Harvard Heart Letter

ACCORD's discord on blood sugar control

Tight control still essential, but no consensus on how low you should go.

High and wildly fluctuating levels of sugar (glucose) and insulin in the bloodstream are the hallmarks of diabetes. They can injure nerves and small blood vessels, which can lead to vision loss, kidney failure, erectile dysfunction in men, or the loss of a foot or leg. Damage to larger blood vessels is also common "" nearly two out of three people with diabetes die of a heart attack, stroke, or other form of cardiovascular disease.

A big question for managing diabetes has long been "How low should you go with blood sugar?" Is it necessary to drive down blood sugar to the level seen in healthy people without diabetes, or can it linger a bit above that?

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