Healthy Living and Fitness

Illness Care: Diabetes Type 1

Treatment

Insulin is essential for survival and is the mainstay treatment for Type I diabetics. A diet plan that compensates for insulin administration and supplies healthy foods is extremely important. Major studies have now provided substantial evidence that intensive treatment with insulin and tight control of blood glucose levels significantly delay the major complications specific to diabetes, including nephropathy and neuropathy. Intensive insulin treatment in early diabetes also helps preserve any residual insulin secretion for at least two years. The primary complication for intensive insulin therapy is a much higher risk for hypoglycemia. Many patients also experience significant weight gain with adverse effects on blood pressure and cholesterol levels. It is important then, to manage cardiovascular risk factors that might develop as a result of intensive treatment. Intensive treatment also appears to cause early signs of retinopathy; after four years, however, in one study, there was no difference in retinopathies between patients who had intensive treatment versus those on standard care. Pancreas transplantation eventually may be recommended for patients who cannot control glucose levels without frequent episodes of severe hypoglycemia.

The goal of intensive therapy is to keep blood glucose levels as close to normal as possible. In one major study even when levels were 40% higher than non-diabetic levels, benefits were still observed. Intensive treatment usually involves three or more daily insulin injections or use of an insulin pump. In addition, during the day the patient should take four or more blood glucose tests. The patient must also maintain a good diet plan and should visit the health care team of doctors, nurses, and dietitians once a month. (Standard insulin therapy is usually one or two insulin injections, one daily blood sugar test, and visits to the health care team every three months.) The regimen is complicated. To save time, some people administer injections directly through their clothing; although not recommended, one study found that it did not increase the risk for infection. Because of the higher risk for hypoglycemia, experts recommend that intensive treatment be used very cautiously in children under 13 and not at all in very young children. One study has indicated that thin children are at higher risk for hypoglycemia, because the injection goes into muscle tissue. Pinching the skin so that only fat tissue is gathered and not muscle or using shorter needles may help.

 

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