Keeping Blood Glucose on Track

Reviewed and updated by Di Bush, PhD, Jan 1. 2014

Over the past several years, we have gained a much better grasp of the relationship between blood sugar and diabetic complications. Two research trials in the 1990’s though showed that blood sugar control can prevent diabetes-related health issues such as eye disease, kidney problems, nerve damage and heart disease. This research has helped health care providers to set healthy ranges of blood sugar levels for diabetics to use as targets to avoid complications.

Type 1 Diabetes

The first trial, The Diabetes Control and Complications Trial (DCCT), lasted almost ten years and enrolled people with Type 1 Diabetes to receive either standard therapy or intense therapy. Intense therapy was given with the hope of keeping blood sugar levels as close to normal as possible by giving three to four doses of insulin daily. The intense therapy group had an average A1C of 7.2% compared to the 9% A1C of those in the standard therapy group.

On average, the blood sugar in the intense therapy group was 150 mg/dL (milligram per deciliter) compared to 230 mg/dl for the standard group. For those patients that had near normal blood sugars in the intense therapy group, their risk of onset of diabetic complications was reduced by 34 to 76 percent.

The result of the DCCT study was that for patients with Type 1 Diabetes, blood sugars that are as close to normal as possible (average HbA1c of 7.2%, average blood sugar value of 150 mg/dl) would help to reduce the chances of onset of diabetic complications.

Type 2 Diabetes

After the DCCT, the question still remained, “Did tight blood sugar control prevent complications with patients with type 2 diabetes?” A large trial in England, called the United Kingdom Prospective Diabetes Study (UKPDS) was performed to answer this question. The study followed more than 5,200 people with newly-onset type 2 diabetes for about ten years.

There was an intense therapy group and a standard therapy group, with patients in the intense therapy group having an A1c of 7.0% and patients in the standard therapy group having an A1c of 8.0%. Patients in the intense therapy group showed slower onset of diabetic eye disease and diabetic kidney disease, and lowered their risk of having a heart attack. This study showed that near normal blood sugar levels reduced the chance of small and large vessel disease in patients with type 2 diabetes.

What should be taken from the two trials?

As a result of these two landmark trials, the American Diabetes Association (ADA) has emphasized that the targets for HbA1c and blood sugars should be as close to normal as possible.

Is your blood sugar tightly controlled?

Treatment for patients with type 1 and 2 diabetes needs to focus on meal planning, staying active, and using diabetes medication or insulin to reach your target blood sugar goal. Your health care team will prescribe the right diabetic medication or insulin for you.

In checking your blood sugars, if you note a pattern of blood sugars greater than 120 mg/dl in the morning or at bedtime, you should contact your health care provider to talk about what you could do to lower your blood sugar levels. Changing your medicine dosage, changing your lifestyle or increasing insulin may be needed to reach your blood sugar goals.  Your blood sugar goals should be set by your healthcare team since very tightly controlled blood sugar may not be right for those with a grave illness. Be sure to check your glucose level and visit your doctor often to ensure that you are on target with your diabetes health goals.

Questions for your doctor

When you visit your doctor, you may want to ask:

  • Am I a candidate for intense therapy?

  • What should my blood glucose levels be to stay healthy?

  • Can I be referred to a diabetes educator to teach me how to monitor my blood sugars?

  • How should I eat?

  • How often should I stay active to control my blood sugars?

  • Do changes in my medications need to be made to better control my blood sugars?

Conclusion

Blood glucose control has become a fine art with new medications and forms of insulin now able to make it easy for diabetics to achieve near normal blood sugars. New research confirmed that blood sugar control will reduce the risk of onset of diabetes complications such as heart, kidney, and eye disease. Therefore, if you know your goals and know your numbers, you can work with your health care provider to make your diabetes health goals come true.

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Constance Brown-Riggs, MSEd, RD, CDE, CDN—an award-winning RD, certified diabetes educator, and past national spokesperson for the Academy of Nutrition and Dietetics, is the author of The African American Guide to Living Well With Diabetes, which received the Favorably Reviewed designation from the American Association of Diabetes Educators, and Eating Soulfully and Healthfully with Diabetes.

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Maureen Sullivan – RN, CDE has worked for many years as a Registered Nurse, most of them in emergency and trauma services. She is a Certified Emergency Nurse, Certified Diabetes Educator, and the former manager of a hospital stroke program. Maureen’s wealth of knowledge, passion for nursing and education, and ability to engage people makes her an excellent teacher and a captivating lecturer. Recently, Maureen has been concentrating on writing, speaking and teaching, as well as working on her award-winning weekly podcast, “The Health and Humor Show.”

Lauren Harris-Pincus, MS, RDN is a nutrition communications specialist, registered dietitian in private practice, social media consultant, speaker, spokesperson and corporate consultant. She is currently the owner of Nutrition Starring YOU, LLC and www.NutritionStarringYOU.com. Lauren strongly believes that we should “Think Healthy, not Skinny”, and “EveryBODY is unique, your diet should be too”. Lauren was co-host of the Family Food Experts Kitchen radio show, available for listening on iHeart Radio and iTunes. Also known as one of the “NutritionBabes”, Lauren co-founded NutritionBabes.com, a popular Health and Wellness website in 2009. NutritionBabes.com was voted one of Healthline’s Top 100 Health Blogs in 2011, 2012 and 2013.

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Katie Ferraro, MPH, RD, CDE is a nationally-recognized registered dietitian, certified diabetes educator and author with an expertise in nutrition communications and curriculum development. She is the co-author of “Diet Therapy in Advanced Practice Nursing” (McGraw Hill, 2014) and an Assistant Clinical Professor of Nutrition at the University of California San Francisco and University of San Diego’s graduate schools of nursing.

Dr. Beverly S. Adler, PhD, CDE (aka “Dr. Bev”) is a clinical psychologist and certified diabetes educator, author and speaker. She specializes treating the emotional issues of people with diabetes. In her private practice, she provides individual, family and/or group therapy utilizing a cognitive behavior therapy orientation, combined with a spiritual approach. Her goal is to empower her patients to manage their diabetes.

Dr. Bev is the author of two self-help diabetes books. She has written numerous articles which are published in print and online – always focused on diabetes from the emotional perspective. She also speaks to audiences of people living with diabetes, as well as, to audiences of healthcare professionals and diabetes educators. Dr. Bev, herself, has been living successfully with type 1 diabetes for 40+ years.

In August 2016, Dr. Bev was honored to receive the “CDE Entrepreneur of the Year” Award from her Metropolitan NY Association of Diabetes Educators.

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OmnichannelHealth Media, publisher of DiabetesDigest.com, does not provide medical advice, diagnosis or treatment. See additional information.