How to Deal with Diabetes with Intensive Therapy


Intensive diabetes therapy is an at­tempt to imitate the way a normal pancreas responds to the body’s need for insulin. It involves frequent blood glucose testing (four or five times a day) and consequent adjustment of insulin dose and meal plan depending on the results of the blood glucose test. In fact, the insulin dose and food intake may change from day to day.

If this seems like a bigger nuisance than conventional ther­apy, it is, but it works. Do not put yourself on intensive therapy, but you may want to discuss the possibility with your physician—who may have already broached the subject. If you do decide to try it, your physician or diabetes educator will show you how. It’s somewhat complex although by no means impossible to learn.

Diabetes

Conventional diabetes therapy focuses on anticipating what you think your insulin needs will be for the next several hours, based on what you plan to eat. This assumes that you will be able to keep in balance all the factors that affect blood glucose. Some­time you can and sometimes you can’t.

Intensive therapy assumes that your eating habits, physical activity, general health, and metabolism are not always the same. To help your body deal with these normal fluctuations, you must test your blood glucose frequently and then take a dose of insulin based both on what your future needs will be, as well as in re­sponse to your present blood glucose level. This attempts to mimic a normal pancreas, which is able to sense the level of glu­cose in the blood and then respond with a release of the correct amount of insulin.

People who usually derive the most benefit from intensive therapy are Type I diabetics who have had the disease for a while and who are adept at using conventional therapy. Diabetics in the early stages of Type I still have some functioning beta cells and therefore do not need intensive therapy.

Because the therapy requires so much attention, and because it causes the diabetes to always be “in your face,” intensive ther­apy requires a high degree of commitment. But for people whose diabetes is in poor control, who are at especially high risk for com­plications, who are pregnant or who plan to become pregnant, or who have an unpredictable lifestyle, intensive therapy is worth it.

The DCCT was done on only Type I diabetics, but most dia­betes specialists believe that it also can be beneficial for Type II diabetics. This makes sense because the focus of intensive therapy is on maintaining normal blood glucose, not on the type or amount of medication taken. In Type II, the goal is achieved mainly through diet and physical activity, although some Type II diabetics will require oral hypoglycemic agents, and maybe even insulin, to achieve tight control. Many diabetics, both Type I and Type II, say they feel better after they have been on intensive therapy for a while because their glucose-insulin patterns closely resemble normal ones.

The major goal of intensive therapy is precision: keeping blood glucose as close to normal as possible for as long as possi­ble. However, this is not as uncomplicated as it sounds. First, there is the question: What precisely is normal? There is a normal range, but how do you decide which of a range of normal numbers is “normal enough”? Second, diabetics must decide how far they are willing to go in interrupting the flow of their daily life in order to achieve this tight control.

There is, as yet, no good answer to the first question, and the second decision is a function of your own values. How far out of your way are you willing to go in order to prevent complications? There is no “right” answer to this; it depends on your lifestyle, what your ultimate goals are, and how you see yourself in relation to your diabetes. Also, you don’t have to make a decision this minute. The option to do intensive therapy will always be there should you decide to wait.

Having said all this, you should know that intensive therapy isn’t for everyone. In fact, there are some people who probably should not begin intensive therapy: those who have a history of severe, frequent hypoglycemia; people younger than seven or older than seventy; cardiac patients; those with severe complica­tions; people who cannot see well or who cannot manipulate dia­betes equipment; those who abuse drugs or alcohol; and people who don’t have the intellectual capacity to make reasonable deci­sions or who are otherwise unable to manage their own care.

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About the Author: Andrew Reinert is a health care professional who loves to share different tips on health and personal care. He is a regular contributor to MegaHowTo and lives in Canada.

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