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Diabetes And Blood Sugar Control

Published:
14-March-2005

By H. Peter Chase, M.D.

The term "sugar control" is used in describe how close blood sugar is kept to normal limits. Good sugar control" refers to blood sugar levels that more closely approach the normal sugar levels of someone without diabetes. In contrast, a person with constant high blood sugar levels is considered "in poor sugar control." This person may have such side effects as frequent thirst, frequent urination, weight loss, or episodes of acidosis.

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It is important to have a reliable method to measure "overall" blood sugar control. It is obviously not possible to measure the blood sugar level every second of the day. Advances were made in the late 1970s to make the measurement of "overall" sugar control possible. This is done using the hemoglobin A1c (HbA1c) test. This test reflects how often the blood sugars have been high every second of the day in the past 90 days.

Sugar Control

Good blood sugar control is the result of balancing the correct insulin dosage, regular exercise, good dietary habits, avoiding stress, and monitoring blood sugar levels. Perhaps the most important of the four is to correct insulin dosage. Blood sugar control will remain poor if insulin is lacking, even if the other three factors are in balance. Thus, it will not help to do extra exercise if the person is not receiving the correct insulin dosage. However, any one of the four factors can result in poor sugar control. For example, if the other three factors are normally in balance, but the person decides to constantly drink sugared soda, good blood sugar control will likely be lost. Similarly, with a lot of stress, the adrenaline levels will be high and will raise the blood sugar levels. Finally, exercise is important both for "burning" extra sugar and for making people more sensitive to insulin. Thus, all four of these factors must be in balance to result in the best sugar control possible for any person.

How Is Sugar Control Measured?

It is not always possible to decide whether a person has good or poor blood sugar control. Some helpful things that reflect sugar control are the following:

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Control of symptoms of Diabetes

A person who goes to the bathroom very frequently (particularly if a person is getting up two or more times per night) or who is often thirsty has obvious symptoms of high blood and urine sugar. This person usually needs more insulin, less sugar in the diet, or more daily exercise.

Occasionally, blurred vision may occur as a symptom of poor sugar control. High sugar levels in the lens of the eye pull water into the lens; this makes it difficult to change the shape of the lens to focus for clear vision. If the blurred vision does not improve when blood sugar control improves, the eye doctor should be contacted.

Vaginal yeast infections are more common in females with diabetes, particularly if blood sugar levels have been high. This may be because yeast grows well in a high sugar environment. When antibiotics are taken for bacterial infections, yeast also tends to grow as bacteria disappears. If vaginal itching or burning is noticed, the diabetes care provider should be contacted.

Blood Glucose (Sugar) Measurements

ll families with someone with diabetes must have a method in the home for measuring blood sugars and must know how to do the tests accurately. Studies have shown that checking the blood sugars and using the test results are as important for good sugar control as is insulin shots or an insulin pump. If good sugar levels are achieved 50-60% of the time, the glucose control is usually good. If more than 50% of the values are consistently above the desired range of if more than 10% of the values are below these levels, the sugar control is not good and the diabetes care provider needs to be contacted. It is important not to be unhappy with a blood test result, but instead to always be pleased that the test was done. Hopefully, the results will be used to help attain better sugar control.

By H. Peter Chase, M.D.
Barbara Davis Center for Childhood Diabetes
Department of Pediatrics