Tight Diabetes Control
Having blood sugar levels near to the normal range can prevent many dangerous complications. Tight control can slow, if not prevent, the development of a lot of diabetes complications and allow you a longer healthy life, still able to take part in your daily activities. Of course, tight diabetes control necessitates lots of effort, and so, may not suit everyone.
What is Tight Control?
Tight control involves getting your blood sugar level to an almost normal level without triggering any diabetes linked problems. The target range ought to be levels between 70 -130 mg/dL just before meals and lower than 180 mg/dL two hours from the beginning of the meal, with a A1c (glycated hemoglobin) level lower than 7 %. When it comes to glycated hemoglobin, the percentage aimed for depends on the test used by your medical practitionerâ’s laboratory.
In reality, you ought to have your medical practitioner help you set your targets. It is not possible to have your blood glucose at a normal level all the time. Furthermore, it is not required for achieving good results. Even a little reduction each time your blood sugar level rises can assist in the prevention of complications.
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How does it help?
Research has yet to uncover the reason for high blood sugar level ability to cause complications in diabetics. However, we do know that some complications are delayed, even prevented, if blood sugar levels can be kept as low as they can safely go.
1,441 type 1 diabetics participated for a number of years in the DCCT (Diabetes Control and Complications Trial). Half the participants continued with their usual diabetes treatment while the rest were given intensive therapy. Those diabetics on intensive therapy had lower blood sugar levels than those on the usual diabetes treatment. The average level, however, was still higher than normal.
So, what did the researchers find? Below are the findings of the researchers when they compared the intensive therapy group with the group getting the standard diabetes treatment.
- Nerve disease was found in one out of three diabetics from the standard treatment.
- Kidney disease was found in only one out of two diabetics from the standard treatment.
- Diabetic eye disease was found in only one out of four diabetics from the standard treatment.
- Fewer people from the intensive therapy group had their mentioned complications deteriorate compared with those from the standard treatment group.
Using tight control
To have tight control, the following has to be done.
- You must be careful with your diet.
- You must have enough exercise regularly.
- Your blood sugar levels must be checked more often.
- If you are using insulin, adjust the amount used and change the schedule of your injection.
Getting intense with insulin
When following an intensive therapy, you give yourself a small amount of insulin every time, only taking more when you consume food. This way of sending in natural levels of insulin into your body is similar to the production of insulin by a normal pancreas.
You have a choice of two methods of sending insulin into your body. One is the use of several injections each day, sometimes called the multiple daily injection therapy and the other is the use of an insulin pump. Since both method are good, your decision lies in their suitability to your lifestyle.
With multiple daily injection therapy, there is the need for at least three insulin injections each day. Normally, you have a pre-meal injection of Regular or short-acting insulin and an intermediate- or long-acting insulin injection at bedtime. So, the number of injections depends upon the number of meals you have.
You can wear a tiny insulin pump which sends insulin through a plastic tube into your bloodstream. The pump sends you a consistent small amount of Regular insulin. When needed, like before consumption of food, you can have the pump send more insulin.
No matter which method you use, your blood sugar levels have to be checked a number of times each day. A blood test ought to be done before each injection to find out how much insulin is required and the time to have the injection before starting the meal. It is also advisable to check blood glucose level again two or three after the meal to confirm that you have given yourself sufficient insulin. Make sure that your insulin dose is right for the amount you will be consuming or the activity you are going to have.
Regardless of the method chosen by you, you have your doctor, dietitian, diabetes educator as well as other medical professionals to assist you with guidelines on the amount of insulin to use and the times for injections. You should also make guidelines on diet and exercise. However, no matter what guidelines you have, they need adjustment based on your blood glucose test results.
Tight control is not something you should try on your own. You need good diabetes healthcare professionals. Go to a doctor who specializes in diabetes or have a good understanding of it. Such a doctor should be able to work together with dietitians and health educationist whom you may need. If you live in a small town where such professionals are not available, it may be worth your while to drive to a city to meet them.
Keeping it going
The idea of having a tight control program may be interesting but it can be difficult with so much to act on. So, how do you keep at it?
Some tips for you:
- Be honest.
If newly diagnosed with diabetes, you need to assess your feeling honestly. Does having diabetes make you angry as well as depressed? It takes time to overcome them and accept the fact so that you are ready to make some changes in your lifestyle. Only when you are ready, can tight control be attempted.
