By Alan L. Rubin, Cait James

Doctors consider your blood glucose normal when it’s less than 100 mg/dl (5.5 mmol/L) if you’ve eaten nothing for 8 to 12 hours. If you’ve eaten, your blood glucose is normal if it’s less than 140 mg/dl (7.8 mmol/L) two hours after eating. If you never see a blood glucose level higher than 140, you’re doing very well, indeed. You can use many tricks to achieve this level of control.

Knowing your blood glucose

No excuse is adequate for you to not know your blood glucose at all times. The capability to measure blood glucose accurately and rapidly is the greatest advance in diabetes care since the discovery of insulin. Yet many people don’t track their blood glucose.

How can you know what to do about your blood glucose if you don’t know what it is in the first place?

If you have very stable blood glucose levels, test once a day — some days in the morning before breakfast, other days in the evening before supper. Varying the time of day you test your blood glucose gives you and your doctor a clearer picture of your control under different circumstances.

Using exercise to control your glucose

When people are asked how much exercise they do, about a third say that they do nothing at all. If you’re a person with diabetes and consider yourself a part of that group that doesn’t exercise, then you aren’t taking advantage of a major tool — not just for controlling your blood glucose but also for improving your physical and mental state in general.

When a large group of people who were expected to develop diabetes because both parents had diabetes participated in a regular exercise program in one recent study, 80 percent who stayed on the program didn’t develop diabetes.

Taking your medications

You have the advantage of having some of the best drugs for diabetes available to you, which wasn’t true as recently as 15 years ago. With the right combination of medications (and by using some of the other tools available to you), just about any patient can achieve excellent control. But no medication works if you don’t take it.

The word compliance applies here. Compliance refers to the willingness of people to follow instructions — specifically, taking their medications. People tend to be very compliant at the beginning of treatment, but as they improve, compliance falls off. Diabetic control falls off along with it.

The fact is, as you get older, the forces that contribute to a worsening of your blood glucose tend to get stronger. You want to do all you can to reverse that tendency. Taking your medications is an essential part of your overall program.

Seeking immediate help for foot problems

One error that leads to a lot of grief in diabetes is failure to seek immediate help for any foot problems. Your doctor may see you and examine your feet only once in two or three months. You need to look at your feet every day. At the first sign of any skin breakdown or other abnormality (such as discoloration), you must see your doctor.

In diabetes, foot problems can go from minor to major in a very brief time — major problems may mean amputation of toes or more. You can reverse most foot problems, if you catch and treat them early. You may require a different shoe or need to keep weight off the foot for a time — minor inconveniences compared to an amputation.

Taking immediate action goes for any infection you develop as a diabetic. Infections raise the blood glucose while you’re sick. Try to avoid taking steroids for anything if you possibly can. Steroids really make the glucose shoot up.

Brushing off dental problems

Keeping your teeth in excellent condition is important, but especially if you have diabetes. “Excellent condition” means brushing them twice a day and using dental floss at the end of the day to reach where the toothbrush never goes. It also means visits to the dentist on a regular basis for cleaning and examination.

Many people with diabetes have dental problems as a result of poor dental hygiene. As a side effect, controlling the blood glucose is much harder.

People with diabetes don’t have more cavities than non-diabetics, but they do have more gum disease if their glucose isn’t under control. Gum disease results from the high glucose that bathes the mouth — a perfect medium for bacteria. Keeping your glucose under control helps you avoid losing teeth as a result of gum disease, as well as the further deterioration in glucose control.

Maintaining a positive attitude

Your mental approach to your diabetes plays a major role in determining your success in controlling the disease. Think of diabetes as a challenge — as you overcome challenges in one area of your life, the skills you master help you in other areas. Looking at something as a challenge allows you to use all your creativity.

Some people do get depressed when they find out they have diabetes. If you’re depressed and your depression isn’t improving after several weeks, consider seeking professional help.

Planning for the unexpected

Life is full of surprises — like when you were told you have diabetes. You probably weren’t ready to hear that news. But you can make yourself ready to deal with surprises that may damage your glucose control.

Most of those surprises have to do with food. You may be offered the wrong kind of food, too much food, or too little food, or the timing of food doesn’t correspond to the requirements of your medication. You need to have plans for all these situations before they occur.

You can always reduce your portions when the food is the wrong kind or excessive, and you can carry portable calories (like glucose tablets) when food is insufficient or delayed.

Becoming aware of new developments

The pace of new discoveries in diabetes is so rapid that keeping on top of the field is difficult even for us, the experts. How much more difficult must it be for you? You don’t have access to all the publications, the drug company representatives, and the medical journals that we see every day.

However, you can keep current in a number of ways. The following tips can help you stay up-to-date on all the advances:

  • Begin by taking a course in diabetes from a certified diabetes educator. Such a course gives you a basis for a future understanding of advances in diabetes. The American Diabetes Association provides the names of certified diabetes educators.

  • Join a diabetes organization, particularly the American Diabetes Association. You’ll start to receive the association’s excellent publication, Diabetes Forecast, in the mail, which often contains the cutting edge of diabetes research as well as available treatments.

  • Go to Dr. Rubin’s website, where you can find linkable addresses for the best and latest information about diabetes on the Net.

  • Finally, don’t hesitate to question your doctor or ask to see a diabetes specialist if your doctor’s answers don’t satisfy you.

Utilizing the experts

The available knowledge about diabetes is huge and growing rapidly. Fortunately, you can turn to multiple people for help. Take advantage of them all at one time or another, including the following people:

  • Your primary physician

  • A diabetes specialist

  • An eye doctor

  • A foot doctor

  • A dietitian

  • A diabetes educator

  • A pharmacist

  • A mental health worker

Take advantage of any or all of these people when you need them. Most insurance companies are enlightened enough to pay for them if you use them.

Avoiding what doesn’t work

Not wasting your time and money on worthless treatments is important. When you consider the almost 20 million people with diabetes in the United States alone, they provide a huge potential market for people with “the latest wonder cure for diabetes.” Before you waste your money, check out the claims of these crooks with your diabetes experts.

Don’t make any substantial changes in your diabetes management without first discussing them with your physician.