Keeping your blood glucose level down

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Treatment aim 1 - keeping your blood glucose level down

How is the blood glucose level monitored?

The blood test that is mainly used to keep a check on your blood glucose level is called the HbA1c test. This test is commonly done every 2-6 months by your doctor or nurse.The HbA1c test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your average blood glucose level over the last 2-3 months.

Treatment aims to lower you HbA1c to below a target level which is usually agreed between you and your doctor. The target level is usually somewhere between 6.5% and 7.5%. If your HbA1c is above your target level then you may be advised to 'step up' treatment to keep your blood glucose level down (for example, by increasing the dose of medication, etc). Some people with diabetes check their actual blood glucose level each day. If you are advised to do this then you doctor or nurse will give you instructions on how to do it.

Lifestyle - diet, weight control and physical activity

You can usually reduce the level of your blood glucose and HbA1c if you:

Eat a healthy balanced diet. A practice nurse and/or dietician will give details on how to eat a healthy diet. The diet is the same as recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Basically, you should aim to eat a diet low in fat, high in fibre, and with plenty of starchy foods, fruit and vegetables.
Lose weight if you are overweight. Getting to a 'perfect weight' is unrealistic for many people. However, losing some weight if you are obese or overweight will help to reduce your blood glucose level (and have other health benefits too).
Do some physical activity regularly. If you are able, a minimum of 30 minutes brisk walking at least five times a week is advised. Anything more vigorous and more often is even better. For example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day. (For example, two fifteen minute spells per day of brisk walking, cycling, dancing, etc.) Regular physical activity also reduces your risk of having a heart attack or stroke.

Many people with Type 2 diabetes can reduce their blood glucose (and HbA1c) to a target level by the above measures. However, if the blood glucose (or HbA1c) level remains too high after a trial of these measures for a few months, then medication is usually advised.

Medication

There are various drugs that can reduce the blood glucose level. Different ones suit different people. Some drugs work by helping insulin to work better on the body's cells. Others work by boosting the amount of insulin made by the pancreas. Another type works by slowing down the absorption of glucose from the gut. Some people need a combination of drugs to control their blood glucose level. Medication is not used instead of a healthy diet, weight control and physical activity - if possible, you should still do these things as well as take medication. See a separate leaflet called 'Treatments for Type 2 Diabetes' for more details.

Insulin injections

Insulin is needed in some cases if the above treatments do not work well enough. You cannot take insulin by mouth as it is destroyed by the digestive juices in the gut.