Type 1 Diabetes Treatment to Prevent Major Complications

Highlights	Complications	Home Management
Introduction	Diagnosis	Transplantation Procedures
Causes	Lifestyle Changes	Resources
Risk Factors	Treatment	References
Symptoms	Treatment of Complications	References

Treatment

Insulin is essential for strict control of blood glucose levels in type 1 diabetes. Good blood glucose control is the best way to prevent major complications in type 1 diabetes, including those that affect the kidneys, eyes, nerve pathways, and blood vessels. Intensive insulin treatment in early diabetes may even help preserve any residual insulin secretion for at least 2 years.

There are, however, some significant problems with intensive insulin therapy:

There is a greater risk for low blood sugar (hypoglycemia).
Many patients experience significant weight gain from insulin administration, which may have adverse effects on blood pressure and cholesterol levels. It is important to manage heart disease risk factors that might develop as a result of insulin treatment.

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A diet plan that compensates for insulin administration and supplies healthy foods is extremely important. [For more information, see In-Depth Report #42: Diabetes diet.] Pancreas transplantation may eventually be considered for patients who cannot control glucose levels without frequent episodes of severe hypoglycemia.

Regimens for Intensive Insulin Treatment

The goal of intensive insulin therapy is to keep blood glucose levels as close to normal as possible.

Glucose Goals for Patients with Diabetes
	Normal	Goal
Blood glucose levels before meals	Less than 100 mg/dL	70 - 130 mg/dL for adults 100 - 180 mg/dL for children under age 6 90 - 180 mg/dL for children 6 - 12 years old 90 - 130 mg/dL for children 13 - 19 years old
Bedtime blood glucose levels	Less than 120 mg/dL	Less than 180 mg/dL for adults 110 - 200 mg/dL for children under age 6 100 - 186 mg/dL for children 6 - 12 years old 90 - 150 mg/dL for children 13 - 19 years old
Glycosylated hemoglobin (A1C) levels	Less than 5.7%	Less than or around 7%
Major source: Standards of Medical Care In Diabetes -- 2011, American Diabetes Association.

Standard insulin therapy usually consists of one or two daily insulin injections, one daily blood sugar test, and visits to the health care team every 3 months. For strictly controlling blood glucose, however, intensive management is required. The regimen is complicated although newer insulin forms may make it easier.