4 Key Factors of Diabetes Management

Combining several strategies for managing diabetes can prevent long-term complications.

man taking glucose test

Updated on March 22, 2024.

A good diabetes management plan can improve your overall health and help prevent some of the common—and potentially serious—complications from diabetes. These include heart disease, kidney disease, vision problems that can lead to blindness, and foot problems that can increase the risk for amputation (removal of a part of the body such as a toe or foot, often requiring surgery).

The ABCs of diabetes management

When you have diabetes, you should closely monitor three key areas: blood sugar levels and HbA1C, blood pressure, and cholesterol. These are sometimes referred to as the ABCs of diabetes management. Monitoring these can also help you make lifestyle changes to improve your diabetes control. 

Here's what to know about these three areas.

Blood sugar levels

It’s important to check your blood sugar levels on an ongoing basis. If you are taking insulin, monitoring your blood sugar levels is important to lower your Hgb A1C (a measure of your average blood sugar levels over the previous three months). Even if you are not on insulin, monitoring them may help you adjust your diet, exercise, and medications. 

According to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), the recommended blood sugar levels are 80 to 130 mg/dL before a meal and less than 180 mg/dL two hours after you started a meal. When your blood sugar level drops below 70 mg/dL, you may experience hypoglycemia (low blood sugar). Alternately, if your blood sugar goes above 200 mg/dL, you may experience hyperglycemia (high blood sugar). Both conditions can be dangerous. Your healthcare provider (HCP) will tell you how many times per day you should check your blood sugar levels.

An A1C test (also called hemoglobin A1C, HbA1c, or glycohemoglobin test) measures the percentage of your red blood cells that have sugar-coated hemoglobin. Hemoglobin is the protein that carries oxygen in red blood cells. A1C tells you how well you are managing your diabetes over time.

Keeping your A1C below 6.5 to 7 percent is crucial for preventing or slowing the progression of diabetes-related complications for most people, says Darria Long Gillespie, MD, clinical assistant professor at the University of Tennessee Health Science Center. There may be different goals for people with cognitive impairment (difficulty thinking, remembering, or making decisions), who have more than one chronic illness, or who are dependent on others for day-to-day functioning.

Insulin and oral diabetes medications can help you control your blood sugar when diet and lifestyle changes are not enough. In fact, long-acting types of insulin, alone or in combination, may help maintain blood sugar at a more steady level for longer lengths of time.

Blood pressure

Blood pressure measures the force at which blood pushes on blood vessel walls. Too much pressure can damage arteries and raise your risk for heart disease. It can also cause kidney and eye disease.

Both the American Diabetes Association and the American Heart Association have released updated guidelines for blood pressure control, lowering the level at which medications should be considered for people without diabetes to 130/80 mm Hg. “People with diabetes must treat blood pressure even more aggressively than people who don’t have diabetes,” says Dr. Gillespie. “So, if your blood pressure is above this level, it’s very important to have a discussion with your physician about the best treatment.”

Cholesterol

Blood tests can measure your levels of cholesterol and triglycerides (fat-like substances in the blood). One type of cholesterol (high-density lipoproteins, or HDL ,"good" cholesterol) is good for your heart health, while too much low-density lipoproteins (LDL, "bad" cholesterol) and triglycerides can raise your risk for heart disease.

Cholesterol control is very important for people with diabetes, which increases your risk for heart disease. Those over age 40 are typically put on a higher dose of cholesterol-lowering medication. People between ages 20 and 39 who have additional heart disease risk factors may be given a higher dosage as well.

You can help raise HDL and lower LDL by eating a heart-healthy diet, maintaining a healthy weight for you, and getting regular physical activity as you are able. If these efforts are not enough, you may need medications to help reach your cholesterol level goals.

Making lifestyle changes

Following a healthy lifestyle can help you manage your diabetes and reduce your risk for many other health problems, even those not related to diabetes, such as cancer. 

"When it comes to diet and diabetes, limiting foods with high sugar, highly processed foods, and trans and saturated fats [which are solid at room temperature, like butter] are crucial for helping maintain blood sugar control and preventing complications,” says Gillespie. Healthy food choices include fresh fruits and vegetables, beans, whole grains, lean protein like chicken and fish, and low- or non-fat dairy.

“Getting regular physical activity helps to lower your blood pressure, maintain good control over your blood sugar, and facilitates weight loss,” Gillespie says. (Being overweight or obese can increase your risk for diabetes and heart disease.) “Aim for at least 30 minutes of exercise most days. You can even break it into smaller increments throughout the day.”

Smoking raises your blood pressure and cholesterol and damages your blood vessels. Quitting smoking is one of the best things you can do to help you manage diabetes and improve your overall health. There are plenty of scientifically proven ways to quit smoking, including using effective smoking cessation aids and medication. If you smoke, talk to your HCP about which strategies for quitting are available to you or may be covered by your insurance.

A Diabetes Record Form will help you to keep track of your ABCs. Ask your HCP for a form or download one online and bring your filled-out document to each appointment.

Article sources open article sources

Centers for Disease Control and Prevention. Diabetes: Steps to Help You Stay Healthy With Diabetes. Last reviewed November 3, 2022.
Centers for Disease Control and Prevention. Diabetes: All About Your A1C. Last reviewed September 30, 2022.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes. Last reviewed December 2016.
American Diabetes Association. Diabetes and High Blood Pressure. Accessed January 12, 2023.
American Heart Association. Understanding Blood Pressure Readings. Accessed January 12, 2023.
American College of Cardiology. 2018 Guideline on the Management of Blood Cholesterol. Updated June 2019.
American Heart Association. Living Healthy With Diabetes. Accessed January 12, 2023.
Centers for Disease Control and Prevention. Diabetes: Living Well With Diabetes. Page last reviewed June 20, 2022.
Centers for Disease Control and Prevention. Diabetes: Living With Diabetes. Page last reviewed March 9, 2022.
ElSayed NA, Aleppo G, et al. Older Adults – Standards of Care in Diabetes - 2023. Diabetes Care 2023; 46 (Supplement_1):S216–S229.
ElSayed NA, Aleppo G, et al. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023. Diabetes Care 2023; 46 (Supplement_1):S216–S229.

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