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You're heard the doctors. You've read the articles. You know all about tight control.
Ever since the results from the Diabetes Control and Complications Trial were published in 1993, everyone has known that reducing A1C levels staves off complications and keeps us healthy longer. We know this. And we've listened.
But many type 1s--and even type 2s who aggressively manage their illness--suspect that they could do better. And just a bit of searching around the web or browsing in your local bookstore will prove you right.
For me, it was the work of Dr. Richard Bernstein. "Diabetics are entitled to the same, normal blood sugars that nondiabetics enjoy," Bernstein wrote in the preface to his book Dr. Bernstein's Diabetes Solution. He's stated that viewpoint repeatedly in interviews and articles.
And who could argue with it? Some disagree with Bernstein's advice on how to get that level of control--an extremely low-carb diet figures into his plan--but his basic notion tantalizes. Are normal blood sugars possible? Can people with diabetes transform good blood sugar control into great blood sugar control?
I think we can. And what's more, it's not that complicated. Here are eight suggestions.
Have a goal.
The American Diabetes Association says that people with diabetes should aim for an A1C--a three-month average blood glucose level--below 7%. The American Association of Clinical Endocrinologists advises an A1C of 6.5% or under. Most doctors would be pleased with either number.
But what's your goal? If your A1C is 8% or 9%, hitting 7% is a worthwhile aim. However, if you've managed to achieve an A1C near 7%, perhaps you could try for a lower number. Talk to your doctor and diabetes educator and see if they think you can safely aim for even tighter control.
Whatever you're aiming for, having that target number in mind will help. That's where you want to go. That's what you want to do. And that goal will help motivate you in the days and weeks ahead.
A note of warning: Don't aim for the impossible right away. If your A1C is quite high, don't immediately try for the lowest possible number. Talk to your doctor and set a reasonable goal. Then meet it. Then set another goal.
Check your blood sugar. A lot.
No piece of advice could be more obvious, but it's easily overlooked in the hustle and bustle of daily life. If you don't know what your blood sugar is, you can't hope to keep it at a nondiabetic level.
According to the National Institutes of Health, which funded the Diabetes Control and Complications Trial, it was once standard practice to check blood sugar a single time each day. That landmark study raised the standard to four.
But four checks a day, while better than one, can miss a lot. If you want tighter control, try six or eight checks a day. That's right: Take your blood sugar every two or three hours when you're awake, and definitely check overnight. You might be surprised to learn where your numbers go.
This can be a costly prospect for some people. You can only do what you can afford. But almost everyone can try the extra checks for a few days or a couple of weeks, and that information alone will be helpful. You'll learn how your body reacts to different kinds of food. You'll find out how long it takes your body to absorb insulin.
This is your baseline information. This is the stuff you have to know. The best technology and the most extensive education don't make the slightest bit of difference if you don't know what your blood sugars are most times of the day.
You also might want to consider a continuous glucose monitor. This device gives you a constantly updated blood glucose trend line and can alert you if your numbers rise too high or fall too low.
Carry glucose tablets. Everywhere.
Lows are a real challenge when trying to maintain near-normal blood sugars for any considerable length of time. Think about it this way: A problematic low of 40 is just 50 points away from a great blood sugar of 90. But it's 200 points away from the high blood sugar of 240. If you hate the way low blood sugars make your feel, it might seem more comfortable to stay in the high range. But that high range increases your risk of serious diabetic complications.
Glucose tablets can help solve this vexing problem. Have a low blood sugar? Pop three of four of them, wait a couple of minutes, and be on your way. Have them available at all times, in all the places that you might need them--at home, in the car, and at work.
The government's Centers for Disease Control and Prevention puts it simply: "Always carry some type of carbohydrate sugar food or drink with you." The CDC also advises wearing a medical alert bracelet and carrying a card in your wallet saying that you have diabetes.
For years, I didn't believe in glucose tablets. Why not use candy, I wondered. Or juice? They were both so much tastier than the tablets. But that's the problem. Who eats just three pieces of candy? Who drinks just a few ounces of OJ? It's too easy to over-correct and send your blood sugar sky high.
Stick with glucose tablets. They're tasty enough to be palatable, but bland enough that you won't be tempted to sneak one when your stomach rumbles.
Get coaching. Now.
Find a diabetes educator or nutritionist. Go to his or her office and learn.
