Defining Good Control

This is information assembled from the ADA website, and a number of other sources, written as I understand it. Cross reference and double check the accuracy of what I am presenting.

The ADA defines tight diabetes control quite differently than I do. This is for two reasons:

1. I got my attitudes on diabetes control when I was pregnant. Many OBs have VERY strict control guidelines for diabetes during pregnancy.

2. They are approaching it from a different perspective, and one of dealing with the averages, and of targeting a wide range of needs. My philosophies are based on my personal goals, and the achievability of them.

They consider that tight control is maintaining a 2 hour post-prandial reading of less than 180. I consider that tight control is maintaining a post-prandial reading of less than 120 (which is actually normal). But I feel that way because this is what is achievable for me, since I am not on insulin.

If you are not using insulin, then your major control strategy is diet and exercise. And the biggest factor is diet. I have a yet undiagnosed muscular disorder which prevents me from exercising effectively, so I have to focus totally on diet. If I eat too much, my blood sugar goes out of control. If I control quantities, it stays tightly controlled.

Once you add insulin injections into the picture, it becomes more complex, but also more flexible in some ways. As long as you are not using your insulin as a justification for eating whatever you want, then you can adjust it to compensate for those times when you have a bit more.

Insulin also changes the expectation of how tightly you can control your blood sugar though. In previous decades, home monitoring was not possible, so doctors had to recommend a level of insulin that kept the blood sugar artificially high because that was the only way to keep people from having dangerously low blood sugar too often. They had to find a level that balanced the patient and kept them from dying either from astronomically high, or extremely low blood sugar. This meant that cellular deterioration from diabetes was a given, and tight control was not a possibility.

Home monitoring means that you can have better control, and the recommendation of 180 post-prandial was appropriate for the initial era of home monitoring. Tighter control was possible, but with the insulin types available, extremely tight control was still not practical. Insulin injections have an effectiveness span of several hours or more, so even timing them to coincide primarily with food consumption, if the insulin level is high enough to achieve a reading of 120 in two hours, the individual might have dangerously low levels in three to four hours. So a balance still had to be struck.

Newer insulin types and delivery options give more flexibility to control, and make it simpler to achieve tighter control. The ADA may or may not eventually adjust their recommendations, because they still realize that they are dealing with many people who simply do not want to take the extra effort to achieve tight control. And for some patients, it might be an unacceptable risk if they are prone to hypoglycemia.

Advances in insulin pump technology mean that for many insulin dependent diabetics, the ability to control blood sugar more and more naturally is becoming available. I have read of newer pumps which are being designed with the ability to monitor blood sugar levels and respond to them on an individual basis. While a machine will never quite be able to do what the body does naturally, such technology could change the long term risks associated with diabetes in a fundamental way.

Many diabetics who were diagnosed with diabetes several decades ago are struggling to change their attitudes along with the advances in technology. The entire world of injections and monitoring have changed radically in the last 20-25 years. While readings over 200 were common for a diabetic, and just part of the disease two decades or more ago, they are not now, and in most cases, need not be! The choices for tighter control mean that a diabetic is given more tools with which to delay the onset of common complications and secondary conditions associated with diabetes. But it also means that you have much more responsibility to actually USE the tools. A home monitor gives you the ability to be on top of your care, and to take an active role in limiting many of the potential risk factors, but in order for it to be of use, you must learn how to use it correctly, and then DO it. And I know so many people who are happy to be given the means to do just that, because it becomes the primary way in which they can keep their body healthy, and not let diabetes beat them.

The role of supplements in tight control is not the simple mathematical calculation that insulin and carb counting is. Each supplement produces a different result for each person, and they should be added one at a time so that effects can be observed, and so that negative effects can be adjusted for, or so the offender can be easily isolated and eliminated if necessary. I have found that an effective supplement may lower my post-prandial readings by as little as 5 points, or as much as 70 points. Since my diabetes seems to be progressing, the effect does not last more than a few weeks at most, and I end up needing to find another one, and will eventually need insulin supplementation. Many supplements though, will enhance blood sugar control whether you take insulin or not. A few will even help lower highs AND eliminate dangerous lows, because they do not just lower blood sugar, they improve body functions in other ways.

Any supplement should be discussed with your doctor, and you should monitor your sugar levels very closely while testing one, and be ready to adjust your diet or insulin in response to any changes that the supplement causes.

Written by Laura Wheeler, Owner of Firelight Business Enterprises, Inc.