Fasting <7, post-meal <10? Wrong! Doctors reveal the 6 key points and 3 cores behind individualized and precise sugar control

Many diabetic patients know that there is a "standard answer" to the sugar control target: fasting blood sugar 4.4-7.0 mmol/L, postprandial blood sugar <10.0 mmol/L, and glycated hemoglobin <7%.

But in fact, doctors often adjust the target value according to the specific situation of the diabetic.

For example, the doctor was satisfied if 70-year-old Aunt Wang’s fasting blood sugar was controlled at 8.0 mmol/L, while 45-year-old Mr. Zhang was required to keep his fasting blood sugar level below 6.5 mmol/L.

Many diabetics are not clear about the scientific basis behind this.

Today, we will uncover the “decision-making code” that doctors use to set individualized blood sugar control goals.

1. 6 immutable factors: “fixed parameters” that cannot be changed

1. Age: Sugar control goals change with age

Young people (e.g., <40 years old): They are in good physical condition, have a high risk of long-term complications, and need to strictly control their blood sugar (e.g., fasting 4.4-6.1 mmol/L).

Elderly people (eg, >65 years): The older you are, the more relaxed your target should be (eg, fasting 5.0-8.3 mmol/L).

2. Diabetes course: The difficulty of controlling sugar goes hand in hand with the disease

Newly diagnosed patients: Pancreatic islet function is more preserved, and targets can be set more stringently (eg, glycated hemoglobin <6.5%).

Patients with long-term illness (e.g., >15 years): often accompanied by complications, safety should be the first priority (e.g., glycated hemoglobin <8.5%).

3. Life expectancy: sugar control needs to be tailored to individual needs

Long life expectancy (eg, >15 years): Long-term prevention of complications is needed and goals can be set more stringently.

People with short life expectancy (such as patients with advanced cancer): Quality of life should be prioritized, and if necessary, blood sugar lowering targets may not even be set.

4. Important complications: “chain reaction” in organ function

Important complications of diabetes include: hypertension, hyperlipidemia, coronary heart disease, myocardial infarction, heart failure, renal failure, tumors, stroke, chronic obstructive pulmonary disease, emphysema, depression, arthritis, etc.

Multiple/severe comorbidities: The more comorbidities a person has (e.g., more than three) and the more severe the condition (e.g., stage 3-4 congestive heart failure), the more relaxed the blood sugar target should be.

Few/mild comorbidities: If you have 1-2 combined diseases and the conditions are relatively mild, you can set stricter blood sugar control goals.

In addition, attention should be paid to whether there is a serious infection to avoid other serious complications such as diabetic ketoacidosis caused by drastic fluctuations in blood sugar.

5. Vascular complications: a dangerous minefield in sugar control

Multiple/severe vascular complications: If the patient has had a myocardial infarction or cerebral infarction, excessive fluctuations in blood sugar may induce a secondary infarction. Such people should pursue stable blood sugar lowering (such as glycated hemoglobin 7.5%-8.5%).

Few/mild vascular complications: more stringent blood sugar control goals can be pursued.

6. Hypoglycemia tolerance: a fragile “life switch”

Elderly people living alone and those with cognitive impairment: Once a hypoglycemia event occurs, it may be life-threatening because no one discovers it, so the blood sugar target value needs to be appropriately adjusted upward.

On the contrary, young people, those with care and normal cognition can control their blood sugar more strictly.

2. 3 variable factors: The "joint decision-making" between you and your doctor affects the results of blood sugar control

1. Patient’s subjective will: treatment is a “two-way journey”

Active cooperation type: Diabetics actively adjust their diet, exercise intervention, and cooperate with the doctor's sugar control plan, and can try more stringent goals.

For those with poor compliance: you can first set phased goals (such as reducing 0.5 mmol/L per month) to avoid “breaking the jar”.

2. Resources and support system: the “logistics team” for sugar control

Strong support: For example, there are positive factors such as nearby diabetes lecture halls, diabetes peer support groups, family members who can participate in diabetes management, good economic conditions, etc., so patients can challenge refined blood sugar management (such as continuous glucose monitoring).

On the contrary, blood sugar targets are appropriately relaxed.

3. Drug risks: a double-edged sword for controlling sugar levels

Use of high-risk hypoglycemia drugs : such as insulin, sulfonylureas, and glinides. The risk of hypoglycemia is high, and the fasting blood glucose target value needs to be reasonably adjusted upward.

Use drugs with low risk of hypoglycemia : If SGLT-2 inhibitors/GLP-1 receptor agonists are used, the risk of hypoglycemia is low and more stringent targets can be set.

Conclusion

The sugar control target is never a cold number, but a "symphony of life" drawn up by doctors after comprehensively considering physical condition, disease risk, and living conditions.

Only by understanding the logic behind individualized sugar control can we manage blood sugar more scientifically and accurately, and thus enjoy a more comfortable and higher quality life.