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 their body's cells don't use the insulin produced 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 close monitoring, diet, exercise, and drug therapy, 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 that destroys the beta islet cells of the pancreas. These are the cells that produce insulin. Type 1 diabetes requires that a person take insulin in the form of shots and makes up only about 5 to 10 percent 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. Ninety to 95 percent of 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.

Race also plays a role in type 2 diabetes, which is more common among African-Americans, Asians, Hispanics, Pacific Islanders, and American Indians than whites.

'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. The disease often leads 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 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). 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 three months by doing a hemoglobin A1C test. This test is analyzed in a laboratory and requires a tube of blood drawn from a vein.

A few disadvantages of tight glucose control are a slightly 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, or a combination of other 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.

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 six sections for food groups. Eat some foods from each group each day. The number of servings you should have each day from these six 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 can 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 should be careful with insulin administration too close to exercise, because it may cause a hypoglycemic reaction.

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 one to three 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.

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.
Thiazolidinediones. These drugs help insulin increase the absorption of glucose in muscle and fat, and reduce the amount of glucose produced and released by the liver.
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. DPP-inhibitors increase insulin production by preventing the breakdown of a substance that is naturally made in the body. DDP-4 inhibitors allow this substance to remain active longer in the blood helping to decrease blood sugar levels when they are elevated.
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 to treat both type 1 and type 2 diabetes. It's a form of a hormone normally produced in the beta cells that helps to maintain blood sugar levels. Exenatide is also approved to treat type 2 diabetes. It lowers blood glucose by increasing the secretion of insulin.

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