Ideally, type 1 diabetics should maintain their levels of glycosylated hemoglobin (HbA1c) at a value of less than 6.5. This should be balanced against the risk of hypoglycaemia and hence a value of <7 is still widely accepted. The HbA1c reflects the average blood glucose control over the last three months.
Hypoglycaemia (low blood glucose) is a complication of insulin therapy, with the number of attacks increasing with tighter control. The cause of hypoglycaemia should always be investigated and appropriate action should be taken to prevent further episodes.
In diabetics with an increased risk for hypoglycaemia, for example elderly people, people with renal, liver or cardiac failure, alcoholics and people with poor socio-economic status, HbA1c control should be relaxed.
Apart from diabetic control, all other risk factors for vascular disease should be carefully monitored and treated. These risk factors often go hand-in-hand with diabetes, and include dyslipidaemia (abnormal levels of fats in the body) and hypertension (high blood pressure).
Reviewed by Dr Suresh Rajpaul (MbChB, FCPsa)