Tight Diabetes Control

Keeping your glucose levels as close to normal as possible can help prevent or slow some of the complications associated with type 2 diabetes. Many studies show that good control can lower the risk of complications such as eye and kidney disease as well as nerve damage.  To be considered for tight diabetes control, you must:

  • Maintain a blood glucose level between 70 and 110-130 mg/dL before meals.
  • Have a glucose reading of less than 140-180 mg/dL two hours after meals.
  • Keep your glycated hemoglobin (A1c) level at or less than 6.5-7 percent.

However, tight control is not for everyone. It does carry some risks and involves hard work, and the benefits may not outweigh the risks or work it requires.

An important note: If you would like to pursue tight diabetes control, it is imperative that you work with your health care team. Your goals should be set with their assistance, as your personal healthy history may affect whether you are a good candidate for keeping tight control of your blood sugar.

How do you practice tight diabetes control?

Tight diabetes control requires that you do the following:

  • Pay closer attention to your diet and exercise.
  • Measure your blood glucose levels more frequently.
  • Take pills or insulin injections if diet and exercise alone do not control your blood glucose.
  • Alter insulin injection schedules to respond to changes in your glucose levels.

How do you start?

Your diabetes care team will set a guideline for how much exercise you should get, how many calories you should eat in a day, if or how you should adjust your diabetes medications, and how often you should test your blood, etc. These guidelines will likely change frequently as you work to find a plan that best suits your lifestyle and gives you the results you’re aiming for. 

Insulin Involvement

People with type 1 diabetes will need to manage their blood sugar levels with multiple daily injections, or by using an insulin pump, if they want to achieve tight blood sugar control.  For people with type 2 diabetes, if diet and exercise alone are not adequate in controlling your blood glucose levels, your doctor may suggest that you begin using insulin injections or other diabetes medications.

For people with type 2 diabetes, the decision to begin using insulin depends on how well your diabetes is controlled by diet and exercise, how closely you plan to monitor and control your diabetes, and how frequently you may need injections.

What is the long-term plan?

Starting a program of tight diabetes control can be overwhelming, but the promise of a healthier, longer life may make the work and anxiety worth it. Here are some ways to keep from burning out.

Make Realistic Goals

Your blood glucose readings will not always be perfect. Make adjustments based on the management plan you worked out with your doctor and healthcare team. If your numbers are consistently too high or too low, however, make an appointment to see your doctor and re-evaluate your plan. 

Don’t Be in a Hurry

Implementing all the components of a tight diabetes control plan at one time may be overwhelming or hard to maintain.. To prevent that, start with one element, such as checking your blood glucose more often, and add the other components later.

Be Honest

You are the primary leader of your diabetes team, so you need to make sure that you choose what works best for you.  The only person you hurt if you lie about how well your program is going is you. If you are not having the success you were hoping for or can no longer maintain a tight diabetes control plan, talk with your doctor about transitioning to a more conventional plan.

Are there any risks?

The greatest risks identified for those who are trying to achieve tight control of their blood sugar is the risk of frequent low blood sugar, and the risk of weight gain.  These risks are primarily associated with insulin or medications that raise the insulin levels in the body. Frequent low blood sugar reactions have been shown to be bad for long term health, so if you are experiencing low blood sugar frequently you need to meet with your health care team to adjust your treatment plan. 

Who might not benefit from tight diabetes control?

Having adequate supplies of glucose in the blood is vital to brain development. Therefore, children should not use a tight diabetes control plan.

Elderly people, those who have had diabetes for a long time, those at risk for low blood sugar, and those with a history of stroke or heart attack, should also avoid this type of diabetes management—hypoglycemia may cause strokes and heart attacks.

If your diabetes is progressed and you already have some complications, tight diabetes control may not be right for you. The complications may be too far advanced for you to benefit from tight diabetes control, and the routine may be too strenuous on your body.