4 key factors of type 2 diabetes management

A good type 2 diabetes management plan can improve your overall health and help prevent some of the common—and potentially serious—complications from the condition. These include heart disease, kidney disease, vision problems that can lead to blindness, and foot problems that can increase the risk for amputation (removal of a part of the body such as a toe or foot, often requiring surgery).

Types of diabetes

There are two types of diabetes.

• Type 1 diabetes is an autoimmune disease, which causes the immune system to attack healthy tissues in the body. People with this type do not make insulin. Insulin is a hormone that carries sugar (glucose) from the food you eat into cells where it can be used for energy.
• Type 2 diabetes is different from type 1 diabetes. People with type 2 diabetes can make insulin. But they may not make enough, or their body might resist it.

Both type 1 and type 2 diabetes cause blood sugar to rise to levels that are higher than normal. Over time, this can cause damage throughout the body.

Type 2 diabetes is much more common than type 1 diabetes. There is no way to prevent type 1 diabetes. But you can take steps to greatly lower your risk of developing type 2 diabetes. These include adopting healthy lifestyle habits, like maintaining a healthy weight and staying active.

Treatment for diabetes depends on which type you have. Type 1 diabetes is often managed with insulin, careful monitoring of blood sugar levels, exercise, and changes to diet. People with type 2 diabetes may or may not need insulin, as well as other medicines to control their blood sugar levels. Type 2 diabetes treatment also includes some lifestyle changes.

The ABCs of type 2 diabetes management

When you have type 2 diabetes, you should closely monitor three key areas: blood sugar levels and HbA1C, blood pressure, and cholesterol. These are sometimes referred to as the ABCs of diabetes management. Monitoring these can also help you make lifestyle changes to improve your type 2 diabetes control.

Here's what to know about these three areas.

Blood sugar levels

It’s important to check your blood sugar levels on an ongoing basis. If you are taking insulin, monitoring your blood sugar levels is important to lower your HbA1C (a measure of your average blood sugar levels over the previous three months). Even if you are not on insulin, monitoring them may help you adjust your diet, exercise, and medications.

According to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), the recommended blood sugar levels are 80 to 130 mg/dL before a meal and less than 180 mg/dL two hours after you started a meal. When your blood sugar level drops below 70 mg/dL, you may experience hypoglycemia (low blood sugar). Alternately, if your blood sugar goes above 200 mg/dL, you may experience hyperglycemia (high blood sugar). Both conditions can be dangerous. Your healthcare provider (HCP) will tell you how many times per day you should check your blood sugar levels and may recommend you use a continuous glucose monitor.

An A1C test (also called hemoglobin A1C, HbA1c, or glycohemoglobin test) measures the percentage of your red blood cells that have sugar-coated hemoglobin. Hemoglobin is the protein that carries oxygen in red blood cells. A1C tells you how well you are managing your type 2 diabetes over time.

Keeping your A1C below 6.5 to 7 percent is crucial for preventing or slowing the progression of diabetes-related complications for most people, says Darria Long Gillespie, MD, clinical assistant professor at the University of Tennessee Health Science Center. There may be different goals for people with cognitive impairment (difficulty thinking, remembering, or making decisions), who have more than one chronic illness, or who are dependent on others for day-to-day functioning.

Insulin and oral or injectable diabetes medications can help you control your blood sugar when diet and lifestyle changes are not enough. In fact, long-acting types of insulin, alone or in combination, may help maintain blood sugar at a steadier level for longer lengths of time.

Blood pressure

Blood pressure measures the force at which blood pushes on blood vessel walls. Too much pressure can damage arteries and raise your risk for heart disease. It can also cause kidney and eye disease.

Both the American Diabetes Association and the American Heart Association have released updated guidelines for blood pressure control. Medication should be used to lower blood pressure to less than 130/80 if lifestyle measures are not effective. Everyone with diabetes and high blood pressure should monitor their blood pressure at home.

Cholesterol

Blood tests can measure your levels of cholesterol and triglycerides (fat-like substances in the blood). One type of cholesterol, high-density lipoprotein, (HDL, "good" cholesterol) is good for your heart health. Too much low-density lipoprotein (LDL, "bad" cholesterol) and triglycerides can raise your risk for heart disease.

Cholesterol control is important for people with type 2 diabetes, since the condition increases your risk for heart disease. You may be prescribed a statin, a medication intended to lower levels of LDL cholesterol. The following is recommended by experts:

• People between ages 20 and 39 who have additional heart disease risk factors should consider statin therapy.
• People ages 40 to 75 years with no heart disease risk factors old should receive moderate-intensity statin therapy.
• People ages 40 to 75 with at least one heart disease risk factor and an LDL cholesterol of at least 70 mg/dL should receive high-intensity statin therapy.

You can help raise HDL and lower LDL by eating a heart-healthy diet, maintaining a healthy weight for you, and getting regular physical activity as you are able. If these efforts are not enough, you may need medications to help reach your cholesterol level goals.

Making lifestyle changes

Following a healthy lifestyle can help you manage your type 2 diabetes and reduce your risk for many other health problems. These include those not related to type 2 diabetes, such as cancer.

"When it comes to diet and diabetes, limiting foods with high sugar, highly processed foods, and trans and saturated fats [which are solid at room temperature, like butter] are crucial for helping maintain blood sugar control and preventing complications,” says Gillespie. Healthy food choices include fresh fruits and vegetables, beans, whole grains, lean protein like chicken and fish, and low- or non-fat dairy.

Exercise also has benefits. “Getting regular physical activity helps to lower your blood pressure, maintain good control over your blood sugar, and facilitates weight loss,” Gillespie says. (Being overweight or obese can increase your risk for diabetes and heart disease.) “Aim for at least 30 minutes of exercise most days. You can even break it into smaller increments throughout the day.”

Smoking raises your blood pressure and cholesterol and damages your blood vessels. Quitting smoking is one of the best things you can do to help you manage type 2 diabetes and improve your overall health. There are plenty of scientifically proven ways to quit smoking, including using effective smoking cessation aids and medication. If you smoke, talk to your HCP about which strategies for quitting are available to you or may be covered by your insurance.

A Diabetes Record Form will help you to keep track of your ABCs. Ask your HCP for a form or download one online and bring your filled-out document to each appointment.