Intensive insulin therapy can help prevent long-term diabetes complications. Consider the benefits.
If you have type 1 diabetes — or you have type 2 diabetes and oral medications aren't keeping your blood sugar levels within your target range — 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 tight blood sugar control and what it requires of you. Then you and your health care team can decide if it's the best approach for you.
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 exciting 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 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 catching a cold — may cause low blood sugar (hypoglycemia). Be aware of early signs and symptoms, such as irritability and chills, 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 or glucose gel.
- 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.
In addition to the known risks of intensive insulin therapy, current research has raised new concerns about intensive insulin therapy in people who have type 2 diabetes and are at high risk of heart disease.
Among 10,000-plus participants in a government-sponsored trial called Action to Control Cardiovascular Risk in Diabetes (ACCORD), early analysis showed that 257 participants receiving intensive insulin therapy for type 2 diabetes with a target A1C level less than 6 percent had died since the beginning of the trial — compared with 203 participants receiving standard treatment with a target A1C level between 7 percent and 7.9 percent. About half the excess deaths were related to heart disease. Due to the possible risks, in February 2008 researchers halted the part of the trial that required intensive insulin therapy.
Participants in the ACCORD trial have type 2 diabetes and are at high risk of heart disease due to factors such as high blood pressure, high cholesterol or obesity. Although the research findings suggest that intensive insulin therapy with a target A1C level less than 6 percent may be detrimental for people who share these characteristics, the risks may not apply to everyone who has type 2 diabetes.
Last Updated: 02/09/2008
