Keeping blood sugar under control is key for good management of type 2 diabetes. Here’s how to navigate this sometimes complicated course of diabetes care.
Life with type 2 diabetes can sometimes seem like an hourly or even minute-by-minute effort to stabilize your blood sugar. All of the recommendations and drugs you’ve been given as part of your type 2 diabetes treatment plan are intended to help you reach — and keep — healthy blood sugar levels most of the time. But doctors are learning that to control type 2 diabetes well, better information about why blood sugar matters and how to manage it is essential.
The Facts About Diabetes and Blood Sugar
As the American Diabetes Association (ADA) explains, your body needs sugar (glucose) for fuel, and there’s a fairly complicated process that makes it possible for your body to use that sugar. Insulin, which is made by the pancreas, is the hormone that enables the cells in your body to take advantage of sugar.
Type 2 diabetes occurs when your body isn’t able to remove sugar from your blood. This can happen if your body stops being sensitive to insulin or if it starts to respond in a delayed or exaggerated way to changes in your blood sugar.
Diabetes is signaled by an elevated blood sugar level of more than 126 milligrams per deciliter (mg/dL) for a fasting blood test, or more than 200 mg/dL at any time during the day. It can also be indicated by a hemoglobin A1C level of 6.5 percent or higher, a measure of the percentage of blood sugar attached to hemoglobin in the blood during the past two to three months. (Hemoglobin is a protein in red blood cells that transports oxygen throughout the body. So an A1C of 6.5 means that 6.5 percent of your red blood cells have sugar attached to them.)
Unchecked high blood sugar gradually damages the blood vessels in your body. Over the long term, this slow, progressive harm can lead to a dangerous loss of sensation in your legs and feet, a loss of eyesight and kidney function, and an increased risk for heart disease and stroke.
Both high and low blood sugar are health threats. “Having low blood sugar can lead to hypoglycemia, which puts people at risk for confusion and loss of consciousness, so it can be life threatening. Fluctuations in the opposite direction, or high blood sugar, can cause fatigue and dehydration,” explains endocrinologist Laure Sayyed Kassem, MD, an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland. “Good diabetes control can help reduce the risks for heart attacks, strokes, visual deficits, kidney disease, and peripheral artery disease.”
Strategies to Stabilize Blood Sugar
Getting your blood sugar to healthy levels may take trial and error, but there are steps to help you achieve it.
“Having a daily routine is critical for good diabetes control,” Dr. Kassem says. “That means following your meal plan, exercising regularly, being consistent with blood sugar testing, and following up regularly with your doctor.” Tracking carbohydrates is particularly important. “Big variations in carbohydrate intake from day to day can lead to fluctuations in blood sugars,” she adds. For example, when you consume excess carbohydrates, the body digests them like sugar and sends them straight to the bloodstream, increasing the risk of blood sugar spikes.
Follow these specific strategies to help control blood sugar:
Exercise A regular exercise program has been shown to help manage blood sugar levels over time, and taking a varied approach to fitness is good for diabetes and health in general. Participants in a 12-week program who exercised for an hour three times a week using both aerobic and resistance training had improved diabetes management, according to research published in February 2015 in the Journal of Sports Medicine and Physical Fitness. So mix it up with strength training, aerobic workouts, and any other activities you enjoy.
Weight Loss If you’re overweight, it will be easier to stabilize blood sugar more effectively if you lose even a few pounds. “For most people with diabetes, losing just 5 or 10 pounds can make a difference in diabetes control or the need for medication,” says endocrinologist Joseph Aloi, MD, section chief and professor of endocrinology and metabolism at Wake Forest Baptist Health in Winston-Salem, North Carolina.
Diet Many people with diabetes achieve better control over their blood sugar by limiting the kinds of foods that can cause blood sugar to spike. For example, your doctor might recommend cutting back on carbohydrates and eating more lean protein, fruits, and vegetables. Fiber can be so helpful that sprinkling even a small amount of a fiber supplement onto a meal that otherwise might spike blood sugar can help stabilize it, Dr. Aloi says, because fiber slows down the body’s digestive process.
Drinking Wisely Alcohol can cause an immediate rise in blood sugar and then a drop a few hours later. It’s best to stick to moderate amounts and have some solid food with your beverage.
Medication Your doctor may recommend different types of medication at different times during your diabetes treatment. Treatment options include the following:
- Biguanides, the drug class that includes metformin, help your body use insulin more effectively and may also reduce the amount of blood sugar made by the liver.
- Sulfonylureas cause certain cells in your pancreas to make more insulin, though low blood sugar (hypoglycemia) is a possible side effect.
- Meglitinides, a class of drugs that includes repaglinide, cause your pancreas to make more insulin, with hypoglycemia as a possible side effect.
- Thiazolidinediones, a class that includes pioglitazone, may help insulin work better.
- Alpha-glucosidase inhibitors, a class including acarbose, stop the body from breaking down starches and may be used to prevent a spike in blood sugar after a meal.
