1. Check Your Blood Sugar When You Wake Up
Measuring “your sugars when you first wake up, when you haven’t eaten for a span of time, gives you your baseline,” says Joseph Monye, MD, an endocrinologist with Kaiser Permanente in Maryland. “You’re then able to better track your diet and overall day, and how it affects your blood sugar.”
To get a fasting blood sugar reading, test your blood sugar when you first wake up before you eat breakfast. Like any other time you test your blood sugar, clean your hands thoroughly before pricking your finger, and keep track of your results. Talk to your doctor about your blood sugar readings if you have questions.
2. Review Your Nighttime CGM Data
“The ritual should be taking a look at your overnight CGM data each morning,” says Dr. Kohlenberg. Even if you wake up in your target range, you may be experiencing overnight low or high blood sugars that otherwise go unnoticed.
Kohlenberg says that it’s helpful to consider if a pattern is emerging over several days, such as consistent hyperglycemia. “That would suggest that your basal dose needs adjustment,” he says. The same data can help you learn whether a higher fasting blood sugar is the result of dawn phenomenon or a rebound from an overnight low blood sugar, both of which may require a different solution.
3. Take Insulin Before Every Meal and Snack
Taking your insulin before you eat — not during or after — could really help you keep your blood sugar in range in the hours after a meal or snack.
Try taking your rapid-acting insulin about 15 minutes before eating to allow it to do a better job of matching and counteracting the glucose rise that results from eating carbohydrates.
It takes some discipline to pre-bolus regularly. To get into the habit of dosing insulin before eating, Kohlenberg recommends tying the practice to something concrete. “Let’s say you’re at home, and you’re setting the dinner table. That would be a good time to take your mealtime insulin,” he says.
And don’t ever skip your mealtime insulin doses. Kohlenberg says one of the most impactful daily rituals is dosing insulin for all carbohydrate intake, including snacks. “Missed doses of rapid-acting insulin are a major cause of high blood sugar,” he says.
For people with type 1 diabetes, “taking insulin can be cumbersome to a certain degree, but maintaining a daily regimen of making sure you take your insulin with your meals is important,” says Dr. Monye.
4. Double-Check Your Tech
Every day, make sure that your CGM and insulin pump are working properly. “Sensors can fall off, infusion sets can kink, and batteries can die,” says Kohlenberg. He suggests checking the battery life of your management devices daily.
Kohlenberg also recommends doing a quick visual check of your CGM site every day. Is the CGM still adhered correctly? Is the skin around the site irritated? Meanwhile, people using insulin pumps should make sure that insulin delivery is occurring and should check the insulin reservoir level on the pump, he says.
Finally, Kohlenberg says to keep track of when you need to change infusion sites or CGMs, and to do so according to the recommended schedule.
5. Evaluate Your Foot Health
If you have diabetes, you may have vulnerable feet. Elevated blood sugar levels cause nerve and blood vessel damage that especially affects your feet and toes, causing a loss of sensation and a higher risk of injury or infection.
“Chronic diabetes, especially when it’s uncontrolled, starts to affect different end organs and nerves, so sensitivity in the feet diminishes, making it easier to sustain cuts and all sorts of wounds,” says Monye.
Connecting this foot inspection to an existing daily practice can help make it easier to remember: “I recommend tying this check to something you already do daily, like stepping out of the shower,” says Kohlenberg.
6. Take a Postprandial Stroll
Having trouble with high blood sugar after meals? A 10-minute postmeal stroll can help tame those spikes.
A gentle walk can actually remove excess sugar from your bloodstream. Kohlenberg says that the movement “can be helpful to reduce the postmeal glucose rise, because with exercise, the muscles take up blood sugar.”
If you’d like to develop an after-meal walking routine, going for a postdinner stroll may be a good place to start. “We tend to have our heaviest meal at dinner,” says Monye. “You want to kick back and relax after a long day, but that’s when you really need to move.”
7. Rotate Your Injection or Infusion Sites
Type 1 diabetes means repeatedly sticking your skin with needles or pump infusion sets. It’s important to avoid using the same injection site every time, as it can increase your risk for lipohypotrophy, or fat buildup under the skin.
“Injecting insulin or delivering insulin into an area with lipohypertrophy results in reduced or erratic insulin absorption,” says Kohlenberg. “Lipohypertrophy is associated with increased glucose variability.”
Several areas of the body can serve as effective insulin injection sites, including the abdomen, under the triceps, and the thighs, says Monye. You can also rotate within the same area, such as using slightly different locations across the abdomen. Try using a chart to keep track of where you’ve injected insulin recently so you know you’re mixing up your site locations frequently enough to avoid lipohypertrophy.
How to Build a Ritual Routine That Sticks
It can take time to build routines that consistently help you manage type 1 diabetes. “Take things in small parts,” says Monye, starting with something simple you can change and slowly replacing less healthy behaviors with more helpful ones.
“I recommend trying to anchor new habits to existing ones,” says Kohlenberg. “For example, if you keep glucose tabs in the same drawer as your car keys, then it can become a ritual to grab them on your way out of the house.”
A major indicator that a daily ritual practice is working well is improving blood sugar control. “The hemoglobin A1C test is the main way that doctors check your average blood glucose level over time,” says Smithson. “Monitoring the amount of time that your blood glucose stays in range with a CGM can reveal how well your routine is working.”
As you work to build your new routines and habits, be patient with yourself. “It’s also important to forgive yourself when you miss a day,” says Kohlenberg. “Consistency over months matters more than perfection over a week.”
The Takeaway
- Consistent daily habits and rituals for managing type 1 diabetes can help stabilize physical health and reduce the mental strain of constant decision-making.
- Kick off your morning by checking your blood sugar when you wake up, as it will give you a baseline for making good decisions throughout your day.
- New rituals, like taking insulin when you set the dining table, double-checking your devices before you leave the house, and taking a walk after dinner, can help improve your short- and long-term blood sugar control.
- To help your new rituals stick, try linking them with things you already do every day.
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