Blood Sugar Monitoring
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Diabetes A to G

A1C Tests and Blood Sugar Monitoring
Blood Pressure
Cholesterol
Diet: Planning for Healthy Eating
Exercise: Choosing Your Activity
Family, Friends, and Feelings
Good Days With Diabetes

A1C Tests and Blood Sugar Monitoring

The A1C test is a standard test that shows the average amount of sugar (glucose) in your blood over the past 2 to 3 months—as well as how well your blood sugar is being controlled over time. A1C can be measured with a blood test in a laboratory or at your doctor's office.

Keeping track of A1C is important, because high blood sugar can, over time, lead to problems, including damage to the blood vessels. The vessel walls become thicker and less elastic, making it harder for blood to pass through.

Talk with your health care provider about what your A1C target should be. Even if your A1C is higher right now than is recommended, remember that every step toward your A1C target helps reduce your risk of problems associated with diabetes.

According to the 2006 American Diabetes Association Guidelines, for most patients with diabetes, the recommended A1C target is less than 7%. Another group of experts, the American Association of Clinical Endocrinologists, recommends an even lower A1C target of 6.5% or less.

Daily Sugar Self-Monitoring

Experts say that most people with diabetes should try to keep their blood sugar level as close as possible to a normal level. The closer to normal your blood sugar is, the lower your chances are of developing damage to your eyes, kidneys, and nerves. Your health care team (including your doctor, nurse, diabetes educator, and dietitian) will help you learn:

  • The right blood sugar range for you
  • The self-testing methods that are right for you, including how to check your blood using a blood sugar meter
  • How often you should check your blood sugar and when

Some people check their blood sugar once a day. Others do it 3 or 4 times a day. You may check before and after eating, before bed, and sometimes in the middle of the night. If your blood has too much or too little sugar, you may need a change in your meal plan, exercise plan, or medicine.

Low Blood Sugar (Hypoglycemia)

In general, a blood sugar reading lower than 70 mg/dL is too low. Low blood sugar happens more often when you're trying to keep your sugar level near normal. This is not a reason to stop trying to control your diabetes; just watch carefully for low levels. Low blood sugar is usually caused by eating less or later than usual, being more active than usual, or taking diabetes medicine that may not be matched to your needs at that time. Learn to recognize the symptoms of low blood sugar. These may include feeling nervous, shaky, sweaty, or just tired. First symptoms may be mild but may worsen quickly if not treated.

If you have signs of low blood sugar, test your blood right away. If your blood sugar level is less than 60 mg/dL, immediately eat or drink something sweet, such as 1/2 cup of juice (4 oz), 3 teaspoons of honey, or 3 to 5 pieces of hard candy. You may need to have a meal or snack within 30 minutes. Waiting to treat low blood sugar is not safe.

High Blood Sugar (Hyperglycemia)

For many people, the normal blood sugar range is 70 to 140 mg/dL, with the higher reading occurring mainly after meals. For most people, blood sugar levels that stay higher than 140 mg/dL (before meals) are too high. When your blood sugar is high, you may have these common symptoms: dry mouth, thirst, frequent urination, tiredness, blurred vision, stomach pain, and weight loss without trying. If you have any of these symptoms, test your blood right away. Reasons for high blood sugar include eating too much, being less active than usual, being sick or under stress, or needing an adjustment in your diabetes medicine.

Talk with your health care team about the blood sugar range that is right for you.

To help prevent high and low blood sugar levels

  • Stay as close to your schedule of eating, activity, and medicine as possible.
  • Check your blood sugar as directed, and share your tracking records with your health care providers.
  • Set goals with your health care team for weight, activity, blood sugar level, and A1C level.
  • Wear something that lets others know that you have diabetes, such as a necklace or bracelet, in case of an emergency.
  • Always carry something sweet (such as hard candy) with you so that you can treat a low blood sugar level at any time.

Talk to your health care provider if you frequently experience high or low blood sugar levels. You may need to discuss changes in diet, activity, or diabetes medicine.

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Blood Pressure

A blood pressure reading measures the force of blood as it presses against the inside walls of the blood vessels.

Blood pressure is written as 2 numbers:

  • Systolic blood pressure (top number) is the force when the heart pumps.
  • Diastolic blood pressure (bottom number) is the force between heart pumps.

High blood pressure (hypertension) may not cause symptoms, but over time it damages the heart, other organs, and blood vessels. High blood pressure is dangerous because it makes your heart work too hard and contributes to hardening of the arteries (atherosclerosis). It increases your risk of heart disease and stroke, which are leading causes of death among Americans. High blood pressure also can result in other conditions, such as congestive heart failure, kidney disease, and blindness.

According to the 2006 American Diabetes Association guidelines, for appropriate patients with diabetes, the blood pressure goal is less than 130/80 mm Hg.

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Cholesterol

Your body needs cholesterol (a type of fat) to function properly. Cholesterol helps your body digest food, build new cells, and produce hormones. However, as with many things in life, too much of a good thing can become bad for you over time.

