Diabetes Control Matters

A Closer Look At Intensive Insulin Therapy

Results of several studies have proven that intensive diabetes management delays the onset and significantly slows the progression of many diabetes complications. Therefore, greater emphasis is now being placed on intensifying insulin management of both type 1 and type 2 diabetes to maximize blood glucose control.

Intensive insulin therapy utilized flexible multiple insulin regimens that can be tailored to your metabolic requirements as well as lifestyle. Specific elements of the regimen include multiple daily injections or an insulin pump to maintain near normal blood glucose. In actuality, "intensive insulin therapy" should become more the norm and in the future perhaps not referred to as "intensive".

The critical ingredient of successful intensive insulin therapy is a knowledgeable patient who is motivated to achieve improved diabetes control through adherence to sound, individually determined self-management principles. Intensive insulin therapy is demanding and may not be advisable for some people. Hypoglycemia and fear of hypoglycemic episode are two major concerns for the individual managing intensive insulin therapy. Patients who are considered for intensive regimens must be assessed for hypoglycemia unawareness.

Elements of Intensive Insulin Therapy

• Multiple insulin injections (or insulin pump)
• Careful balance of food intake, physical activity, and insulin
• Self blood glucose monitoring (SBGM) several times each day.
• Adjustment of food intake, exercise, and insulin dosage.
• Individualized target blood glucose levels.
• Patient comprehension of and adherence to treatment plan.
• Quarterly hemoglobin A1c.
• Frequent contact between patient and health care team.

Patient Selection for Intensive Therapy

• Poor diabetes control with conventional therapy
• Motivation to pursue intensive therapy
• Able and willing to perform frequent SBGM
• Sufficient education and technical ability to follow program of intensive therapy
• Psychological stability adequate to manage intensive therapy
• Trained and skilled medical staff available to direct treatment program and provide increased attention.

Patient Selection For Pump Therapy

• Patients who have difficulty maintaining optimal control on multiple daily injections.
• Those who are concerned about preventing or delaying complications of diabetes, have kidney transplants, gastropahty, or painful neuropathy.
• Those with erratic daily eating and exercise schedules or who desire greater lifestyle flexibility.
• Pregnancy or concerning pregnancy.
• All persons with type 1 diabetes should be considered for insulin pump therapy.