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Tight control: Is it right for you?

The pros and cons to tight control and not only how it helps manage your blood sugar but also how to determine if it's the right treatment for you

Health Monitor Staff

Provided by HealthMonitor

With high blood sugar the hallmark of diabetes, it seems logical that keeping your blood sugar around the 150 mg/dL mark or lower (that’s an A1C of 7% or less)—a strategy known as “tight” control—would be the right treatment for all diabetes patients. But some researchers say it's not that simple.

The pros
“Tight control is right for most diabetes patients,” confirms endocrinologist Thomas Donner, MD, associate professor of medicine and acting director of the Johns Hopkins Comprehensive Diabetes Center. According to a study in the Archives of Internal Medicine, type 1 patients who kept their A1C levels at or below 7% for 6½ years following diagnosis warded off complications, such as retinopathy and kidney disease. And British researchers who followed more than 5,000 people with type 2 diabetes for 20 years found that tight control lowered the risk of complications by 25%. Indeed, if you’re in the early stages of type 1 or type 2, tight control may reduce damage to small blood vessels—the culprit that causes eye, kidney and nerve problems.
People also generally feel much better and have more energy when their blood sugar levels are closer to normal. Take Massachusetts resident Jenny Ruhl, 63. Using a combination of carbohydrate restriction and oral medication, she’s avoided all complications since being diagnosed with type 2 diabetes 14 years ago. “My goal is to keep my A1C in the 5% range [about 110 mg/dL].” That may not always be easy, but it’s worth the effort, says Jenny, who’s especially motivated by her family history. “I didn’t want to die of a heart attack in my 50s like my uncles did, or develop kidney disease like my grandmother.”

The Cons
In a landmark study of tight control in type 1 diabetes patients, researchers found it tripled the risk of low blood sugar, which can cause confusion, dizziness and coma. In older people, low blood sugar may even lead to strokes or heart attacks. Says Dr. Donner, “The older you get and the more the disease progresses, the more likely you are to have complications from aggressive control.” Plus, the stress of achieving tight control can take its toll—it means monitoring frequently and, often, taking multiple doses of different types of insulin throughout the day.

The Bottom Line
Discuss the strategy with your doctor and diabetes educator (see the sidebar for questions to ask) and weigh the pros and cons for a decision you can really thrive with!
Just Ask!
1.Do you think I am a candidate for tight control? If so, why?
2.Should I aim to keep my A1C levels at 7% (about 150 mg/dL), or is it safe for me to aim for 6.5% or less?
3.If I opt for tight control, how many times a day will I have to monitor my blood sugar levels? How often will I need to administer insulin or take other medication?
4.Will tight control cause me to gain weight? If so, will that override the benefits?
Diabetes Mellitis (Type II) Renal Failure Balance Confusion Disoriented Dizziness Loss Of Balance Mental Status Change Stress Unsteadiness Woozy Humalog Diabetes Myocardial Infarction

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