You've probably heard your child's doctor talk a lot about "diabetes control," which usually refers to how close the blood sugar, or glucose, is kept to the desired range. What does this mean and why is it important?

When Diabetes Isn't Under Control

Too much or not enough sugar in the bloodstream can lead to short-term problems that must be treated right away, like hypoglycemia, hyperglycemia, or diabetic ketoacidosis.

Too much sugar in the bloodstream also can cause long-term damage to the vessels that supply blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems.

These problems don't usually affect kids or teens with diabetes who've had the disease for only a few years. But they can occur in adults with diabetes, particularly if they haven't managed or controlled their diabetes properly.

Kids with diabetes who don't control their blood sugar levels may also have problems with growth and development and can even experience a delay in the onset of puberty.

Also important is avoiding frequent and/or severe episodes of hypoglycemia (low blood sugar), which can interfere with participation in school and other activities, making it hard for kids to cope with their diabetes and achieve a healthy, happy childhood and adulthood.

Controlling diabetes means keeping blood sugar levels as close to normal as possible. It's a three-way balancing act: Your child's medications (such as insulin), food, and activity level all need to be balanced to keep blood sugar levels under control. If any one of these is off, blood sugar levels will be, too.

In general, poorly controlled blood sugar levels can be due to any of the following:

• not taking medications as prescribed
• not following the meal plan (like eating too much or not enough food without adjusting medications)
• not getting regular exercise or not making the necessary adjustments in the diabetes treatment plan when there is a significant change in physical activity level
• illness or stress
• not monitoring blood sugar levels closely enough so that changes can be recognized and addressed promptly

The Benefits of Good Control

The complications associated with diabetes can seem frightening, but the good news is that studies have shown that people with diabetes who keep their blood sugar levels as close to normal as possible have a much lower likelihood of developing diabetes complications.

One large study showed that people with type 1 diabetes who checked blood sugar levels four or more times a day — and adjusted the amounts of insulin and other diabetes medicines, diet, and exercise based on their readings — had a reduced risk of developing eye disease, kidney problems, nerve damage, and high cholesterol levels (a major risk factor for heart disease).

How to Know if Diabetes Is Under Control

How do you find out if your child's diabetes is under control? First, the diabetes health care team will tell you what the blood sugar levels should be (the "target" range), which is based on factors such as your child's age and medical condition.

Day to day, the only way to know if the blood sugar levels are close to your child's target range is to measure them several times a day with a glucose meter. The diabetes health care team will recommend how and when to test based on your child's treatment plan. Checking regularly and keeping an organized and accurate record of the results will ensure that the health care team has the information needed to adjust your child's diabetes management plan.

Besides daily checks with a glucose meter (to measure the current blood sugar level), you might also use the glycosylated hemoglobin test, which shows blood sugar levels over a longer period. The HbA1C test will give you and the health care team information about your child's blood glucose control during the 2 to 3 months before the test.

Helping Your Child Control Diabetes

Helping your child achieve good blood sugar control can be challenging. Here are some tips:

• Make sure your child takes insulin or other diabetes medicines as prescribed.
• Provide meals and snacks that fit into your child's meal plan.
• Encourage your child to engage in regular physical activity.
• Check blood sugar levels often and make changes in the treatment plan with guidance from the diabetes health care team.
• Make sure your child gets regular medical checkups.
• Learn as much as possible about diabetes.

Working with the diabetes health care team will help you better understand and manage the challenges of diabetes and help your child avoid many of the problems associated with it.

Reviewed by: Steven Dowshen, MD
Date reviewed: April 2011