Treatment
Insulin is essential for strict control of blood glucose levels in type 1 diabetes. Tight blood glucose control is the best way to prevent major complications in type 1 diabetes including those that affect the kidneys, eyes, nerve pathways, and blood vessels. Intensive insulin treatment in early diabetes may even help preserve any residual insulin secretion for at least 2 years.
There are, however, some significant problems with intensive insulin therapy:
- There is a higher risk for low blood sugar (hypoglycemia).
- Many patients experience significant weight gain from insulin administration, which may have adverse effects on blood pressure and cholesterol levels. It is important to manage heart disease risk factors that might develop as a result of insulin treatment.
A diet plan that compensates for insulin administration and supplies healthy foods is extremely important. [For detailed information, see In-Depth Report #42: Diabetes diet.] Pancreas transplantation eventually may be recommended for patients who cannot control glucose levels without frequent episodes of severe hypoglycemia.
Regimens for Intensive Insulin Treatment
The goal of intensive insulin therapy is to keep blood glucose levels as close to normal as possible. In one major study, even when levels were 40% higher than nondiabetic levels, benefits were still observed.
Glucose Goals for Patients with Diabetes |
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Normal |
Goal |
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Blood glucose levels before meals |
Less than 110 mg/dL (or 6.1 mmol/L) |
90-130 mg/dL (or 5-7.2 mmol/L) |
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Bedtime blood glucose levels |
Less than 120 mg/dL (6.6 mmol/L) |
110-150 mg/dL (or 6.1-8.3 mmol/L) |
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Glycated hemoglobin (HbA1c) levels |
4 - 6% |
Less than 7% |
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From Diabetes Management in the 21st Century: Multiple Therapeutic Options for Achieving Glycemic Control, Diabetes and Endocrinology Treatment Updates, © 2000 Medscape, Inc. |
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Standard insulin therapy is usually one or two insulin injections, one daily blood sugar test, and visits to the health care team every 3 months. For strictly controlling blood glucose, however, intensive management is required. The regimen is complicated although newer insulin forms may make it easier.
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