Controlling diabetes involves more than just taking medication. To stay well and live longer, diabetics must make a commitment to maintaining a healthy lifestyle, such as regular exercise and a healthy diet to stay at a healthy weight, not smoking and being aware of their blood sugar (also known as blood glucose) levels.

All Type 1 diabetics need to take insulin because their bodies do not make enough of this substance. Insulin injections require a very thin, short needle and are easy to self-administer, but are inconvenient and can be uncomfortable. Now, implanted insulin pumps are available, which provide a steady stream of insulin to the body. The user then programs the pump to give a higher dose of insulin when it is needed, before meals.

Most Type 2 diabetics do produce insulin, but their bodies are not using it correctly. For them, pills are used rather than insulin shots. There are many types of diabetes pills; each type works in a different way to keep the blood sugar at a normal level. Some Type 2 diabetics can control their disease with diet, exercise and weight loss alone.

Most diabetics need to check their blood sugar levels at home regularly. Some check once a day; others may need to check four or more times a day. Home blood glucose meters are small devices that require a drop of blood to be drawn from a fingertip. The device then gives a reading. Ideally, blood sugar levels should be between 90 and 130 before meals for most people, and no higher than 180 after meals.

High blood sugar levels are called hyperglycemia; low blood sugar is called hypoglycemia. If blood sugar levels are frequently above or below the target range, a diabetic needs to talk to a diabetes expert about changing their medication, diet and/or exercise plan. Extremely high (above 240) or low (below 70) blood sugar levels are dangerous; every diabetic needs to know what to do in these cases.

Another blood test called glycosylated hemoglobin (also known as HbA1C or just A1C) indicates how high your blood sugar levels have been on average over the previous three months. This test is done by a lab, and is usually ordered every three to six months. An A1C of 7 or less is desirable.

It’s also very important for diabetics to keep their blood pressure at 130/80 or less, and their LDL cholesterol level at 100 or less.

High blood sugar causes damage to the body over time. The organs most likely to be damaged by high blood sugar levels are the blood vessels and heart, eyes, nerves and kidneys.

Heart disease is the greatest risk for people with diabetes. High cholesterol levels and blood pressure compound the damage done by diabetes, further increasing heart disease risk. Heart attacks and strokes are the cause of death for 65 percent of diabetics.

People with diabetes are at risk for vision loss because high blood sugar levels damage the tiny blood vessels of the eyes. Diabetic retinopathy is the most common eye problem. Signs include blurry or double vision, flashing lights, blank spots in the vision and loss of ability to see out of the corners of your eyes. Early cataracts and glaucoma can also affect diabetics.

Nerve damage in diabetics is called diabetic neuropathy. Over the years, diabetics may notice numbness, tingling or pain in the feet, hands, arms and legs. Erectitile dysfunction (impotence) in diabetic men is related to nerve damage, also.

Kidney disease is another major complication for diabetics. Eventually, the kidneys can fail to function, so dialysis or a kidney transplant becomes necessary.

Keeping blood sugar levels within the normal range can minimize these complications.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU.