Diabetes may be the health condition for which people who have it can do most to influence its effects. If you have Type 1 or Type 2 diabetes, keeping on top of blood glucose — or blood sugar — levels reduces your risk of short- and long-term complications and improves your quality of life.
Factors in Managing Blood Sugar
— Medication regimen.
— Daily and mealtime finger sticks.
— Stabilizing glucose through diet.
— Exercise/physical activity.
— Weight reduction if needed.
— Periodic hemoglobin AIC testing.
— Continuous glucose monitoring.
— Collaboration with your health care team.
“It’s important for patients to monitor their blood sugar so they’re able to advocate for themselves when discussing their diabetes with their primary care provider,” says Capreia Davis, an educational specialist with the Sentara Virginia Beach General Hospital Diabetes Center team. “Checking your blood sugar gives you the confirmation that what you’re doing — medications, diet, exercise — is working.”
[See: The Best Diets to Prevent and Manage Diabetes.]
Blood Sugar and Health
“We know from both old and new patient studies that good glucose control helps reduce the risk of blindness, kidney disease and painful diabetic neuropathy,” says Dr. Jessica Perini, associate division chief of endocrinology at West Virginia University Medicine and program director for the WVU Medicine endocrine fellowship program. “Long-term glucose control may also help limit some cardiovascular risks.”
On a daily basis, you’ll also feel better if your blood sugars are neither too high (hyperglycemia) nor too low (hypoglycemia), Perini says. Avoiding blood sugar extremes can help stave off these health issues:
High Blood Sugar Effects
— Daytime tiredness: “I explain to patients that the oxygen in their blood is trying to swim through a sea of sugar, so it’s no wonder they’re tired,” Perini says.
— Eye disease, nerve damage, kidney disease, feet problems, bone and joint problems and oral infections are among longer-term complications of hyperglycemia.
Too-Low Blood Sugar Effects
— Confusion, anxiety, heart palpitations, shakiness, and anxiety.
— Hypoglycemic shock. Severe hypoglycemia, or insulin shock can, lead to double vision, loss of consciousness, seizures and coma. It can be fatal if untreated.
— Impaired cognition.
In a long-term study of older adults with Type 2 diabetes, those with a history of severe hypoglycemia had smaller brain volumes on MRI tests, and were more likely to have dementia, according to findings in the April 2018 issue of the journal Diabetologia.
[See: 12 Medical Emergencies You Need to Address Right Away.]
Monitoring Methods
Technologies for measuring blood sugar range from traditional blood glucose meters to advanced insulin pumps and continuous glucose monitors. Work with your doctor and diabetes educator to find the right option for you:
— Glucometer. A blood glucose meter, or glucometer, with finger-sticks is the tried-and-true method for self-monitoring your blood sugar.
— Continuous glucose monitor. A CGM is attached to the skin anywhere from seven to 14 days at a time and can sense sugar levels every few minutes without painful finger-sticks, Perini explains.
Finger-Stick Steps
Here are the basics of monitoring your blood sugar with a blood glucose meter:
— Wash and dry your hands thoroughly.
— Place a disposable test strip into the device.
— Use a sterile lancet on the side of your fingertip to draw a drop of blood.
— Touch the blood drop to the edge of the test strip until the target area fills.
— Check the display for your blood glucose level.
— Log your result.
Steps may vary depending upon the type of glucometer you have and manufacturer instructions. For instance, some devices let you stick areas other than your fingertip, such as the fleshy part of your palm, your forearm or thigh.
“Checking morning fasting levels helps a person know what sugar level they are setting themselves up for as a baseline for the day,” Perini says. “Checking finger-sticks at other times helps people know what effects different types and meals and activities are having on their sugars.”
Insurance typically covers glucometers, but affordable store brands are also available without insurance, Davis notes.
CGM Considerations
CGM devices provide information regarding trends in sugars overnight or during times when you may not have time to do a finger-stick, Perini notes. “The sugar data is then visible to the wearer of the device on their phone and can be available to others as well, such as a parent or caregiver,” she adds. The devices can alarm when blood sugar moves beyond upper or lower limits that you’ve set.
However, “depending on the system and type of diabetes control, it will not replace finger-stick blood glucose monitoring,” Kelly points out. “As a general rule, CGM values can lag behind finger-stick numbers between zero and 15 minutes.”
Whether or not insurance will cover the CGM device is a significant limiting factor, Perini notes.
Glucose-Range Goals
Blood sugar targets guidelines vary by diabetes groups and possibly by your individual situation (like being pregnant).
According to American Diabetes Association guidelines, these are general glucose targets to aim for:
— Fasting: 80 to 130 milligrams/deciliter.
— Two hours after meals: Less than 180 mg/dL.
Some clinicians might use different guidelines. According to the American Association of Clinical Endocrinologists, these are (slightly stricter) glucose targets:
— Fasting: Less than 110 mg/dL.
— Two hours after meals: Less than 140 mg/dL.
“As a rule, we are moving away from ‘control’ and instead focusing on time in (someone’s) specified targets,” says Erin Kelly, clinical manager of educational services at Joslin Diabetes Center in Boston. “Targets can be different by individual depending on age and risk factors.”
