Managing blood glucose: Finding the right balance
1/9/2025 by Elizabeth Miles, APRN, C.N.P.
Managing diabetes means finding a good balance in different parts of life. This includes balancing the disease with other health issues and keeping mental and physical health in line with life's other demands. It also means considering the benefits and risks of treatment and lowering blood sugar.
Diabetes is recognized by elevated blood glucose levels caused by:
- Your body is not making enough insulin, using it well, or both (type 2).
- Your pancreas is not producing insulin (type 1).
Diabetes complications
The concern around poorly controlled blood sugar levels is that it affects almost every part of your body.
Diabetes:
- Is the 8th leading cause of death in the U.S.
- Is the leading cause of new cases of blindness among adults.
- Is the leading cause of chronic kidney disease (CKD).
- Can increase the risk of needing lower limb amputation.
- Significantly increases the risk of heart disease and strokes.
- Can damage nerves, causing numbness and pain in your feet and legs as well as unstable blood pressure and pulse. It can also affect digestion.
- Can affect your teeth and gums, which could lead to tooth loss.
- Can increase the risk of depression.
Measuring glucose control
Controlling blood sugar levels is the key to reducing the risk of these complications. There are two ways to measure glucose control:
- Blood glucose monitoring:
- Self-monitoring of blood glucose (SMBG): This means using a blood sugar meter to check your blood sugar levels at different times during the day, depending on your diabetic program. You do this by pricking your finger and putting a small drop of blood on a test strip.
- Continuous glucose monitoring (CGM):
- This system uses a small sensor under the skin to measure blood sugar levels all day and night. It gives real-time data and shows trends.
- Hemoglobin A1c (HbA1c) test:
- This blood test measures the average glucose level during the past 2-3 months. It provides a longer-term view of blood sugar control and is usually done in a healthcare setting.
HbA1c and blood glucose goals
Blood sugar goals and treatment should be personalized because every person is different. To prevent serious complications from diabetes, it is important to aim for goals that are right for you. The American Diabetes Association provides general goals appropriate for most people but stresses the importance of individualizing these goals based on discussions with your healthcare clinician. More stringent goals of an A1c of 7% or less may be recommended if they can be achieved safely with an acceptable burden of therapy. Less stringent goals, an A1c up to 8%, may be recommended if the risks and burdens outweigh the potential benefits. Working with your healthcare clinician to determine your A1c and glucose goals is essential.
Hyperglycemia (high blood sugar)
Blood sugar levels above 180 mg/dL are considered high, corresponding to a HbA1c of 8%. These levels may indicate the need for changes to your diabetes program. It is crucial to discuss high blood sugar levels with your healthcare clinician and how you should treat them when and if they occur.
Symptoms of high sugar can include:
- No symptoms.
- Increased thirst.
- Frequent urination.
- Blurred vision.
- Feeling weak or unusually tired.
- Confusion.
- Loss of consciousness.
- Nausea and vomiting
Hypoglycemia (low blood sugar)
Trying to lower blood sugar too much can lead to levels that are too low, something referred to as hypoglycemia. Blood sugar levels under 70 mg/dL are considered low. Blood sugars at this level can be harmful and should be treated promptly, including assessing why it occurs and identifying steps to prevent it from happening again.
Symptoms of low sugar can include:
- No symptoms.
- Feeling shaky, nervous or anxious.
- Sweating, chills and clamminess.
- Irritability or impatience.
- Confusion.
- Fast heartbeat.
- Feeling lightheaded or dizzy.
- Hunger.
- Nausea.
- Feeling sleepy.
- Feeling weak or having no energy.
- Vision changes.
- Tingling or numbness in lips, tongue or cheeks.
- Seizures.
Finding the right balance
Balance changes over time, so what worked for you before might not work now. That's why talking with your healthcare team about your goals, preferences and concerns is very important. Together, you can find a diabetes treatment plan that is right for you.
Elizabeth Miles, APRN, CNP, is a family nurse practitioner in the Department of Endocrinology, Diabetes, Metabolism, and Nutrition. She specializes in managing type 1 and type 2 diabetes and has over 15 years of experience in endocrinology. Elizabeth is an Instructor in Medicine and Associate Program Director for the Mayo Clinic School of Health Sciences Nurse Practitioner Program.