Intensive insulin therapy: Achieving tight blood sugar control

If you have type 1 diabetes — and in some cases if you have type 2 diabetes — intensive insulin therapy may be the key to long-term health.

This aggressive therapy isn't easy, but the benefits are real. Find out how intensive insulin therapy can help you achieve desired blood sugar control and what intensive insulin therapy requires of you. Then you and your health care team can decide if intensive insulin therapy is the best approach for you.

What is intensive insulin therapy?

Intensive insulin therapy is an aggressive treatment approach designed to control your blood sugar levels. Intensive insulin therapy requires close monitoring of blood sugar levels and frequent doses of insulin.

If you choose to try intensive insulin therapy, you'll work with your doctor to set various goals. Ideally, this means:

• Blood sugar level before meals: 70 to 130 milligrams per deciliter (mg/dL), or 3.9 to 7.2 millimoles per liter (mmol/L)
• Blood sugar level two hours after meals: less than 180 mg/dL (10 mmol/L)
• Hemoglobin A1C (glycated hemoglobin, an indicator of your blood sugar control for the past few months): less than 7 percent

What are the benefits of intensive insulin therapy?

Intensive insulin therapy can prevent or slow the progression of long-term diabetes complications. In fact, in one study, tight control of blood sugar levels reduced the risk of diabetes-related heart attacks and strokes by more than 50 percent.

Older studies provide appealing statistics as well. Intensive insulin therapy can:

• Reduce the risk of eye damage by more than 75 percent
• Reduce the risk of nerve damage by 60 percent
• Prevent or slow the progression of kidney disease by 50 percent

And there's more good news. Intensive insulin therapy can boost your energy and help you feel better in general.

What's the commitment?

To achieve tight blood sugar control with intensive insulin therapy, you must follow a strict treatment regimen.

• You'll need frequent doses of insulin. You may need an injection of short-acting insulin before each meal and an injection of intermediate or long-acting insulin before you go to bed. Or you may choose to use an insulin pump, which releases insulin into your body through a plastic tube placed under the skin on your abdomen. The pump delivers a continuous infusion of short-acting insulin and a bolus — extra insulin to cover an expected rise in blood sugar — before meals.
• You must check your blood sugar often. You'll need to check your blood sugar at least four times a day, before meals and bedtime — probably more often than you're used to. It's also important to track the results of each blood sugar test.
• You must closely follow your eating and exercise plans. What you eat has a direct effect on your blood sugar. Physical activity also influences blood sugar. Your doctor may ask you to track what you eat and how much you exercise in a detailed diary.

Diabetes record (PDF file requiring Adobe Reader)

What are the risks of intensive insulin therapy?

Intensive insulin therapy may lead to:

• Low blood sugar. When you have tight blood sugar levels, any change in your daily routine — such as exercising more than usual or not eating enough — may cause low blood sugar (hypoglycemia). Be aware of early signs and symptoms, such as anxiety, sweating and shaking, and respond quickly. Drink a glass of orange juice or suck on a few pieces of hard candy. Your doctor may recommend carrying glucose tablets.
• Weight gain. When you use insulin to lower your blood sugar, the sugar in your bloodstream enters cells in your body instead of being excreted in your urine. Your body converts the sugar your cells don't use for energy into fat, which can lead to weight gain. To limit weight gain, closely follow your exercise and meal plans.

Is intensive insulin therapy right for you?

Intensive insulin therapy is recommended for most people who have type 1 diabetes and some people who have type 2 diabetes — but it isn't right for everyone.

Intensive insulin therapy may not be for you if:

• You struggle with frequent or severe bouts of low blood sugar
• You are a child
• You are an older adult
• You have heart disease, blood vessel disease or severe diabetes complications

Recent research has also challenged the benefits of and raised concerns about achieving glucose levels that are similar to those found in people who don't have diabetes. This is particularly true for individuals with type 2 diabetes who attempt to achieve A1C levels lower than 6 percent. However, additional research is needed to clarify what factors may contribute to the lack of benefit and increased risk in this group. If you have type 2 diabetes, talk to your doctor about whether intensive insulin therapy is right for you.

Ultimately, it's up to you and your health care team to decide if intensive insulin therapy is for you. This decision should be based on the potential risks and benefits the therapy may offer for your specific situation.

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