If you have diabetes, you know your blood sugar levels are important. If you keep your blood sugar level as close to your targets as possible, you may reap health benefits. This is called tight or intensive blood sugar control. But, "tight" is not right for everyone.
Although tight or intensive blood sugar control has been shown to reduce some diabetic complications, there has been controversy about just what the other benefits of tight blood sugar control are. And it also poses dangers, including hypoglycemia or low blood sugar.
Several recent studies suggest that tight control may not protect against heart disease as once thought. One study also showed a slight increase in risk of death while practicing tight control. Past studies reported a decrease in heart disease with tight control if it was started soon after diabetes was diagnosed. With these conflicting reports, it's important to know the benefits and risks of tight blood sugar control and for whom it works best.
The basics still stand
The American Diabetes Association says hemoglobin A1c levels less than 7 percent should be the goal for most people with diabetes. A1c is an indicator of your blood sugar level over several months.
If you practice tight blood sugar control, you may prevent or slow the progression of end-organ damage. These are diseases in the brain, kidneys and eyes. Tight blood sugar control is achieved in different ways for people with type 1 and type 2 diabetes.
Tight blood sugar control for type 1 diabetes
In type 1 diabetes, your body doesn't make insulin. Because of this, your body relies on insulin injections to work properly. This can make it a challenge to keep your blood sugar levels in the target range.
For type 1 diabetes, tight blood sugar control means keeping blood sugar levels as close to your target range as possible through frequent testing and adjustment of insulin doses.
The key components include:
- Testing blood sugar frequently, often four or more times per day.
- Regulating your insulin by using a long-acting, low-level insulin supplemented by additional insulin doses as needed, based on your blood sugar readings and your treatment plan. This may mean taking an insulin bolus before you eat or exercise. Instead of shots, you may use an an insulin pump that releases insulin into your body.
- Eating a healthy diet rich in fruits and vegetables, and low in fat and sodium.
- Exercising regularly as recommended by your doctor.
The benefits of tight control need to be balanced against the risk for a low blood sugar reaction called hypoglycemia. People with type 1 diabetes who practice tight control have a higher risk of hypoglycemia. You can lower this risk by following a good treatment plan. The key is to check your blood sugar as often as your doctor recommends and act on those results. Work with your doctor to design a diabetes treatment plan that is safe for you.
Tight blood sugar control for type 2 diabetes
In people with type 2 diabetes, the body makes some insulin, but can't use it effectively. Type 2 diabetics may not need to take insulin for their condition. Instead they take medications that may help the body use insulin better, such as glucophage (Metformin), or increase the amount of insulin in the body. Other medications may stop the body from releasing its own stores of glucose into the blood or from absorbing sugars through the intestines. Daily blood sugar levels are usually more stable, so the goal of tight control for people with type 2 diabetes is more long-term. To keep blood sugar within range, people with type 2 diabetes often rely on diet, exercise and non-insulin medications.
People with type 2 diabetes can help gain tight control by making adjustments to their lifestyle. Adjustments may include:
- Test your blood sugar as directed by your doctor (this can range from once or twice a day to once a week).
- Lose weight if you are overweight.
- Exercise regularly as your doctor directs.
- Eat a healthy diet rich in fruits and vegetables, and low in fat and sodium.
- Take medication as prescribed by your doctor if lifestyle changes are not enough.
- Keep your doctor's appointments and get your blood tests, including hemoglobin A1c as suggested.
Is tight control right for me?
Only you and your doctor can decide if tight blood sugar control is for you. It requires working closely with your doctor, diabetes educator and dietitian. Tight blood sugar control may not be a good idea for some of the following people:
- People at high risk for hypoglycemia or who have had serious episodes of hypoglycemia in the past
- People with a life expectancy of less than 10 years
- Young children, because they need blood glucose for organ development
- People who already have end-organ damage, because the goal of tight control is to prevent this
- People with longstanding or hard-to-control diabetes
Tips for successful tight control
- Work closely with your health care team to design a plan that's right for you.
- Tight control can be a lot of work. If you get burned out on tight control, talk to your doctor about adjusting your treatment plan.
- Know the symptoms of hypoglycemia and how to treat it promptly to avoid a diabetic emergency.
Created on 02/26/2009
Updated on 06/15/2011
- American Heart Association. Risk factors and coronary heart disease.
- American Diabetes Association. Tight diabetes control.
- Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32(1):187-192.
- American Diabetes Association. Joint statement from ACC, ADA and AHA revises recommendations for glycemic targets for some patients.