- DPP-4 inhibitors allow GLP-1, a gut-based hormone naturally found in the body, to last longer and help stabilize blood sugar levels.
- SGLT2 inhibitors cause excess glucose to be eliminated in the urine.
- Insulin may be necessary to help your body use blood sugar more effectively.
Asking More Questions Don’t be shy about asking your doctor or diabetes educator about how to interpret blood sugar numbers, or for clearer instructions to help stabilize blood sugar. “You should know what your medications are for and what your goals are,” Aloi says. Strategies to stabilize blood sugar are most effective when you understand how they work and how to use them. And the answers may be as close as your phone. When Australian researchers offered telephone counseling to 94 adults with type 2 diabetes, they found it improved diabetes management, according to a study published in September 2014 in the Internal Medicine Journal.
Blood Sugar Testing Options
Specific recommendations for testing blood sugar depend on your type of treatment. “If it’s oral treatment, stagger the tests because this gives us a better idea of blood sugars through the day. It allows us to tailor medication better. But people on insulin have to be tested at regular times every day,” Kassem explains.
From self-tests to lab tests, from daily testing to testing every few months, these different blood sugar tests can give you a more complete picture of your diabetes and how to go about managing it best:
Testing Strips and Glucose Monitors These are fingertip blood sample tests you can do at home. Depending on the status of the diabetes and your doctor’s recommendations, you may need to test multiple times a day to keep tabs on your blood sugar levels. Get to know your condition better by keeping a diary of your meals and activities and the blood sugar levels that result.
Use these self-check blood sugar testing tools to find out how your body responds to changes in your diet, exercise, and overall health. There are many brands of monitors, each with their own lancets and testing strips, so talk to your doctor about which design is best for you and about how often you should be checking your blood sugar levels at home.
Lab Work Your doctor will often order lab-drawn blood sugar tests as part of your regular office visits to monitor how well you’re managing diabetes and other chronic health conditions.
A1C Tests This is a lab-drawn blood test that provides your doctor with information about how your blood sugar control has been over the past three months. Every time your A1C drops by a point, you cut the risk of diabetes complications by about 30 percent, Aloi says.
Responding to High or Low Blood Sugar Levels
As you learn more about living with diabetes and monitoring your blood sugar levels, you’ll experience times when your blood sugar levels are too high or too low. But don’t panic over these results, Aloi says. The complications of diabetes are caused by poor blood sugar control over the long term — typically not by the occasional short-lived elevations in your blood sugar levels. Still, it’s important to be aware of the long-term effects of blood sugar that’s too high (hyperglycemia) or too low (hypoglycemia), and how it’s treated.
Blood sugar levels that are too high for too long are considered hyperglycemia. If your blood sugar is more than 240 mg/dL, you should also check for ketones in your urine before you take steps to lower your blood sugar, according to the ADA. Rarely, someone with type 2 diabetes will develop diabetic ketoacidosis (DKA), a serious condition characterized by high blood sugar, low insulin and the presence of moderate to high ketone levels. DKA is a medical emergency and requires urgent medical care.
Ways to treat hyperglycemia include the following:
Exercise. Physical activity is a good way to bring down blood sugar. Aloi points out that 10 minutes of exercise used to be the recommendation for children with type 1 diabetes as a way to stabilize blood sugar before insulin was commonly available. But if you have high levels of ketones in your urine, hold off on exercise because it may make that situation worse. Let your doctor know if your blood sugar or ketone levels are too high for an extended period of time.
Change your diet. High blood sugar can result from eating too much or eating the wrong foods. If you’ve strayed from your diabetes diet, get back to eating healthy as your doctor recommends. Making your very next meal high in protein and fiber should help. Whatever you do, don’t fast.
Aloi notes that many people with diabetes get frustrated over their somewhat unpredictable response to food and decide not to eat in an attempt to lower blood sugar levels. Fasting causes stress, which can actually cause your blood sugar levels to go up or stay up.
Adjust your medication. Blood sugar that’s too high may call for a medication change, but only with your doctor’s advisement. Talk to your doctor about what to do in response to high blood sugar levels before you alter your medication plan.
For many people, low blood sugar can lead to dizziness and feeling ill, and it can be extremely dangerous if it results in loss of consciousness, according to the ADA. You need about 15 grams of carbohydrates to bring your blood sugar levels up. Many people carry glucose tablets with them just in case, but 4 ounces of juice or soda, four or five crackers, or a tablespoon of honey will also do the job. Test your blood sugar again in about 20 minutes to make sure it’s back to more acceptable levels.
If you have episodes of low blood sugar, wear a medical identification bracelet or necklace in case you’re unable to treat yourself.
Some people find a formula that works well to stabilize their blood sugar and they can depend on it, day after day. For others, blood sugar levels can seem like a moving target. If this sounds like you, build a partnership with your diabetes care team — including your primary care provider, endocrinologist, nutritionist — and together you can find strategies for better blood sugar control that work for you.