Individuals with diabetes should control their blood sugars. This has been shown with certainty in the last few years with the publication of two important studies
looking at the long-term care of diabetes. Not only does good control of sugar allow the person to function better in the short term, but there are long-term benefits. The
Diabetes Control and Complication Trial (DCCT) looked at the benefits for type 1 diabetes and the United Kingdom Prospective Diabetes Study (UKPDS) looked at type 2 diabetes.
Good control with an average blood sugar of 150 mg/dl versus 210 mg/dl decreased complications (eye, kidney, and nerve) for the type 1 diabetic individual by 54-63%,
on the average, over nine years. For type2 diabetes good control with an average blood sugar of 180 mg/dl versus 210 mg/dl decreased complications by 17-33% over
fifteen years. These two studies have been the key in changing attitudes about the need for an aggressive approach for diabetes care.
It is important that people with diabetes try to obtain these goals, or better to insure that everything be done to prevent the complications. Therefore, acquiring all the information about self-care of diabetes is important for the patient. Once
individuals are educated about the problem they can become an active part of the health care team. It is in this manner that the long-term problems can be prevented.
Not only controlling blood sugar, but also understanding all of the other issues that may contribute to the complications is important. Recommendations by the American Diabetes Association are listed below:
Recommendations for Glycemic Control*
| Biochemical Index | Normal | Goal | Additional Action Suggested |
| Average fasting/premeal glucose (mg/dl) | <110 | 80-120 | <80 or >140 |
| Average bedtime glucose (mg/dl)** | <120 | 100-140 | <100 or >160 |
| Glycated hemoglobin (HbA1c)(%) | <6 | <7 | >8 |
*Non-pregnant adults **Measurement of capillary blood glucose
Lipid and Blood Pressure Goals (for non-pregnant adults)
| Blood Pressure | Lipids (mg/dl) |
| Systolic <130 | Cholesterol <200 |
| Diastolic <85 | LDL-C < 100 |
| HDL-C > 45 (men) and > 55 (women) | |
| Triglycerides < 200 |
Key Tests/Exams
| Test/Exam | Frequency |
| Glycated hemoglobin (HbA1c) |
|
| Dilated eye exam | Yearly |
| Comprehensive foot exam | At least yearly (more often if needed) |
| Lipid profile | Yearly (less frequently if normal) |
| Urinalysis for protein | Yearly |
| Microalbumin measurement | Yearly if urinalysis is negative for protein |
| Blood pressure | Each regular diabetes visit |
| Weight | Each regular diabetes visit |
Nutritional Goals
| Provide regular meal planning advice and guidelines | < 10% of calories from saturated fat |
| Balance food intake with drug therapy and exercise | < 10% of calories from polyunsaturated fat |
| Maintain reasonable weight by monitoring calorie consumption | 60% to 70% of calories from monounsaturated fat and carbohydrate |
| 10 % to 20% of calories from protein | < 300 mg cholesterol per day |
Other measures such as taking 81-325 mg of enteric coated aspirin to prevent cardiovascular disease is recommended. Pneumococcal vaccine (to prevent common types of pneumonia) should be administered as indicated as well as a yearly influenza vaccine. Of course, smoking is not good for the individual with diabetes as it aggravate the complications of diabetes.
Recognizing that there are many things individuals with diabetes can do to influence their health is important. Be familiar with all the issues that can contribute to the complications and take charge of your health.
For more information about these issues and others regarding diabetes call
1-800-DIABETES or visit the American Diabetes Association website.
