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When you're diabetic, it sometimes seems as if your blood glucose levels spiral from one extreme to another, hypo or hyper and never finding the mid-ground. Here, we explore why that could be and find out how you can get off the glucose merry-go-round.

Surprising Reason: Stress

When we are stressed, our adrenal glands release the emergency glucose stored in our bodies.

In times of stress, our body activates epinephrine and norepinephrine. Norepinephrine prepares us for fight or flight by preventing blood pressure dropping too-low, but epinephrine works to convert the glycogen (the glucose stored in our muscles and liver) into ready fuel, ready to fight or flee. However, when the stress is emotional or long-term, that system doesn't turn off, leading to blood glucose levels remaining high. Additionally, diabetics are famously bad at turning-off this process once the stress has passed.

If you are stressed, look into meditation, or other forms of relaxation.

Surprising Reason: Weather

Both excessive heat and excessive cold can have an impact on your blood glucose control.

Hot Weather

Spending time outside in high temperatures may increase the risk of dehydration which - as we've already discovered - puts a strain on your body. However, Type 1 Diabetics, or Type 2 Diabetics who use insulin, may be more at risk of hypos, as insulin is absorbed more quickly at the injection site.

Your insulin can also become damaged in the heat, making it less effective. If damaged, it may turn grainy, cloudy or brownish. Store insulin in the fridge and do not use damaged insulin.

Diabetics with neuropathy (nerve damage) may also not notice their feet or limbs burning. Wear a high SPF sun cream, flip-flops (rather than bare feet),  and observe safe time-limits when sitting in the sun.

To keep safe in heat, drink lots of cool water (avoiding alcohol), don't stay in the sun too long, and measure your blood glucose levels more regularly.

Cold Weather

Cold weather also affects blood glucose levels, causing them to rise. As it gets cold and icy, people stay indoors and do less activity which causes a rise in blood sugars. Though some believe it's actually more complex than that.

Some believe diabetes is actually an evolutionary survival mechanism. Sugar is a natural substance that prevents liquid freezing (the scientist Dr. Moalem draws our attention to German ice-wine, a sweet wine made with nearly-frozen grapes; the grapes never fully-freeze, as the sugar content prevents it). But how does this relate to diabetes? Dr. Moalem theorised that, in winter, our prehistoric ancestors produced less insulin so that their blood sugars would rise, preventing them becoming little Neanderthal icicles by the time the thaw set-in.

Fortunately, we're no longer shivering in animal skins every winter. Unfortunately, our pancreas never got the message, and we're still stuck with this little evolutionary quirk.

There's nothing you can do about it, except to wrap-up warm. But it might help to explain why so many diabetics are diagnosed between November and February.

Surprising Reason: Caffeine

The average American consumes 474ml of coffee a day, and 280mg of caffeine. For healthy adults, it appears that drinking up to 400mg of caffeine is safe, and may even prevent diabetes, but the same might not be true for diabetic adults.

For diabetic adults caffeine has a destabilising effect on blood glucose levels, raising them in some people and lowering them in others. As little as 200mg of caffeine (or just two-and-a-half short Starbucks Cappuccinos per day) can have this effect.

If your blood glucose levels are unstable, try cutting your caffeine consumption.

Surprising Reason: Pain or Illness

Just like stress, when we're in pain or ill our bodies release hormones (such as cortisol, and adrenaline). These hormones fight against insulin, causing your blood glucose levels to rise.

Continue to take all anti-diabetes medications. Even if you don't feel like eating much, take small 15g portions of carbohydrate every hour such as dry toast, rice pudding, fruit juice or regular soda (full-sugar, not diet), and applesauce. Be sure to drink regularly, as dehydration makes hyperglycaemia worse.

If you have a fever, your blood glucose readings are consistently 250mg/dL (13.9mmol/L) while ill, or you have vomiting or diarrhoea for 24 hours or more (sooner if you are becoming dehydrated) seek medical advice.

Go straight to your local emergency department if you have the following signs: abdominal pain, "fruity" breath, nausea and/or vomiting, weakness, rapid breathing, confusion, or unconsciousness. These are signs of ketoacidosis. Ketoacidosis kills.

Surprising Reason: Physical Activity

Okay, not so surprising, because this is where we came in. It's widely known that the amount of physical activity you do will affect your blood glucose levels, but did you know it will effect them for up to 48 hours?

However, exercise is not always good for your blood glucose levels. You should not exercise if your blood glucose levels are higher than 250 mg/dL (13.9 mmol/L in the UK) as exercising temporarily raises your blood glucose levels. Blood glucose levels in this range may indicate that your insulin is not controlling your sugars. Test your urine for ketones, if possible. If not possible, seek advice of a doctor before you exercise. Exercising while ketones are present may lead to ketoacidosis, a dangerous complication that must be immediately treated.

Do not exercise, too, if your glucose levels are below 100 mg/dL (5.6 mmol/L). Instead, eat between 15 and 30g of carbohydrate first: oatcakes, 2 rice cakes, or a small banana are all good choices. Once you start, stop immediately and test your blood glucose levels if you feel dizzy, unwell, or develop a headache.

Always consult a doctor before starting a new exercise programme.

Better blood glucose testing

If your readings are always alarmingly high, make sure they're actually accurate.

Many people forget to wash their hands before taking a reading, and when they get a high reading, it can be quite a jolt. This often happens when people are in a hurry. One Dutch study told participants to touch a piece of fruit before testing their blood glucose levels; 88% of the readings read at least 10% higher than they actually were. So, remember to wash your hands.

Make sure, too, that you clean the machine and use a clean lancet for each blood glucose testing. Modern machines are very sensitive to interference and a smear of old blood may mean that you don't get an accurate reading. You probably do all this, but some people don't.

But the most important thing is to test regularly. Knowing your blood glucose levels can help you keep track of all possible problems , so you can control them as best you can with your support team, helping to prevent complications in the future.

That way, you can go out there, knowing you're in the best shape possible to enjoy life.

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