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Tight glucose control


Shoot for these sugar levels
Shoot for these sugar levels

The American Diabetes Association recommends that people with diabetes keep their blood glucose at these levels:

Before meals90 mg/dL to 130 mg/dLAfter mealsless than 180 mg/dLA1c levelbelow 7 percent

Your healthcare provider may recommend slightly different targets for you.


The sour signs of sugar
The sour signs of sugar

Signs of high blood sugar levels include blurry vision, fatigue, excessive thirst and hunger, weight loss and frequent urination—although early-stage diabetes may produce no symptoms at all.

Stabilizing your blood sugar can either prevent or eliminate these symptoms and prolong your life.


Not-so-sweet complications
Not-so-sweet complications

If you have diabetes, being careless about managing your blood sugar levels puts you at risk for these complications:

  • high cholesterol, high blood pressure, atherosclerosis, heart disease and stroke
  • retinopathy, which can lead to blindness
  • nephrology (kidney disease), which can lead to kidney failure and death
  • neuropathy (nerve damage), particularly in the feet, which can result in amputation
  • peripheral arterial disease, which occurs when leg arteries become clogged by plaque and can lead to amputation
  • erectile dysfunction
  • gum disease and tooth loss

Rebecca, one of the nearly 20.8 million Americans who have diabetes, has a mantra: “Blindness, dialysis, amputation. I remind myself that that’s what I have to look forward to if I don’t control my blood sugar. I repeat it whenever I’m staring at a luscious-looking birthday cake.”

Unfortunately, not every person with diabetes is as diligent as Rebecca, who eats well, exercises daily and regularly checks her blood sugar. Studies show that one in five people with the disease has poor blood sugar control. But if you have diabetes and want to avoid further health problems (see “Not-so-sweet complications”), keeping blood glucose levels in a healthy range is critical. And it may not mean always giving up birthday cake.

With discipline and determination, you can manage your blood sugar with a diabetes care plan that includes these steps:

  • Eat a well-balanced, low-fat diet. Work with your healthcare provider, a registered dietitian or a diabetes educator to plan a meal schedule that includes foods and portion sizes that promote stable blood sugar.
  • Exercise regularly. Along with keeping blood sugar levels steady, regular exercise helps control your blood pressure and prevent heart disease and stroke. Exercise also helps you shed pounds, which alone can lower your glucose levels to normal.
  • Take your diabetes medication as directed. Check to see how other medicines, vitamins or herbal supplements you’re taking may affect your diabetes medication.
  • Get your blood sugar levels tested. You can use a blood glucose monitor to draw and test a drop of your blood from your finger, hand, forearm or thigh. Different types of meters are available, including some with memory and others with easy-to-read displays for people with poor eyesight.

At least twice a year, get an A1c blood test, which gives you a reading of your average blood sugar level over the past two to three months.

Another option—a continuous glucose monitoring system—features a small sensor implanted under your abdominal skin that can identify dangerously low or high blood sugar levels not caught by A1c tests or a blood glucose monitor. You download results to be analyzed onto a computer.

Tight glucose control

According to the American Diabetes Association, keeping “tight control” of your blood sugar levels means staying as close as possible to a normal (nondiabetic) blood glucose level. The goal is to prevent health complications. A long-term study of more than 1,400 people showed that people with type 1 diabetes who practiced tight control, compared with people using standard diabetes treatment, were less likely to develop eye, kidney and nerve damage. Later reports revealed tight control also lowers atherosclerosis, heart attack and stroke risks.

While tight glucose control can help you feel more energetic, it takes discipline and can lead to episodes of low blood sugar and, if you take insulin, weight gain. People who don’t take insulin—such as people with type 2 diabetes—can achieve tight control by strictly adhering to the diet, exercise regimen, medication schedule and regular blood sugar tests recommended by their doctors.

Tight glucose control is not for everyone. Children, older adults and people who already have severe diabetes complications such as vision loss, heart disease or end-stage kidney disease should not attempt tight glucose control.

Maybe the most important part of controlling your blood sugar is getting help when you need it. Keeping track of your blood sugar levels lets you and your doctor know whether your diabetes care plan is working. If it isn’t, and your blood sugar levels are high, don’t be frustrated—ask for guidance to bring your levels into a healthy range.