- Reviewed by Pat F. Bass, III, MD, MPH
Keeping blood sugar under control is key to 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 medications
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 it, type 2 diabetes occurs when 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 for use elsewhere. 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. An elevated blood sugar level that signals diabetes is a reading over 126 milligrams per deciliter (mg/dL) for a fasting blood test or over 200 mg/dL at any time during the day.
Beyond the effects of diabetes itself, 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, high blood sugar, can cause fatigue and dehydration," explains endocrinologist Laure Kassem, MD, an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio. "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.
Follow these specific strategies to help control blood sugar:
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 medications 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:
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, not the occasional spike in your blood sugar levels. However, be aware of the long-term effects of blood sugar that’s too high (hyperglycemia) or too low (hypoglycemia) and how it’s treated:
The Facts About Diabetes and Blood Sugar
As the American Diabetes Association (ADA) explains it, type 2 diabetes occurs when 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 for use elsewhere. 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. An elevated blood sugar level that signals diabetes is a reading over 126 milligrams per deciliter (mg/dL) for a fasting blood test or over 200 mg/dL at any time during the day.
Beyond the effects of diabetes itself, 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, high blood sugar, can cause fatigue and dehydration," explains endocrinologist Laure Kassem, MD, an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio. "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.
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 in the February 2015 issue of 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 some 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.
- 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.
- Medications. Your doctor may recommend different
types of medications at different times during your diabetes treatment.
Treatment options include:
- Biguanide. This type of medication helps your body use insulin more effectively and may also reduce the amount of blood sugar made by the liver.
- Sulfonylurea. Drugs in this class cause certain cells in your pancreas to make more insulin. However, low blood sugar (hypoglycemia) is a possible side effect.
- Meglitinide. This is another drug that causes your pancreas to make more insulin, with hypoglycemia as a possible side effect.
- Thiazolidinediones. This class of medication may help insulin work better.
- Alpha-glucosidase inhibitors. These drugs stop the body from breaking down starches and may be used to prevent a spike in blood sugar after a meal.
- DPP-4 inhibitors. These medications allow GLP-1, a gut-based hormone naturally found in the body, to last longer and help stabilize blood sugar levels.
- SGLT2 inhibitors. These medications cause excess glucose to be eliminated in the urine.
- Insulin. Taking supplemental 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 answers may be as close as your telephone. When Australian researchers offered telephone counseling to 94 adults with type 2 diabetes, they found it improved diabetes management, according to results published in the September 2014 Internal Medicine Journal.
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 medications 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 your 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 may order lab-drawn blood sugar tests as part of your regular office visits to monitor how well you’re managing your 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.
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, not the occasional spike in your blood sugar levels. However, be aware of the long-term effects of blood sugar that’s too high (hyperglycemia) or too low (hypoglycemia) and how it’s treated:
- Hyperglycemia: 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. Ways to
treat hyperglycemia include:
- 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. However, 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 is 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 medications. 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.
- Hypoglycemia. 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.
