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Intensive blood glucose management

A major research study in the early 1990s proved that the best way to avoid complications of diabetes is to follow what is called "intensive blood glucose management."

This is the highest standard of diabetes care for those over 13. It can greatly reduce the long-term health risks of having diabetes.

Intensive management involves:

  • 3 or 4 daily injections of insulin or the use of an insulin pump
  • Testing blood glucose 4 - 7 times a day
  • Adjusting insulin doses to match exercise and food intake
  • A diet and exercise plan
  • Monthly visits to a health care team

Intensive management is not easy, but it does have both short- and long-term benefits. In the short run, intensive management allows more freedom to eat a variety of foods and exercise more freely. In the long run, intensive management significantly reduces the risk of eye disease, kidney disease, and nerve disease.

Unfortunately, this program is extremely difficult to carry out and is not a truly practical solution for many patients. In addition, intensive management does have one significant health drawback -- it increases the risk of low sugar complications (such as seizures and coma).

The program requires discipline, but the long-term benefits are definitely worth considering. Discuss with your doctor whether you are a good candidate for this approach.

References

American Diabetes Association. Standards of medical care in diabetes--2009. Diabetes Care. 2009 Jan;32 Suppl 1:S13-61.

Alemzadeh R, Wyatt DT. Diabetes mellitus in children. In: Kliegman RM, ed. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders;2007:chap 590.

Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kornenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 31.

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Review Date: 5/26/2009
Reviewed By: Robert Cooper, MD, Endocinology Specialist and Chief of Medicine, Holyoke Medical Center, Assistant Professor of Medicine, Tufts University School of Medicine, Boston MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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