Controlling blood sugar in diabetes: How low should you go?(Report)

Controlling blood sugar in diabetes: How low should you go?

Diabetes is an ancient disease, but the first effective drug therapy was not available until 1922, when insulin revolutionized the management of the disorder. Insulin is administered by injection, but treatment took another great leap forward in 1956, when the first oral diabetic drug was introduced. Since then, dozens of new medications have been developed, but scientists are still learning how best to use them. And new studies are prompting doctors to re-examine a fundamental therapeutic question: what level of blood sugar is best?

Normal metabolism

To understand diabetes, you should first understand how your body handles glucose, the sugar that fuels your metabolism. After you eat, your digestive tract breaks down carbohydrates into simple sugars that are small enough to be absorbed into your bloodstream. Glucose is far and away the most important of these sugars, and it's an indispensable source of energy for your body's cells. But to provide that energy, it must travel from your blood into your cells.

Insulin is the hormone that unlocks the door to your cells. When your blood glucose levels rise after a meal, the beta cells of your pancreas spring into action, pouring insulin into your blood. If you produce enough insulin and your cells respond normally, your blood sugar level drops as glucose enters the cells, where it is burned for energy or stored for future use in your liver as glycogen. Insulin also helps your body turn amino acids into proteins and fatty acids into body fat. The net effect is to allow your body to turn food into energy and to store excess energy to keep your engine running if fuel becomes scarce in the future.

A diabetes primer

Diabetes is a single name for a group of disorders. All forms of the disease develop when the pancreas is unable to supply enough insulin to meet the body's needs. In some cases, the problem is a low supply, in others, the body resists the insulin it has, and in still others, it's both a low supply and insulin resistance.

Type 1 diabetes usually begins abruptly before the age of 20, often with a critical rise in blood sugar levels. The disease is caused by a combination of genetic abnormalities and environmental triggers that cause the body's immune system to attack the pancreas, destroying its ability to produce insulin. Since insulin is required for glucose to enter cells, blood sugar levels rise sharply. Type 1 diabetes is …