LDL (bad) cholesterol can damage arteries. When you have type 2 diabetes, LDL cholesterol is often smaller and denser than normal. It may be especially dangerous to artery walls and often cannot be fully corrected through blood sugar control.

HDL (good) cholesterol works to clear LDL cholesterol from the blood, helping to keep arteries healthy. When you have type 2 diabetes, HDL cholesterol levels are often lower than normal. This means that less LDL cholesterol can be cleared from the blood, increasing the risk of artery damage.

Triglycerides
Triglycerides are another type of fat in the blood. Having type 2 diabetes can lead to elevated triglyceride levels. HDL helps take triglycerides out of the blood like it does with LDL cholesterol. Elevated levels of triglycerides prevent HDL from removing normal amounts of LDL cholesterol from the blood. This sets the stage for deposits of cholesterol and other materials (plaque) to form, which can be dangerous.

According to the 2006 American Diabetes Association guidelines, targets in appropriate patients with diabetes are

  • HDL cholesterol greater than 40 mg/dL for men
  • HDL cholesterol greater than 50 mg/dL for women
  • LDL cholesterol less than 100 mg/dL
  • Triglycerides less than 150 mg/dL

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Diet: Planning for Healthy Eating

The thought of a diet can feel overwhelming. However, diet is not solely about eating less of the foods that you love or about losing weight—it is also about making some simple lifestyle modifications that you can enjoy and maintain. It may surprise you to find that you can still eat many of the foods that you like. Learn more about making informed decisions at common fast-food establishments.

The American Diabetes Association offers the following recommendations from each food group:

  • Breads, grains, and other starches
    The foods in this group contain mostly carbohydrates. Choose 6 to 11 servings per day.
  • Vegetables
    Vegetables are low in fat and full of vitamins, minerals, and fiber. Choose 3 to 5 servings per day.
  • Fruits
    Fruits contain carbohydrates and have plenty of vitamins, minerals, and fiber. Choose 2 to 4 servings per day.
  • Milk
    Milk products contain plenty of protein, calcium, and vitamins. Select nonfat or low-fat dairy products. Choose 2 to 3 servings per day.
  • Meat, meat substitutes, and other proteins
    Proteins are full of vitamins and minerals. Choose 4 to 6 ounces per day divided between meals.
  • Fats, oils, and sweets
    Try to keep servings small.

You should discuss your specific dietary needs with your health care provider. Eating a variety of foods from the basic food groups as directed by a health care provider may help manage your diabetes. Also, remember that you don't have to accept weight gain (a side effect of some diabetes medications) as part of the process of controlling diabetes. Discuss with your health care team all the things that could be affecting your weight, including your medication, the foods you eat, and your exercise program.

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Exercise: Choosing Your Activity

Regular exercise is important for everyone, but it is especially important if you have diabetes. Regular exercise helps control the amount of sugar in the blood and increases levels of HDL (good) cholesterol. It also burns excess calories and fat to help you achieve optimal weight.

However, exercise doesn't necessarily mean spending hours at the gym or running for miles. It can mean many kinds of physical activity. Choose an activity that you enjoy, or try a new activity!

Activities may include

  • Walking around the block
  • Dancing
  • Taking the stairs instead of the elevator
  • Bowling
  • Biking to work
  • Mowing the lawn
  • Vacuuming
  • Gardening and pulling weeds
  • Swimming a few laps
  • Parking the car farther away from your destination and walking
  • Washing your car

Do some physical activity each day. If you haven't been very active lately, talk to your health care provider first, and then begin slowly. Start with 5 to 10 minutes and then add more time, or exercise for 10 minutes 3 times a day. Read about 30 easy ways to get 30 minutes of exercise a day.

It is important to work with your health care provider to create an exercise program that is right for you.

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Family, Friends, and Feelings

Living with diabetes can be a daily challenge—and can be emotionally difficult at times. It is important to understand that many other people with type 2 diabetes have similar feelings.

It is also important to know that you don't have to deal with your diabetes alone. With the support of your family and friends, your health care team, and your community, you can take charge of your diabetes.

Build your own personal support system of family and friends. Explain your condition to them, and suggest specific ways that they can help support you. Your family and friends want to see you healthy and enjoying each day.

Consider joining a diabetes support group, where people can talk about their diabetes and share how they deal with it. If there are no support groups in your area, you may want to call a diabetes organization about starting one. One-on-one and family counseling sessions may also help. Your health care provider can help you find a counselor.

Ask your health care provider about ways to handle stress. If you are feeling sad or are unable to cope with problems, ask about how to get help.

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Good Days With Diabetes

You will have good days and bad days with diabetes. It may help to think of every day as a new opportunity to do something good for yourself. You don't have to make all your changes at once. Take small steps. Set a manageable goal each day, and work to achieve it.

Celebrate every lifestyle improvement that you make, no matter how small.

Feel good about your efforts to manage your diabetes. Understand that even though every day may not be perfect, you can always start fresh with your next meal.

It may help to realize how much control you do have over your diabetes. You will feel good knowing that what you do each day will be helpful down the road. Your efforts can help control the disease and help you to live a long, healthy, happy life.

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