Managing Diabetes: A Balancing Act
While chronically high glucose levels are the hallmark of diabetes, blood sugars that dip too low are also a hazard of the disease, particularly for people living with type 1 diabetes. Hypoglycemia, or a low blood sugar level, is dangerous because the brain requires glucose to function properly. The most common triggers for a “hypo” include the following:
An imbalance of food and insulin, such as when too much insulin is administered for the amount of carbohydrates eaten
Certain type 2 oral medications
Exercise without sufficient carb intake in individuals taking insulin and certain oral medications
Excess alcohol intake without food in individuals taking insulin and certain oral medications
Some people who take insulin also experience overnight dips in blood glucose levels.
A normal, non-fasting blood glucose reading is between 60 and 140 mg/dl (or 3.3 to 7.8 mmol/l). A casual (i.e., any time of day) plasma glucose reading of 200 mg/dl (11.1 mmol/l) or higher, a fasting plasma glucose reading of 126 mg/dl (7.0 mmol/l) or higher, or an oral glucose tolerance test with a two-hour post-load value of 200 mg/dl (11.1 mmol/l) or higher are high readings that may indicate diabetes.
Controlling Blood Glucose
The ultimate goal of management of any type of diabetes mellitus is to bring blood glucose to a level that is as close to normal as possible as consistently as possible. The American Diabetes Association (ADA) suggests adults with diabetes try to achieve blood glucose levels of 70 to 130 mg/dl (milligrams per deciliter) or 3.9 to 7.2 mmol/l (millimoles per liter) before meals, and less than 180 mg/dl (10.0 mmol/l) one to two hours after eating (i.e., postprandial).
The American Academy of Clinical Endocrinologists (AACE) suggests slightly different goals of less than 110 mg/dl (6.1 mmol/l) for a fasting blood glucose level and less than 140 mg/dl (7.7 mmol/l) two hours after meals.
It's important to remember, however, that each patient has unique blood glucose treatment targets. Those who are particularly susceptible to episodes of hypoglycemia may have a slightly higher goal than those who aren't, while women who are trying to bring their glucose levels down as part of a preconception plan for pregnancy may have a lower target (i.e., need tighter control). Everyone is different, and your doctor will need to work with you to figure out what goals are right for you.
How do you bring blood sugars down to a controlled range? Each person will have his or her own unique treatment plan, but the main tools at your disposal are diet, exercise, and medication. People with type 1 diabetes require insulin therapy. Those with type 2 diabetes can sometimes control their disease with a combination of dietary regulation and exercise, and often they require medication. No matter what your type of diabetes, proper nutrition and exercise should be a cornerstone of both disease management and healthy living.