Patients often ask, “Doctor, why does my blood sugar not come down?” Or “Why does my blood sugar go up and down?” . This problem cannot be explained clearly in a few words, because there are many factors affecting blood sugar, including diet, exercise, medication, blood sugar monitoring, psychological factors and so on. We often talk to patients about the fact that we are treating diabetes in patients with diabetes and not just diabetes. Here we will list the common clinical “offenders” that affect blood sugar control. 1, poor dietary control Diet therapy is the basis of diabetes treatment. Whether type 1 diabetes or type 2 diabetes, whether or not medication is applied, diet should be controlled regardless of the severity of the disease. There are two extremes in diet control for patients. The first is to eat and drink without paying any attention to diet control, and the other is to be afraid to eat anything, close to “starvation therapy”. In fact, the diet control is to scientific ratios, not only to meet the normal energy needs of the physiology, but also to not consume too much calories. 2, lack of exercise As with diet control, exercise is also one of the foundations of diabetes treatment for diabetics. The benefits of exercise are that it can mobilize the body’s peripheral glucose application, reduce weight, increase insulin sensitivity, it can also soothe the nerves, relax the mood and reduce blood sugar fluctuations. Exercise should be aerobic exercise (jogging, brisk walking, swimming, etc.), master the appropriate amount of exercise intensity, avoid high-intensity anaerobic exercise. 3, bad psychological factors Psychological factors have great influence on blood sugar. For example: tension, anxiety, great joy and sadness, insomnia, depression, irregular life, staying up late, etc. will lead to an increase in the secretion of glucagon, which will raise blood sugar and is not conducive to the control of blood sugar. 4, inappropriate selection of hypoglycemic drugs Diabetic patients should be individualized treatment. The type of diabetes, pancreatic islet function, age, gender, fat and thin, blood sugar fluctuations, etc. will affect the effect of glucose-lowering drugs. For example, obese type 2 diabetic patients should be given insulin sensitizers and biguanide glucose-lowering drugs. This is because type 2 diabetic patients are mainly insulin resistance with insulin relative secretion deficiency, excessive supplementation of insulin will not only not increase the effect of insulin in lowering sugar, but also increase the degree of insulin resistance and obesity, forming a vicious circle. Many type 2 diabetic patients will suffer from islet failure as the disease progresses. Many glucose-lowering drugs (e.g. insulin stimulants) are applied on the premise that they have certain islet function, and when the islet function fails, the effect of such drugs will be greatly reduced or even invalidated, resulting in high blood sugar. 6, insulin resistance Insulin resistance is commonly known as insulin can not play a normal role in lowering sugar. Many obese type 2 diabetic patients are accompanied by different degrees of insulin resistance, at this time, the simple application of insulin promoter or insulin can not play a very good effect of lowering sugar, at this time should be combined with the improvement of insulin resistance of hypoglycemic drugs. 7, the impact of stress factors surgery, trauma, infection, acute cardiovascular events, pregnancy, etc. are all stress factors. Stress will increase the secretion of glucose-raising hormone and weaken the hypoglycemic effect of insulin, leading to the increase of blood glucose in patients. Therefore, for many patients with high blood glucose, attention should be paid to exclude stress factors and find the cause. 8, neglect blood glucose monitoring Regular blood glucose monitoring is helpful to understand the condition and guide the medication. In the clinic, many patients neglect blood glucose monitoring and follow their senses with medication, so their blood glucose is high and low, and the control is very unstable, and some patients only measure fasting blood glucose without paying attention to postprandial blood glucose. Therefore, regular monitoring of blood glucose is essential to control blood glucose. Some patients may miss or forget to take glucose-lowering drugs for various reasons, and some patients may stop applying glucose-lowering drugs because of normal blood glucose measurement, and then take the original glucose-lowering drugs when blood glucose rises, which often fails to achieve the original glucose-lowering effect, resulting in high and low blood glucose and great fluctuations. Here, we remind all diabetic patients to take glucose-lowering drugs regularly in order to reduce blood sugar, and to adhere to it for a long time. All in all, controlling blood sugar is a comprehensive and systematic project. When blood sugar is not well controlled, we must maintain a positive and optimistic attitude, pay attention to finding the causes and carry out targeted treatment, and it is not difficult to achieve good results in controlling blood sugar.