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. To be successful at tight diabetes control, you must:

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

Studies have shown that people who practice tight control delay the onset of diabetes-related complications by months and even years.

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

An important note: If you would like to pursue tight diabetes control, it is imperative that you work with your doctor or nurse educator. Your goals should be set with their assistance, as your personal healthy history may affect the way you practice tight control.

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 doctor and diabetes care team will work out a plan with you. It’s important that you work with them if you want to try tight diabetes control—doing it without supervision may result in complications or serious side effects.

Your diabetes care team will set a guideline for how much exercise you should get, how many calories you should eat in a day, 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

Most type 2 diabetics do not use insulin as part of their treatment. However, if diet and exercise alone are not adequate in controlling your blood glucose levels, your doctor may suggest that you begin using insulin injections. Maintaining a low level of insulin at all times, plus injecting extra insulin when you eat, more truly mimics the way a healthy pancreas should work. 

To get this additional insulin, you may have to give yourself multiple daily injections. 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 too much. It may cause you to fail. To prevent that, start with one element, such as checking your blood glucose more often, and add the other components later.

Be Honest

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?

Some studies have shown that very aggressive diabetes control may increase the risk of heart attack and early death in people with type 2 diabetes. Individuals whose tight diabetes management plans required that they work to keep their A1c levels below 6 percent experienced a greater percentage of early death, compared to those who kept their A1c between 7 and 7.9 percent. Though the research does not provide a conclusive answer as to why the aggressive treatment increased the risk of death, researchers do not think that low or fluctuating blood sugar levels play a role.

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, or 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.