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4 Key Factors of Diabetes Management

A multi-pronged approach to managing diabetes can prevent long-term complications.

Diabetes is a chronic, life-long disease that patients must deal with on a daily, weekly and yearly basis. A good diabetes management plan can improve your overall health and help prevent some of the common—and potentially serious—complications from diabetes, including heart disease, kidney failure, blindness and amputation.

What gets measured gets managed
Surely, you’ve heard this proverb (or cliche, depending on your point of view) that says when you monitor something, you pay attention to it and therefore change it in a good way. For example, when you weigh yourself often, you tend to be more likely to lose weight. If you record your blood sugar levels, you’re more likely to associate what you do, or what you eat, with how it affects your blood glucose and adjust accordingly.

When you have diabetes, you should closely monitor four key areas: blood glucose, blood pressure, cholesterol and lifestyle. These are sometimes referred to as the A, B, Cs of diabetes management. Let’s look at each of these more closely.

Blood glucose levels. It’s important to measure your blood glucose on an on-going basis. According to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), the recommended blood glucose 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 glucose level drops below 70 mg/dL, you may experience hypoglycemia (low blood sugar) and, alternately, if your blood sugar spikes above 200 mg/dL, you may experience hyperglycemia. Both conditions can be dangerous. Your doctor will tell you how many times per day you should check your blood glucose levels.

Your average three-month rolling blood glucose level is determined using an A1c test (also called hemoglobin A1c, HbA1c or glycohemoglobin test). It’s a measurement, reported as a percentage, of the ratio of blood glucose to 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,” says Darria Long Gillespie, MD, senior vice president of Clinical Strategy at Sharecare.

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 patients maintain more even blood glucose levels for longer stretches.

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

Historically, patients were encouraged to keep their blood pressure below 140/90 mm Hg. That has recently changed. “People with diabetes should be aware that the American Heart Association released new guidelines for blood pressure control, lowering the level to consider medical treatment for people without diabetes to 130/80 mm Hg,” says Dr. Gillespie. “People with diabetes must treat blood pressure even more aggressively than people who don’t have diabetes. 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 cholesterol and triglyceride (fat) levels. One type of cholesterol (high-density lipoproteins, or HDL) is good for your heart health, while too much low-density lipoproteins (LDL) and triglycerides can raise your risk for heart disease.

“Given the elevated risk of heart disease in people with diabetes, many people with diabetes over age 40 will need to be put on a cholesterol-lowering medication, since having diabetes means you need to control your cholesterol even more carefully.” Dr. Gillespie says. You can help raise HDL and lower LDL by eating a nutritious diet, maintaining a healthy weight and getting regular physical activity. If these efforts are not enough, you may need medications to help you achieve safe cholesterol levels.

Lifestyle. 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. Let’s start with diet. “When it comes to diet and diabetes, limiting foods with high sugar, highly processed foods and trans and saturated fats are crucial for helping maintain blood sugar control and preventing complications,” says Dr. Gillespie. Good food choices include fresh fruits and vegetables, beans, whole grains, lean poultry, fish and low- or non-fat dairy.

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

Finally, you know smoking is bad for you in so many ways. It raises your blood pressure and cholesterol and hurts 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 effective smoking cessation aids. If you smoke, talk to your doctor about strategies for quitting.

A Diabetes Record Form will help you to keep track of your A, B, Cs. Ask your doctor for a form or download one online and bring your filled-out document to each doctor’s appointment.

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