How To Control Blood Glucose

In a diabetic patient, what are the recommended blood glucose levels? “The first thing to emphasize is that in people with diabetes, the objectives should be individualized according to the type of diabetes, associated diseases, age, duration…”, Esteban Jódar, head of the Endocrinology Department at the Quirónsalud Madrid University Hospital, Complejo Hospitalario Ruber Juan Bravo and Quirónsalud San José, explains to CuídatePlus.

The main parameter is glycosylated hemoglobin (HbA1c, percentage of a red blood cell protein that is bound to glucose), which in people without diabetes is less than 6.5 percent. For people with type 2 diabetes the general target is an HbA1c of less than 7 percent, although it may be stricter in younger patients with little risk of, for example, hypoglycemia, or somewhat higher (up to 8 percent) in older patients with more “ailments”. The same applies to type 1 diabetes, in which the general target is less than 7 percent HbA1c, but less than 7.5 percent may be acceptable depending on age.

According to Jódar, “there are also capillary glucose targets (the one measured on the finger) between 80-130 before meals and less than 180 after meals. The objectives in the case of gestational diabetes -that which affects some pregnant women- are even more intense”.

Risks and complications of poor control

Diabetes can be a devastating disease if it is not properly controlled, warns this specialist in Endocrinology. In the majority of cases (type 2 diabetes, more associated with age and obesity) there are also other vascular risk factors that increase the probability of suffering cardiovascular problems (heart attack, stroke, ischemia in the legs or feet, etc.) by a factor of 2 to 4. On the other hand, the chronic elevation of glucose in the blood is associated with the appearance of diseases due to alterations in the small vessels, such as retinopathy (which can cause loss of vision), nephropathy (one of the most common causes of end-stage renal damage) or neuropathy (which can be very painful and disabling).

Well, adds Jódar, “we have evidence showing that they are much more common, especially those of small vessels, in people who are less well controlled compared to those who achieve the objectives and that, when they are already present, good glucose control also reduces their progression”.

Recommendations for better blood glucose management

The endocrinologist at Quirónsalud indicates that, to better manage blood glucose, “we recommend balanced diets, adapted as far as possible to cultural preferences, with a slight calorie deficit (500-800 kilocalories/day) in the case of obesity, regular exercise (no more than two days without doing it) with about 150 minutes a week of moderate intensity (you can talk while doing it, but it is hard to sing)”.

The pharmacological treatment plan today can be very broad, with different oral and injectable options, many of them free of the risk of low blood sugar or even helping to lose weight. “The choice should be up to the person with diabetes, guided or advised by his or her diabetologist and, of course, it is key to put an end to the therapeutic inertia of certain colleagues or to the lack of adherence of the people to be treated,” Jódar points out.

In gestational diabetes, is it more complicated to achieve the objectives?

Pregnancy has some unique characteristics, specifies the diabetes specialist, “the first is that, indeed, there are more hormones that oppose insulin and, therefore, control -especially at certain times of the day such as after breakfast- is difficult, but it is also that the objectives are more demanding to avoid complications in the mother and the newborn and, finally, we only use the treatments that have been shown to be safe in that situation, which reduces the possibilities. On the other hand, pregnant women with diabetes are often incredibly cooperative and do more work than usual to achieve their management goals.”

Have the methods for glucose control evolved?

The methods available for controlling glucose levels have evolved enormously, says the expert, “although we are still waiting for new developments, both the reflectometers for measuring capillary blood glucose and, especially, continuous glucose monitoring systems, continuous glucose monitoring systems (either flash type -the disk inserted in the back of the arm- or CGM -with a catheter inserted in the abdomen-) give us almost continuous readings throughout the day and allow us to reduce the too wide variation of blood glucose and help us to make better decisions on diet, type of treatment or therapeutic dose”.

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