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A physician-patient’s perspective on lowering glycemic variability–Part III: the role of lifestyle

Elsamma Chacko* & Christine Signore

A physician with type 2 diabetes for 19 years and impaired awareness of hypoglycemia sought to lower the hypoglycemia risk with the help of continuous glucose monitoring. The idea was to optimize the medications-meals-exercise triad. When the patient adopted a personalized low carb, balanced meal plan, glargine insulin dose came down from 36 units to 18. The meal plan called for eating every 2-4 hours. Also, more carbohydrate ingestion during early part of the day lowered glycemic variability. Insulin dose came down further to 7 units when a third medication, dulaglutide, was added to metformin and insulin. In the course of this lifestyle modification the patient made a remarkable observation: although four glycogen depleting exercises, followed by a brief walk offered comparable immediate glycemia benefits, the effect extending significantly to the next day was seen only with the split exercise (pre-breakfast+ post-breakfast walk). Several exercise combinations were identified for lowering glycemic variability. Weight, HbA1c and lipids have been moving in the right direction with the new lifestyle.