• You’ll have more hypoglycemia episodes. People in the DCCT using intensive diabetes management had three times as many severe low blood glucose episodes than those on the conventional treatment program. This happened because their overall blood glucose levels were much lower.
• You may gain weight. People in DCCT following intensive management tended to gain more weight than those using a conventional treatment program because they were no longer losing calories in the form of glucose in their urine. Taking more insulin also made their bodies more efficient at capturing and storing calories.
Is Intensive Management Right for You?
Are you already reaching your blood glucose and blood pressure goals? Do you firmly believe that you are doing fine without intensifying your diabetes management? Do you dislike the idea of having your life dictated by your diabetes care or schedule? If you answered yes to any of these questions, then intensive management may not be right for you.
However, if you want to reduce the long-term risk of complications, you may decide that intensive diabetes management is worth the extra effort, time, and side effects. In the end, intensive management may offer you more flexibility in your day-to-day living. You monitor your blood glucose more frequently so that you can make adjustments in your insulin dose to accommodate variety in your eating and activity patterns.
Intensive diabetes management can benefit almost anyone with diabetes. For years, women with type 1 or type 2 diabetes who were planning a pregnancy and women who developed gestational diabetes have been advised to take an intensive approach to their diabetes. It is particularly important during pregnancy to keep glucose levels close to normal to avoid problems in the development and growth of the baby.
Keep in mind, intensive diabetes management is not safe for some groups of people: children, elderly people, and people experiencing severe complications of diabetes, such as life-limiting illnesses or trouble with cognition or function.
Intensive Diabetes Management May Not Be Right for You If…
• You have a history of severe hypoglycemic episodes or hypoglycemia unawareness.
• You are younger than 10, unless you have motivated parents and/or caregivers.
• You are elderly, with other health problems or impairments.
• You have cardiovascular disease, angina, or other medical conditions complicated by hypoglycemia or you take certain medications like beta-blockers.
• You have severe complications of diabetes. Although intensive therapy can slow down the development of complications, there is no evidence that it can reverse the process.
• You have conditions, such as debilitating arthritis or severe visual impairment, that would make it difficult to carry out tasks.
• You have drug or alcohol abuse problems or are unable to make reasonable decisions about your everyday diabetes management.
• You are unable or unwilling to carry out the tasks associated with intensive management.
Intensive diabetes management in children can be risky because it raises the risk of hypoglycemia. Severe hypoglycemia can interfere with normal brain development, particularly in very young children. Intensive diabetes management in children also requires close supervision, usually from a diabetes specialist.
The increased risk of hypoglycemia can also be an issue with the elderly. Hypoglycemia may make it harder to live alone or be independent. Some older people may find the potential benefits are not worth the risk, particularly if they have other health problems or impairments. However, if you are in good health, believe the benefits are worth the wait (they may take 10 years), and are willing to take on the responsibility, then let your health care team know.
Intensive Diabetes Management Education
The idea of embarking on an intensive diabetes management plan may seem overwhelming. There is a lot to remember, but keep in mind that it is an ongoing process. You can’t learn it overnight, and no one expects that of you. Your health care team is there to help you.
You’ll have many questions as you begin. How many units of insulin should you take if you blood glucose is a little high? How should you change what you eat for your next meal? It will require trial and error and coordination and advice from your health care team as you learn to make adjustments. Over a short period of time, you will gain the confidence to make these adjustments on your own.
Talk to your health care team about the best way to approach intensive management. Maybe your local community hospital or health care team offers classes in intensive management. Maybe your diabetes educator wants to arrange several one-on-one sessions with you.
Intensive Diabetes Management Classes
Look for these topics when considering an intensive diabetes management class.
• Nutritional guidelines and carbohydrate counting to determine the effect of food on blood glucose levels.
• Insulin action and dosage adjustment or dosing of other injectable medications.
• How to measure the effect of exercise.
• Blood glucose and urine ketone monitoring and interpretation of the results.
• Strategies to help you make changes in your lifestyle and cope more effectively with diabetes.
Choosing Intensive Diabetes Management Goals
The goal of intensive diabetes management is to keep blood glucose levels as close to normal as possible. You may want to tailor this approach to goals that are reasonable and safe for you. It is a group decision that you, your family, and your health care team need to make together.
People with diabetes need to take action to lower their blood glucose either by injecting insulin or compensating with food or insulin at the next mealtime. You may hear that keeping your blood glucose below 130 mg/dl is the magic number. In fact, your target range may be a little higher or lower depending on several factors such as your age, capabilities, and life situation.
For people without diabetes, blood glucose levels rarely go over 120 mg/dl, even after eating a meal.
Factors to Consider When Setting Goals
• Your age
• How long you’ve had diabetes
• Type of diabetes
• Frequency and severity of hypoglycemia
• Lifestyle and occupation
• Other medical conditions
• How much support you get from family and friends
• Your personal motivation for diabetes self-management
The American Diabetes Association has established recommended targets for glucose levels. The ADA recommends that patients keep blood glucose between 70 and 130 mg/dl before meals and less than 180 mg/dl after meals. You may choose these or different goals. But remember, the DCCT showed that any improvement in lowering blood glucose levels provides real benefits.
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