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Keeping Blood Sugar in Check

The words "blood" and "sugar" are a single phrase for millions of Americans: "blood sugar."

The official term is glucose, and keeping it within a certain range occupies the minds of people with diabetes daily sometimes even hourly.

People with diabetes either do not produce insulin, do not produce enough insulin, or have an increased need for insulin because their bodies' cells don't use the insulin efficiently. Insulin is necessary for the cells to use sugar from food as fuel. Insulin allows sugar carried by the blood to enter cells. Without sufficient insulin, the sugar stays in the blood and the level of blood sugar rises, the cells don't have energy for normal activities, and, over time, damage can occur to heart, kidneys, eyes, blood vessels, and nerves.

Keeping blood sugar levels within a prescribed range reduces the risk of long-term complications of diabetes. This can be achieved by most people with diabetes through diet, exercise, drug therapy, and close monitoring, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The diseases

Both type 1 and type 2 diabetes require regular monitoring of blood sugar, careful attention to diet and exercise, and usually medication.

Type 1 diabetes was once commonly known as juvenile diabetes because it usually develops in children and adolescents. It is an autoimmune disease in which a person's body attacks its own cells, destroying the beta cells of the islets of the pancreas. These are the cells that produce insulin. With type 1 diabetes, these cells are unable to produce insulin. Type 1 diabetes requires that a person take insulin in the form of shots.

Type 1 diabetes makes up only a small percentage of the people with diagnosed diabetes. Type 1 is more common among whites than nonwhites; some northern European countries have high rates of type 1. The reason for this difference is not known. 

Type 2 diabetes was commonly known as adult onset diabetes. It is more common than type 1. Most people diagnosed with diabetes have type 2.

In type 2, the body either fails to make enough insulin or it does not properly use the insulin it makes. 

The majority of people with type 2 are overweight or obese. Scores of medical studies have linked prolonged obesity with the development of type 2 diabetes. People with type 2 diabetes often have elevated blood pressure and high levels of blood lipids (cholesterol). As more children and teenagers become overweight, type 2 diabetes is becoming more common in young people.

Genetics play a very important role in type 2 diabetes. People with a family history or of certain races (African-Americans, Asians, Hispanics, Pacific Islanders, and American Indians) are more predisposed to develop type 2 diabetes.  

'Tight' control of blood sugar

Chronically high blood glucose levels can cause damage to some internal organs and tissues. Diabetes is associated with long-term complications that affect almost every part of the body. If diabetes is not managed adequately, it can lead to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. The overall goal of treatment is to keep blood sugar levels as close to normal range as is safely possible to prevent these complications.

Diet, exercise, and regular measurement of blood glucose levels are important for tight control. If insulin is part of the treatment plan, insulin doses may have to be adjusted daily depending on blood glucose levels. If oral diabetes medication is part of the plan, a health care provider may alter doses depending on home blood glucose levels taken over a period of time, or if symptoms of too low a blood sugar (hypoglycemia) or too high a blood sugar (hyperglycemia) occur.

People with diabetes can check their blood sugar levels at home using blood glucose monitors, small computerized machines that analyze a small drop of blood usually obtained from a prick of the finger. The American Diabetes Association (ADA) recommends blood glucose levels be checked at home for anyone:

  • Taking insulin or diabetes pills

  • On intensive insulin therapy

  • Having a hard time controlling blood glucose levels

  • Having severe low blood glucose levels or ketones from high blood glucose levels

  • Having low blood glucose levels without the usual warning signs

Home monitoring can be done as often as needed. Some common schedules are several times a day (usually for people with type 1); or once a day or even once a week (usually for people with type 2); or when the person with diabetes is ill (illness can affect blood sugar levels dramatically). Different schedules or a combination of these may be prescribed by a health care provider.

At routine office visits, health care providers can check the average blood sugar level for the past 3 months by doing a hemoglobin A1C test. This test is analyzed in a laboratory and may require a tube of blood drawn from a vein.

A few disadvantages of tight glucose control are an increased risk of hypoglycemia (low blood sugar) and some weight gain, according to a study by the NIDDK. But the long-term benefits outweigh the short-term complications, says NIDDK. People with diabetes often get hypoglycemic because of too much insulin, too much diabetes medication, not eating adequately, unplanned physical activity, or a combination of factors, such as not eating enough before exercise.

Diet

Although people with diabetes should monitor their diets, the approach for a person with type 1 diabetes is different than the approach for a person with type 2.

People with type 1 diabetes should coordinate their diets with their insulin regimen. The goal is to match how much insulin they take to how much insulin they need, which is largely determined by meal size and content. Thus, it is important for a person with type 1 to understand the impact of specific foods on glucose levels.

