Is Intensive Insulin Therapy Right For You?

For people with type 1 diabetes, and for some individuals with type 2, intensive insulin therapy helps ensure long term well-being.

However, this treatment approach requiring frequent monitoring plus several daily doses of insulin is not easy to maintain, and deserves careful consideration.

Typical Goals

Those who choose intensive insulin therapy (IIT) will work closely with their health care team to set glucose management goals based on factors such as general health status, and age. Typical IIT targets are:

• Pre-meal glucose levels of 70 to 130 mg/dL, or 3.9 to 7.2 mmol/L.
• Glucose level less than 180 mg/dL (or 10 mmol/L) two hours after meals.
• A1C readings less than 7 percent.

The new monitoring and insulin delivery methods currently being tested, such as closed-loop systems, may soon make achieving strict IIT goals easier, and less risky.

A Couple Risks

The primary risk with IIT is hypoglycemia, or low blood sugar, particularly when there are alterations in daily routine. For instance, changes in the type, or amount of food eaten, or an increase in exercise might trigger a low blood sugar episode. People using IIT must be cognizant of hypoglycemia signs (e.g., sweating, shaking, anxiety) and always have a carb source at hand.

There is also a chance that people will experience weight gain with IIT. When insulin effectively controls glucose, the sugar in our bloodstream is utilized by the body’s cells, instead of being excreted in our urine. Any sugar that isn’t burnt for fuel is stored for later use as fat, but closely adhering to diet and exercise routines should minimize fat reserves.

Big Benefits and Commitment

For many individuals, the benefits of IIT far outweigh the risks. They generally report better overall energy, a greater sense of well-being, and they appreciate the reduced chances of long term diabetes complications. Research shows, for example that IIT lowers the risk of vision loss by over 75 percent, reduces nerve damage risk by 60 percent, and slows or prevents kidney problems 50 percent.

Reaping these IIT advantages requires substantial patient commitment:

• Frequent doses of insulin are required, including injections of short-acting insulin prior to eating, and intermediate or long-acting insulin at bedtime. Some people opt to use insulin pumps, sending insulin into their bodies via a tube placed beneath the skin.
• Frequent monitoring and tracking of glucose levels are required—at minimum before each meal, and at bedtime.
• Diet and exercise plans must be followed closely, and doctors may ask patients to keep detailed records of food intake and physical activity.

Though IIT may seem overwhelming at first, like anything we do repeatedly the monitoring and tracking eventually become an inconvenient, but familiar part of daily routine.

Is IIT For You?

While IIT is suggested for most people with type 1 diabetes, and certain individuals with type 2, it’s generally not suitable for children, and many older adults. Those who have severe, recurring hypoglycemic episodes may be advised against IIT, as might people with cardiovascular disease, or advanced diabetes complications.

Your health care team will help asses the risks and benefits of IIT in light of your motivation, age, diabetes, and other medical history.

Source: Mayo Clinic
Photo credit: Ayurvedic India