Perhaps you've had diabetes for a long time and think you know everything you need to know. Perhaps you don't want someone in his 20s or 30s telling you how to manage your disease. Perhaps you think you get along just fine on your own.
If you think any of these things, you really do need to see the educator. Because it's easy for veteran patients to lie to themselves--to say that certain high blood sugars "don't count" or that they're not responsible when bad things happen.
An educator sees right through that. He or she won't discipline you, exactly, but you will need to talk openly and honestly about your disease and how it's going. And your educator will then arm you with knowledge and advice.
Boston's Joslin Diabetes Center actually recommends that people with diabetes go through the education process every year or two, making sure they keep up to date with the latest research and their own goals.
You will leave motivated and ready to look at your disease in a different way. And for those looking to take control to the next level, this motivation is invaluable.
For people more recently diagnosed, educators serve a different role. They can help you understand how the disease works and smooth out your ups and downs. Getting good advice at the start can keep you from making mistakes later.
Consider a medical device.
I've already touched on continuous glucose monitors. But it's also important to talk about insulin pumps. Both of these devices can remake your routine for the better. A consistent flow of fast-acting insulin from a pump can more accurately reflect the way a pancreas works. And the constant monitoring available from a CGM gives you nearly real-time feedback.
Neither device works miracles on its own. Nothing about the devices changes the basic nature of diabetes or the challenges of controlling the disease. People on insulin pumps can have poor control. So can people with CGMs.
But the education provided with the devices can be invaluable. And the mere act of closely looking after the disease pays off. It's important to commit to the treatment, learn all you can about it, and give it a chance.
Diabetes educators and medical device companies can be great sources of information if you're considering taking this step. Don't hesitate to ask them for advice and information.
Don't just count carbs. Limit them.
Not all experts will agree with this point, but it's one that has worked for me.
The standard for diabetic treatment these days is counting carbohydrates in food. That is, your insulin shot should cover the amount of sugar in your food (most starches, like those in bread, break down into sugar). What that means is that you can eat most meats, cheeses, and green vegetables without affecting your blood sugar that much.
If you want more consistent blood sugars, it only makes sense that you would not only know how many carbs you ate so you could give yourself insulin to cover them, but that you would also limit those carbs. If you ate fewer of them, you'd need less insulin, and your blood sugar wouldn't seesaw so much.
I won't say how drastically you should limit those carbs. Different people react to these plans differently, and not everyone can handle restricting such a core part of the diet. It's up to you and your doctor or nutritionist.
What I would urge is that you do some reading. Not just the books by folks like Dr. Bernstein or science journalist Gary Taubes (both of whom advocate very low-carb diets), but also books and websites from those touting more moderate approaches (like the South Beach or Mediterranean diets).
You already plan your meals to one extent or another. It only makes sense that you pick an approach that feels right to you.
I don't want to write this, and you don't want to hear it. But it's the most important point I can make, and it's the one that any person with diabetes must take to heart.
This is your job. This is your life.
Minnesota's Mayo Clinic puts this item on top of its list of "10 ways to prevent diabetes complications." You have to take responsibility, the clinic says, and you have to make the long-term commitment that such responsibility requires.
Ultimately, you can blame no one else for your health or your decisions. Diabetes is a disease that depends on the choices that we make, day in and day out. The decisions often seem small and unimportant. But over time, they accumulate and mark the progress of the disease.
Do we stay healthy, monitoring our blood sugars and food intake, consulting with our healthcare professionals? Or do we let these healthy behaviors slide, with the understanding that we'll always have time to fix it later?
We don't have time. We have to address our health now.
That doesn't mean we panic, and it doesn't mean that we can't ever have a chocolate bar again. But it does mean that we must take real responsibility for ourselves.
Ultimately, if you take responsibility for your disease, the other seven tips here should follow naturally. They're all about taking a commonsense approach to a challenging situation and improving it bit by bit and day by day.
You won't be perfect. But you don't have to be. You just have to be better than you were yesterday.
*These tips are not intended to replace your healthcare's professional advice. Ask them for their opinion, prior to making any changes to your current therapy.
Categories: A1c Test, American Diabetes Association, Blood Sugar, Centers for Disease and Control, Diabetes, Diabetes, Diabetes Control and Complications Trial, Diabetic, Diets, Food, Health, Low Carb, Medical Alert Bracelet, National Institutes of Health, Type 1 Issues, Type 2 Issues