Previously, people with type 1 diabetes had to plan meals around when they took their insulin, but the emphasis now is on tailoring shots around eating habits. Frequent monitoring of blood sugar allows people with this type of diabetes to adjust their insulin dose to match glucose levels and make corrections if necessary. Regular eating patterns are needed to maintain tight control in some insulin plans.

People who are overweight or obese are more prone to develop type 2 diabetes. A person with this type of diabetes should reduce his or her calorie, fat, and salt intake, and increase his or her physical activity and exercise. Even modest weight loss (5 to 10 pounds) may lower blood sugar levels to a range where medications become unnecessary.

People with diabetes should consult with a dietitian about proper diet.

People with diabetes can also use the diabetes food pyramid, which consists of 6 sections for food groups. Eat some foods from each group each day. The number of servings you should have each day from these 6 groups varies depending on your goals, and caloric and nutrition needs.

Fats, sweets, and alcohol do not have to be eliminated from the diet of a person with diabetes, but they must be consumed in moderation. If a diabetic drinks alcohol, he or she must also be careful since alcohol intake can lead to abrupt swings in blood sugar levels. 

People with diabetes who have frequent hypoglycemia should carry around sweets to counteract hypoglycemia if their glucose starts to drop, according to the ADA. Fruit juice, raisins, candy, or a glass of milk can work as well as fast-acting glucose tablets at raising sugar levels within about 10 to 15 minutes.

Exercise

Exercise lowers glucose levels and boosts the body's sensitivity to insulin, countering the insulin resistance common in type 2 diabetes.

Even though people with either type of diabetes benefit from exercise, people with type 2 diabetes typically experience a number of benefits because of their disease's relationship to obesity. Exercise consumes glucose and forces cells to draw on the glucose stored in the liver and muscles.

Because both insulin and exercise metabolize blood sugar, people with diabetes taking insulin should be careful because it may cause hypoglycemia. Often, insulin doses may have to be adjusted. 

Some oral medications for type 2 diabetes can also cause blood sugar to drop too low during exercise. Check with your doctor about your medications' effects with exercise.

Generally, people with diabetes should spend at least 30 minutes doing aerobic exercise three or four times a week. The best times are usually 1 to 3 hours after eating, when blood sugar levels are highest. Anyone with diabetes should talk to his or her doctor before beginning or changing an exercise regimen.

Latest drugs

Treatment options for diabetes have "exploded" recently. Most new drugs are for type 2 diabetes only.  

According to the ADA, in addition to sulfonylureas, drugs that have been around since the 1950s, new classes of oral medication offer different courses of action, depending on a person's needs:

  • Biguanides. These drugs decrease the amount of glucose produced and released by the liver. Metformin is a biguanide. These often cause diarrhea, nausea, and vomiting. 

  • Thiazolidinediones. These drugs help insulin increase the use of glucose by muscle and fat, and reduce the amount of glucose produced and released by the liver. Pioglitazone and Rosiglitazone are drugs that belong in this group. These often cause fluid retention, weight gain, heart failure, and osteoporosis. 

  • Alpha-glucosidase inhibitors. These drugs work by blocking the breakdown of starches in the intestine so the body does not absorb them into the blood.

  • Meglitinides. These drugs stimulate the pancreas to release insulin.

  • DPP-4 inhibitors. DDP-4 inhibitors prevent breakdown of a naturally occurring hormone, which stimulates insulin release in the blood if the sugar levels are elevated. 

  • Sodium-glucose cotransporter 2 (SGLT-2) inhibitors. SGLT-2 inhibitors reduce blood glucose by increasing glucose loss in urine. The use of this medication is associated with increased urinary and genital infections. 

  • Oral combination therapy. Since the drugs can have different effects, combinations of the medications are sometimes used. For example, a biguanide and a sulfonylurea may be combined. Drug combinations can be helpful in situations where one drug is not providing enough blood glucose control. 

Two injectable medications are also available for people with diabetes. Pramlintide is approved for use with insulin to treat both type 1 and type 2 diabetes. Pramlintide often causes nausea and vomiting. It can cause serious hypoglycemia when used in people with type 1 diabetes. It's a form of a hormone normally produced in the beta cells that helps to maintain blood sugar levels. Exenatide and liraglutide are also approved to treat type 2 diabetes. These drugs lower blood glucose by increasing the secretion of insulin if sugar level is elevated. These drugs often cause nausea and vomiting. Other side effects of these drugs are still being investigated.

Other treatments for diabetes include alternative methods of delivering insulin, such as insulin pens, insulin analogues, and insulin pumps.  

Talk with your doctor if you have questions about the new medications that might be right for you.

Online Medical Reviewer: Grantham, Paula, RN, BSN
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Last Review Date: 2/4/2014
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