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Tight Blood Glucose Control

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Updated December 12, 2011

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Tight Blood Glucose Control

Tight control over your glucose is a matter of balancing insulin, food and exercise.

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How tight control of your blood sugar can improve your health:

Everyone with type 1 diabetes would like to maintain his or her blood sugar levels in a "normal" range most of the time. But to do this you have to practice what is called "tight control" of your blood glucose. While there are many potential benefits of tight control, it involves a lot of deliberate effort and isn’t an approach every person will find appealing. Let’s take a closer look at what’s involved.

What does it mean to have tight control of glucose?

Tight control of glucose means that you are trying to maintain your blood sugar levels in a range that would be considered close to normal for a person who does not have diabetes. That translates to blood glucose levels between 70 and 130 mg/dl before meals and less than 180 two hours after starting a meal. It also means that you aim for an A1c test result of less than 7%.

In reality, it is not practical to assume that you can always keep your blood sugar in that range. Even those with the most vigilant diabetes management habits experience fluctuations in their glucose levels from time to time. The goal of tight control is to create a management routine that attempts to keep your blood sugar in that range most of the time.

What are the potential benefits of tight control?

Reliable research has shown that people who practice tight control of their glucose levels experience fewer diabetes-related health complications than those who don’t practice tight control. The most definitive study on this subject to date, called the Diabetes Control and Complications Trial (DCCT), showed that those who practiced tight control experienced significantly fewer diabetes-related:

Of those who participated in the study, but already had one or more of these complications, many found that tight control kept their condition from getting worse.

In addition to preventing or delaying the onset of health complications, tight control can also help you feel better, have more energy and provide more flexibility in your daily activities.

What does tight control require me to do?

Tight control of your blood sugar usually requires you to change your diabetes management routine; sometimes significantly. Specifically, you must:
  • Create an insulin routine that mimics a healthy pancreas. This means that you must give yourself multiple injections of fast-acting insulin at mealtimes throughout the day and intermediate or long-acting insulin at bedtime. You can also use an insulin pump to accomplish the same effect. This routine is often referred to as intensive insulin therapy.

  • Test your blood glucose more often. Whether you manually inject your insulin or use an insulin pump, you will need to test your blood glucose several times each day. This includes before every injection and perhaps two to three hours after eating to monitor blood sugar fluctuations.

  • Be attentive to your diet and exercise. Food intake raises your blood sugar, and exercise will lower it. You must be mindful of how much activity you have, what you are eating and how much, and how it might affect your blood sugar levels.

  • Maintain contact with your healthcare team. A routine of tight control inevitably raises new questions that you will need answers to, such as: how to manage sick days, problematic glucose readings and insulin dosage changes in unusual circumstances, among others.

What are the potential challenges that could result from tight control?

Aside from the inconvenience of more insulin injections and glucose checks, you might also experience:
  • Low blood sugar reactions (hypoglycemia). Trying to maintain your blood sugar in a more narrow range can result in periodic low blood sugar. Because of this tendency, it is particularly important to check your blood sugar frequently, especially before driving.

  • Weight gain. Because you are taking more frequent doses of insulin, there is a tendency for you to gain additional weight. The average amount of weight gain experienced by the participants of the DCCT study was 10 pounds.

  • Cost of supplies. More injections and glucose checks mean that you are using more syringes, insulin and glucose meter test strips.

Finally, it is very important that you not attempt to start tight glucose control without first working out a plan of action with your diabetes healthcare team. They can help you establish the insulin routine, number of daily glucose checks, dietary plan and exercise limitations that will best suit your needs.

Sources:

American Diabetes Association. "Tight Diabetes Control.”

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