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Control Your Blood Sugar

Glycemic Control Is Your Ultimate Goal

The aim of diabetes treatment is to help you avoid serious complications and avoid or relieve diabetes-related symptoms. To do this, you need to bring your blood glucose level within the normal range and keep it there. This is called maintaining glycemic control.

You will probably have to monitor your blood glucose level regularly, perhaps every day or even several times a day, because blood sugar levels vary, especially before and after meals.

To determine your degree of glycemic control, your doctor will use the hemoglobin A1C test. According to the American Diabetes Association, ideal levels should be:

A1C less than 7%
Blood glucose (before meal): 70 to 130 mg/dL
Blood glucose (1 to 2 hours after meal): less than 180 mg/dL

The A1C test measures control over a longer period of time. Here's how it works:

The average life span of a red blood cell is about 120 days
Glucose attaches (binds) to the hemoglobin of your red blood cells
The more glucose you have in your blood over time, the more your hemoglobin becomes glycated (bound by glucose)
By measuring the percentage your hemoglobin that is glycated, your doctor can get a sense of your average blood glucose level over the previous 120 days

A lucky minority of people with diabetes can achieve and maintain glycemic control with diet, exercise, and stress management alone. Others require one or more prescription drugs to keep blood glucose levels in check.

Major Types of Diabetes Medications

Type of Drug	Effect(s) of Drug	Common Side Effects
DPP-4 inhibitor	Helps the pancreas make more insulin after a meal when blood sugar level is elevated	Upper respiratory infection, stuffy nose, sore throat, headache, diarrhea
Glitazone (GLIT-tah-zone) also known as thiazolidi- nedione (thigh-ah-zo-le-deen DIE-own) or TZD	Increases sensitivity of fat and muscle cells to the action of insulin; preserves the ability of the pancreas to make insulin	Weight gain
Glitinide (GLIT-tin-ide)	Helps the pancreas make more insulin	Hypoglycemia (low blood sugar) if taken without a meal
Glucosidase inhibitor (GLU-co-sid-ace)	Slows down carbohydrate digestion to slow down the release of glucose into the blood	Excess intestinal gas, bloating, flatulence
Incretin mimetic (in-KREE-tin)	Helps the pancreas make more insulin after a meal when blood sugar level is elevated; slows the emptying of the stomach; suppresses appetite	Nausea, gastrointestinal disturbances, hypoglycemia
Insulin (IN-suh-lyn)	Improves glucose uptake in tissues	Hypoglycemia, weight gain.
Metformin (met-FOR-min) Metformin is the only drug of its class (biguanides) on the market.	Slows the release of glucose from the liver and increases sensitivity of muscle cells to the action of insulin	Nausea, diarrhea, and stomach cramps
Sulfonylurea (sul-fo nil-you-REE-ah)	Helps the pancreas make more insulin	Hypoglycemia; if you don't eat regularly through the day, weight gain

Insulin Therapy

Most people with diabetes will eventually need to take insulin to help keep blood sugar levels under control, even if they were once able to control their diabetes by eating healthy foods, exercising, and taking oral diabetes medications. That is because diabetes is a progressive disease, which means that, over time, the pancreas becomes less and less able to produce enough insulin to meet the body’s needs. If your healthcare provider prescribed insulin to you to help control your blood sugar, it does not mean that you failed to control your diabetes through diet, exercise, and other medications.

Many people are anxious about needing to take insulin every day to keep their blood sugar levels in a normal range, especially because it is injected with a needle. While that’s understandable, it is very important to realize that insulin therapy helps prevent serious damage your kidneys, eyes, and nerves that can be caused by unchecked high blood sugar.

If you are nervous about starting insulin therapy or have a hard time taking it exactly as prescribed by your healthcare provider, there are many resources available to help you with this important part of your diabetes treatment. A certified diabetes educator can help you with strategies to make insulin injections more comfortable for you, your healthcare provider can prescribe insulin that comes in prefilled pens with thin needles, and Web sites like www.diabetesselfmanagement.com can provide easy-to-understand information on insulin and tips for staying on track with your scheduled insulin injections.

Self-Monitoring of Blood Glucose (SMBG)

SMBG is just what it sounds like: you check your own blood glucose levels using a tiny sample of your blood and a device about the size of a cell phone. Although it takes practice to master, anyone can do it.

Generally, a person who has just been diagnosed with type 2 diabetes will be asked to monitor blood glucose level at least twice a day—perhaps once in the morning and one other time during the day. You and your healthcare provider will decide on the schedule that makes sense for you.

It’s very important that you write down each result of your monitoring to create what’s called a blood glucose log. This log will help you recognize patterns in your blood glucose levels. Your healthcare provider will also use the log to make adjustments or additions to your diabetes drug regimen, and your dietitian can use it to help you adjust your diet. As you become skilled at managing your diabetes, your doctor may even allow you to use your glucose log to make your own adjustments to your diet, medication, and exercise.

Checking your own blood sugar can be very motivating. If you want proof that physical activity lowers your blood sugar, compare your blood glucose levels immediately before and immediately after 30 minutes of moderate exercise. And when you make healthy changes to your diet, like cutting calories or limiting starch, check your blood glucose levels before and after eating to see what effect those changes have on your blood sugar.

Special Risks: Smoking, Lipids, and Blood Pressure

All smokers should quit. We should all bring our cholesterol levels in line with the recommended norms. And everyone should keep blood pressure below 130/80. But for people with diabetes, these issues are especially important.

Smoking
Smoking increases the risk of vascular (vein and artery) disease in people with diabetes. It also increases the risk of death in people with diabetes and is linked to insulin resistance. Quitting is one of the most difficult things a person can attempt, but if you are a smoker, your doctor may be able to offer you medications that will help. Your diabetes educator can also help you design a plan that includes external support and reinforcement.

Lipids
Cardiovascular issues take on added importance in diabetes. When a person with diabetes passes away, it is usually related to a heart attack, a stroke, or other consequences related to these cardiovascular events.

High levels of LDL cholesterol (“bad cholesterol”) and triglycerides, along with low levels of HDL cholesterol (“good cholesterol”) increase your risk of cardiovascular disease.
On the other hand, HDL cholesterol helps dispose of fat. The best thing you can do to keep your LDL cholesterol level down is to limit your intake of saturated fat—mainly fats from animal products such as meat, milk, cheese, and ice cream. Instead, you should choose non-fat or low-fat dairy products and eat only lean meats.

Recommended lipid targets for adults with diabetes: