Updated on August 3, 2023.
Diabetes is a chronic, lifelong 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. These include heart disease, kidney failure, blindness, and amputation.
‘What gets measured gets managed’
Perhaps you’ve heard this proverb (or cliché, depending on your point of view). It says that 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 you adjust accordingly.
When you have diabetes, you should closely monitor three key areas: blood glucose and Hgb A1C, blood pressure, and cholesterol. These are sometimes referred to as the ABCs of diabetes management. Monitoring these will also help you make lifestyle changes to improve your diabetes control.
Let’s look at each of these areas more closely.
Blood glucose levels
It’s important to measure your blood glucose on an ongoing basis. If you are taking insulin, monitoring is important to lower your Hgb A1C (a measure of your average blood glucose levels over the previous three months). Even if you are not on insulin, monitoring will help you adjust your diet, exercise, and medications.
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). Alternately, if your blood sugar spikes above 200 mg/dL, you may experience hyperglycemia. Both conditions can be dangerous. Your healthcare provider (HCP) will tell you how many times per day you should check your blood glucose levels.
An A1C test (also called hemoglobin A1C, HbA1c, or glycohemoglobin test) measures the percentage of your red blood cells that have sugar-coated 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 for most people, says Darria Long Gillespie, MD, clinical assistant professor at the University of Tennessee Health Science Center. There are exceptions for people with cognitive impairment, who have more than one chronic illness, or who are dependent on others for day-to-day function. They can shoot for a less-stringent A1C of 8 percent or lower.
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 changed in recent years.
Both the American Diabetes Association and the American Heart Association have released updated guidelines for blood pressure control, lowering the level to consider medical treatment for people without diabetes to 130/80 mm Hg. “People with diabetes must treat blood pressure even more aggressively than people who don’t have diabetes,” says Dr. Gillespie. “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 their elevated risk of heart disease, people with diabetes must control cholesterol carefully. Those over age 40 are typically put on a moderate-intensity cholesterol-lowering medication. People between ages 20 and 39 who have additional heart disease risk factors may be given this medication, as well.
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.
Making lifestyle changes
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 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,” Gillespie says. (Being overweight or obese is a risk factor for diabetes and heart disease.) “Aim for at least 30 minutes of exercise 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 using effective smoking cessation aids. If you smoke, talk to your HCP about strategies for quitting.
A Diabetes Record Form will help you to keep track of your ABCs. Ask your HCP for a form or download one online and bring your filled-out document to each appointment.
