- Glucose control - when and how to measure sugar
- Glycemic control - glycated hemoglobin HbA1c
- Recommended frequency of blood glucose testing
- Diabetes compensation criteria
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Balanced glycemia is the primary goal of diabetes treatment, and at the same time a way for a diabetic to live a long and he althy life, without any serious organ complications. But how to take care of good glycemic control? What test results should a diabetic patient have?
Glucose control(i.e. blood glucose level) is the basis of diabetes treatment, because both too high blood glucose (hyperglycemia) and too low (hypoglycemia) can cause serious consequences for the body. However, the control of diabetes mellitus depends not only on glucose concentration, but also on the level of lipids, blood pressure and the correct body weight.
All these parameters are closely correlated - patients with diabetes who start to eat properly, check their sugar regularly and at the same time stay physically active, soon notice that their blood glucose, blood pressure, as well as cholesterol and cholesterol improve. triglycerides are close to normal.
Glucose control - when and how to measure sugar
In order to control the level of glucose, you must first of all systematically control it and properly react to any fluctuations. Of course, it is not simple, and it depends on many factors - such as the treatment of diabetes, i.e. whether the patient is taking oral antidiabetic drugs, or insulin administered in the form of multiple injections or continuous subcutaneous infusion, or whether the patient is only on a diet.
In addition, you need to take into account the fact that physiologically glucose concentration is higher in the morning, in the afternoon it decreases, and e.g. stress increases sugar periodically, while infections - around the clock.
A diabetic should therefore have extensive knowledge about his disease and how to react in certain situations, and also remember to regularly check the blood glucose level. The latter is associated with the cumbersome pricking of the fingers to collect a blood sample and test it with a glucometer. Over time, the still punctured pads harden and become keratinized, which is why some people stop checking up as often as they should. In order not to neglect this important research, it is worth using special moisturizing and lubricating creams that nourish and rebuild the skin on the hands.
Glycemic control - glycated hemoglobin HbA1c
Another methodGlycemic control is a test of the percentage of glycated hemoglobin HbA1c. It is performed once every three months in patients who have not yet achieved glycemic control and once a year in patients with a stable disease course.
This study shows the average blood glucose level for the last three months, with about 50 percent. HbA1c in the blood is formed in the last month.
Thanks to this test, we can also find out if the excess glucose caused damage to tissues, blood vessels or nerves, and if so, to what extent.
However, it must be remembered that the percentage of glycated hemoglobin is an average value. There may be times when a patient who has low blood glucose levels and then reactive spikes in blood glucose will have the same HbA1c value as someone who has stable blood glucose levels. Therefore, the HbA1c test should not be considered an alternative to daily finger sugar measurements, but both should be performed.
Recommended frequency of blood glucose testing
| Diabetes treatment | Frequency of blood glucose measurements during self-monitoring |
| Multiple (i.e. at least 3 times a day) injections of insulin. Intensive functional insulin therapy, regardless of the type of diabetes | Multiple (i.e. at least 4 times a day) measurements during the day according to the agreed treatment principles and the patient's needs |
| Patients treated only with diet | Shortened blood glucose profile once a month (fasting and 2 hours after main meals) and once a week at different times of the day |
| Patients using oral antidiabetic drugs and / or GLP analogues | Abbreviated blood glucose profile once a week (fasting and after main meals), 1 test daily at different times of the day |
| Patients with type 2 diabetes treated with constant doses of insulin | Daily 1-2 measurements of blood glucose, additionally a shortened glycemic profile once a week (fasting and after main meals) and once a month daily blood glucose profile |
| All sick | Ad hoc measurements in the event of malaise, sudden deterioration of he alth, etc. |
Source: Polish Diabetes Society
Diabetes compensation criteria
The goal of diabetes treatment is to obtain the desired values for blood glucose, blood pressure, lipid profile, and body weight. They are:
Aims to balance the carbohydrate balance:
- HbA1c ≤ 7.0% in most patients
- HbA1c ≤ 6.5% in type 1 diabetes, in short-term diabetestype 2 and in children and adolescents regardless of the type of disease
- HbA1c ≤ 8.0% in elderly and / or diabetic patients with complications of macroangiopathy (past myocardial infarction, stroke) and / or multiple comorbidities
- HbA1c<6,5% u kobiet planujących ciążę, <6,0% w II i III trymestrze ciąży, jeżeli nie wiąże się z większą częstością hipoglikemii
Since a sudden reduction in blood glucose levels can lead to episodes of hypoglycaemia, the above levels should be achieved gradually, and the intensity of treatment in each case must be adjusted to the patient's condition and the capabilities of the patient's body.
Aims of lipid balance:
- LDL cholesterol concentration:<70 mg/dl (<1,9 mmol/l) lub redukcja o co najmniej 50%, jeżeli wyjściowo stężenie LDL-C mieściło się w przedziale 70-135 mg/dl (1,9-3,5 mmol/l) u osób z cukrzycą bardzo wysokiego ryzyka sercowo-naczyniowego
- LDL-C concentration<100 mg/dl (2,6 mmol/l) lub redukcja o co najmniej 50%, jeżeli wyjściowo stężenie LDL-C mieściło się w przedziale 100-200 mg/dl (2,6-5,2 mmol/l) u osób z cukrzycą wysokiego ryzyka sercowo naczyniowego
- LDL-C concentration<115 mg/dl (3,0 mmol/l) u osób małego i umiarkowanego ryzyka sercowo-naczyniowego (osoby <40 rż. z cukrzycą typu 1 bez przewlekłych powikłań i innych czynników ryzyka sercowo naczyniowego)
- "non-HDL" cholesterol<100 mg/dl (2,6 mmol/l) u osób z cukrzycą bardzo wysokiego ryzyka sercowo naczyniowego
- "non-HDL" cholesterol<130 mg/dl (3,4 mmol/l) u osób z cukrzycą wysokiego ryzyka
- "non-HDL" cholesterol<145 mg/dl (3,7 mmol/l) u osób <40 r. ż. z cukrzycą typu 1 bez powikłań naczyniowych i innych czynników ryzyka sercowo-naczyniowego
- HDL cholesterol:>40 mg / dL (>1.0 mmol / L) [for women 10 mg / dL (0.275 mmol / L) higher]
- triglyceride concentration:<150 mg/dl (<1,7 mmol/l)
Blood pressure control purposes:
- systolic pressure:<140 mm Hg
- diastolic pressure:<90 mm Hg
In diabetics with newly diagnosed hypertension and still without organ complications, try to get the pressure<130/80 mm Hg. Jednak zawsze w przypadku złej tolerancji niskiego ciśnienia dąży się do uzyskania wartości najbardziej zbliżonych do referencyjnych, które są dobrze tolerowane przez chorego.
Source: Polish Diabetes Society