About A1C
The hemoglobin A1C is a measure of longer-term glucose control. Specifically, the A1C number indicates your average blood sugar for the previous two to three months. A hemoglobin A1C test requires a blood sample from your vein (as opposed to the finger-sticks you do on your own).
Latest A1C Targets
— Less than 7% (ADA guidelines).
— 6.5% or less (AACE guidelines).
Communicate with your doctor to determine which guidelines to aim for. Your A1C levels and target ranges should be evaluated on an individual basis by your endocrinologist or primary care provider, Davis says.
A1C targets have been evolving, with more variability to better address differences in patient situations, Perini says. “We no longer try to get everyone’s A1C as low as possible, with accommodations given to the elderly, those who can’t sense that they have low sugars and those with significant other comorbidities,” she says.
Dietary Tips
Learning how different foods and meal timing affect your individual blood glucose fluctuations is a complex, ongoing process. Your registered dietitian or diabetes educator can work with you. This is general dietary advice for diabetes:
— Try eating on a consistent schedule, choosing low glycemic-index foods, Kelly advises.
— Eat three balanced meals per day, no more than four to five hours apart, and eliminate sugary beverages, Davis says.
— “If a person can consume roughly similar amounts of carbohydrates at each meal, they can use roughly the same amount of insulin at each meal,” Perini says. Know how to quantify the amount of carbs you take in to help determine your insulin needs.
— Talk to your primary care provider about a referral to an accredited diabetes self-management program or to meet with a certified diabetes care and education specialist for an individual appointment, Davis suggests.
Exercise
Physical activity is important for maintaining a healthy weight and keeping blood sugar under control. Exercising with diabetes does require extra awareness. Keep these pointers in mind:
— Exercise regularly. Walking is a great way to get started, the American Diabetes Association suggests.
— Be physically active for at least 30 minutes most days of the week. Always check with you doctor if you’re new to exercise or starting a new exercise program, Davis says.
— It’s important to check your blood sugar before exercise, Davis adds. Don’t begin exercising if your blood sugar is less than 100 mg/dL.
— Check your blood sugar one to two hours after exercising as the glucose-lowering effect will continue.
— Keep a journal of how your exercise affects your glucose values, Kelly advises. That helps you determine how and when to exercise.
If you have Type 1 diabetes, the ADA recommends the following exercise-related actions:
— Check your blood sugar before, during and after exercise.
— Have a pre-exercise snack if your blood sugar is low or trending downward.
— Always carry a carbohydrate/glucose food or drink.
— If you have an insulin pump, it may help to adjust your basal (minimal) insulin rate during activity.
— Consult your doctor if you have ongoing problems with blood sugar dropping with exercise.
— If your blood sugar is high before exercise, check your blood or urine for ketones. Ketones indicate that your body is breaking down body fat, rather than glucose, for energy. Avoid vigorous activity if you test positive for ketones.
Safety Supplies
Have these supplies on hand for blood sugar fluctuations or emergencies:
— Juice boxes or hard candy.
— Fast-acting glucose tabs, liquids or gels for a hypoglycemic event.
— Diabetes identification such as a necklace, bracelet or ID card.
— Glucagon kit at home and at work or school if you take insulin.
[See: 10 Myths About Diabetes.]
Medications
Finding the right diabetes medication and adjusting as needed are paramount for effective blood sugar control. Your health care provider may prescribe the following types of medications:
— Oral medications such as metformin, sulfonylureas, meglitinides, DPP-4 and SGLT2 inhibitors act on the body to reduce blood sugar in various ways.
— GLP-1 receptor agonists are typically injectable medications to reduce blood sugar in people with Type 2 diabetes. The Food and Drug Administration approved an oral GLP-1 medication in September 2019.
— Insulin is injectable medicine that’s essential for treating Type 1 diabetes and may also be used with Type 2 diabetes. People inject themselves with insulin several times a day, or use an insulin pump that’s attached to the skin.
There are “always” developments in insulin therapy, Kelly notes:
— New insulin pump systems that are smarter and make some decisions for users.
— Newer insulins that work faster or last longer.
— Mobile apps that enable technology to push data through the internet, so fewer devices require actual download to a computer.
“Pumps which continuously provide insulin can be directed to give more, less or no insulin based on glucose data provided by the CGMs,” Perini says. “This takes away from the person the need for constant vigilance that can really weigh on (someone) with diabetes.”
Support Team
When it comes to keeping your blood sugar on target, rely on these health care experts for help:
— Primary care provider.
— Diabetes educator.
— Registered dietitian nutritionist.
— Exercise physiologist.
— School nurse.
Family members and friends can provide meal planning assistance and moral support, act as exercise buddies and serve as watchful eyes for early symptoms of hypo- or hyperglycemia.
“Diabetes health care providers are largely looking for patterns,” Kelly says. “Glucose levels are ever-changing and influenced by many lifestyles factors — stress, illness, sleep, food, exercise, adrenaline (and others). Keeping a log, gathering information and piecing the puzzle together will ultimately lead to a faster and more effective strategy both in terms of lifestyle and medication management.”
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Tips for Monitoring and Controlling Blood Sugar Levels originally appeared on usnews.com