- Start slowly.
Move one step at a time. The first step you take may be the carrying out of more blood tests per day only. When you are used to that, go on to having multiple daily injections. When tests and injections have become habitual, include whatever changes you intend to make on your exercise program as well as your diet.
- Be realistic.
You have to accept the fact that regardless of any effort you put in, your blood sugar reading will never be perfect at all times. If the blood sugar levels are usually too high or too low, you should consult your doctor about your diabetes plan to see whether adjustment is necessary. However, if these levels happen only once in a while, that is acceptable. Through practice, you will be better at giving yourself the right doses of insulin for the many different situations in your life.
- Have a break.
You may find the going too tough and need a break. When that happens, have a break from this tight control schedule and start on it again when you are ready.
Pluses and Minuses
The prevention of later complications is an important reason for tight control. Even, right from the start, there are benefits in tight control.
- You can feel much better and possess more energy.
- You can have different types of activity.
- You can vary the time you have your meals.
- The possibility of birth defects is reduced.
According to the DCCT (Diabetes Control and Complications Trial), tight control can lead two serious problems:
- Weight Gain – Diabetics on tight control have the tendency to increase more weight when compared with diabetics on standard therapy. Ten pounds was the average weight gain, according to the DCCT. If you wish to prevent weight gain, you can get your dietitian as well as doctor to create a suitable meal as well as exercise plan.
- Low Blood Sugar (Hypoglycemia) – Diabetics using tight control suffered three times the number of hypoglycemia cases in the other group. You must be vigilant and give yourself treatment when the symptoms of hypoglycemia appear. You must always test your blood sugar before you go for a drive. During tight control, if you frequently get low blood sugar reactions, you should consult your doctor. You may have to adjust your targets or return to standard therapy for some time.
What’s the cost?
- You need more consultation with health professionals.
- The cost of a pump is about $5000 – $6000, You need $60 – $80 a month for pump supplies.
- Multiple injection therapy costs very much less but you will need more supplies, like syringes and test strips, than when you were on standard therapy.
What about type II diabetes?
Although DCCT only consists of people with type 1 diabetes, doctors think tight control for the prevention of complications is also applicable to people with type 2 diabetes. However, most type 2 diabetics do not use insulin. So, how can tight control be achieved without insulin?
Losing weight could be a way to it. Getting rid of extra weight can reduce your blood sugar level. To lose weight and remain at your new weight can be done by consuming less food and doing more exercise. You should discuss with your doctor to create a food and exercise plan that you can carry out. Exercise is important, even when you do not want any weight loss, as it assist you to manage your blood sugar levels. It gets your cells to remove glucose from your blood.
Regular testing of your blood sugar is necessary. Get your doctor to help you decide how often your blood sugar needs to be checked. For some type 2 diabetics, even a test a day or a test a week may be sufficient. However, if exercise together with a good meal plan cannot get your blood sugar under control, pills may have to be prescribed by your doctor. And if the problem persists, you need insulin. Before starting tight control, type 2 diabetics should consult their doctors.
Tight Control May Not Be Safe.
Tight control can be dangerous for some diabetics.
Tight Control is not safe for children. For the brain of a child to develop well, having a sufficient supply of glucose to the brain is essential. Some doctors claim tight control is fine for a child who has reached the age of 13 years while others claim it is alright even for a child of 7 years.
Tight control is probably not suitable for elderly people. Strokes as well as heart attacks can be caused by hypoglycemia. It may not be necessary for elderly people as the complications tight control hope to prevent, occurs later, after many years. Tight control is only worth it if the people who go on the tight control can live a minimum another ten years.
Those diabetics who already suffer from complications should no longer try tight control. For instance, diabetics with kidney failure or serious loss of vision should not do tight control. Their complications can no longer be reversed or improve. Some people with vascular disease or coronary artery disease ought not to try it. People having hypoglycemia without realizing it should also not take on tight diabetes control.
- It is important that you work together with a team of medical professionals to develop and maintain a plan to achieve your targets.
- Keeping levels of sugar down to the lowest possible can slow, if not prevent, some complications.
- The disadvantages are greater possibility for weight gain and hypoglycemia.
- Tight diabetes control is not suitable for everyone.