Blood glucose levels are tightly controlled in the body, so that after eating a meal glucose is promptly taken up by cells and is either stored for later or used to do perform cellular work. If the regulatory mechanisms of glucose control are compromised, glucose can build-up in the blood. Chronically high glucose levels can cause damage to multiple organs including the heart, blood vessels, eyes, kidneys and nerves. The most common disease that affects blood glucose control is diabetes, which results in the body does not making enough insulin and prevents cells from responding well to insulin. The basic steps for blood glucose regulation are to reduce weight if persons are overweight by changing the diet and increasing exercise; implementing drug therapy and to self monitor blood glucose levels.
Guidelines
The American Diabetes Association recommends that fasting blood glucose levels stay in the range of 70 to 130 mg/deciliter and that they remain below 180 mg/dL two hours after consuming a meal. A1C levels estimate average blood glucose concentrations over a two to three month time period. The American Diabetes Association states that diabetics should try to keep A1C levels below seven percent in order to delay or prevent diabetes complications.
Diet
In individuals that are overweight, high blood glucose levels are significantly reduced by weight loss. A study published in the June 2007 issue of the "American Journal of Clinical Nutrition" found that a diet low in fat and high in fruits and vegetables substantially decreased weight in obese women. Other effective diets found to decrease weight include those incorporating carbohydrates that break down more slowly during digestion, meal replacement strategies and caloric restriction. A weight loss of approximately nine pounds ameliorates hyperglycemia, reports the January 2009 issue of "Diabetes Care". However, if weight loss is not sustained the effects on blood glucose control disappear.
Exercise
A clinical trial study published in the September 2007 issue of "Annals of Internal Medicine" found that both aerobic exercise and resistance training improve glycemic control in Type 2 diabetes and the effect is greater if both types of exercise are combined. Exercise is encouraged for Type 1 diabetics also, but exercise may make blood glucose levels too low and adjustments to the insulin dose may be prescribed prior to exercising.
Anti-diabetic Drugs
The American Diabetes Association recommends that initial treatment of diabetes begin with diet and exercise along with Metformin treatment. A review article published in the April 2010 issue of the "International Journal of Clinical Practice" reports that Metformin consistently improves glycemic control in diabetics without causing weight gain in contrast to thiazolinediones and sulfonylureas. Additionally, Metformin reduces the risk of cardiovascular disease. The newer classes of anti-diabetic drugs, GLP-1 receptor agonists and DPP-4 inhibitors also have been found to effectively reduce blood glucose levels without causing weight gain. The American Association of Clinical Endocrinologists/American College of Endocrinology Consensus Panel reported in the October 2009 issue of "Endocrine Practice" GLP-1 receptor agonists and the DPP-4 inhibitors reduce hyperglycemia, do not cause weight gain and decrease the risk of cardiovascular disease.
Glucose Monitoring
Both the American Diabetes Association and The American Association of Clinical Endocrinologists/American College of Endocrinology Consensus Panel recommend regular blood glucose monitoring in conjunction with lifestyle intervention and anti-diabetic drugs to manage blood glucose levels. Self-blood glucose monitoring is helpful in managing blood glucose levels after meals and in preventing hypoglycemia, particularly in Type 1 diabetics during and after exercise. New devices that continuously monitor blood glucose levels by detecting glucose from probes inserted under the skin were shown in a randomized controlled trial published in "Diabetes Care" to decrease the frequency of hyperglycemia and hypoglycemia in diabetics.
References
- Diabetes.org: Tight Diabetes Control
- "American Journal of Clinical Nutrition": Dietary Energy Density in the Treatment of Obesity: a Year-long Trial Comparing 2 Weight-loss Diets
- "Diabetes Care": Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy
- PubMed:"Annals of Internal Medicine": Effects of Aerobic Training, Resistance Training
- "International Journal of Clinical Practice": Comparing the Actions of Older and Newer Therapies on Body Weight: to What Extent Should These Effects Guide the Selection of Antidiabetic Therapy?
