioning with blood sugars between 70-99 mg/dL, the body makes an attempt to function at a higher blood sugar level.

By the time the symptoms of diabetes set in, the blood sugar levels are usually well over 180 mg/dL.

This is why it is important to screen for diabetes early.

So now we have 'a reset thermostat'. Think about it like an air-conditioning system. If the thermostat is set at 73 degrees then the system does not come on until the temperature rises above 73 degrees. And then it cools the room down till it is below 73 degrees and then turns off.

In the case of a diabetic, the 'blood sugar thermostat' has been reset to a higher level. Say over 180 mg/dL.

Now here comes an ambitious healthcare provider. Our goal is to get the blood sugar levels down to the target range. Because from research, we know that when we achieve this goal, the complications of diabetes are reduced.

However, as the blood sugars begin to go down with treatment, the body sends out alarm signals. These alarm signals feel just like hypoglycemia. Hypoglycemia is a very scary feeling for a type 2 diabetic. Once they experience it once, most diabetics will usually do everything they can to avoid experiencing again.

So how can you bring your blood sugars levels down to target range without feeling lousy?

Here are some tips to discuss with your healthcare provider. Remember open communication leads to better results.

    * If you are experiencing this issue make sure you follow up with your doctor.
    * Discuss about possibly bringing the sugars down slowly. This way their 'thermostat' resets itself slowly without sending out those alarm signals.
    * If you feel that your blood sugars are dropping low, check the levels first before eating. Most times the blood levels are still outside of range.
    * Do not to skip a meal. Try to eat smaller more frequent meals.

Remember that your goal is to maintain your blood sugar levels within the target range. This requires that you are committed to your health. And also that you are willing to ask questions.

By Eno A. Nsima-Obot, MD