Intensive insulin therapy: Tight blood sugar control

If you have type 1 diabetes — and in some cases if you have type 2 diabetes — intensive insulin therapy may improve your long-term health.

Insulin therapy can take some work, but the benefits are real. Work with your health care team to learn if intensive insulin therapy might be the best approach for you.

What is intensive insulin therapy?

Intensive insulin therapy is a treatment approach designed to keep your blood sugar levels closer to the levels of someone who doesn’t have diabetes. This treatment requires close monitoring of blood sugar levels and multiple doses of insulin.

Newer methods of blood sugar monitoring and insulin delivery may make it easier and safer to maintain more normal blood sugar levels. One such method is called a sensor-augmented insulin pump. This system combines continuous blood sugar monitoring, insulin pump delivery and a computer algorithm that controls some of the insulin delivery.

Setting a blood sugar goal

The American Diabetes Association (ADA) encourages individualized blood sugar goals. But the ADA suggests that most adults aim for a hemoglobin A1C of less than 7%. Hemoglobin A1C is an indicator of your blood sugar control for the past few months.

If you’d like to keep your blood sugar levels lower, work with your doctor to set a goal based on your age, overall health and other individual factors. Your doctor can advise you what your ideal daily blood sugar range is, as well as how to adjust your insulin dosing to meet that goal.

What are the benefits of aiming for a lower blood sugar?

When you consistently work on keeping your blood sugar levels closer to normal, you may prevent or slow the progression of long-term diabetes complications.

Striving for a hemoglobin A1C of less than 7% can reduce your risk of:

• Eye damage from diabetes
• Diabetes-related nerve damage
• Kidney disease from diabetes
• Diabetes-related heart disease and stroke
• Skin ulcers from diabetes

What’s the commitment?

For tight blood sugar management on insulin therapy, you’ll need to:

• Take multiple daily doses of insulin. You may need an injection of short-acting insulin before each meal and an injection of intermediate or long-acting insulin once or twice daily, usually just before bedtime. Or you may choose to use an insulin pump, which releases insulin into your body through a plastic tube placed under the skin on your abdomen.
• Check your blood sugar often. You’ll need to check your blood sugar at least four times a day, before meals and bedtime. Your doctor may ask you to write down the results of each blood sugar test.
• Track how food and exercise impacts your blood sugar. What you eat has a direct effect on your blood sugar. When you’re on insulin therapy, you’ll need to count the carbohydrates in your food to ensure that you get the proper dose of insulin for meals and snacks. Physical activity also influences blood sugar.

Are there risks to keeping my blood sugar levels lower?

Intensive insulin therapy may lead to:

• Low blood sugar. When you have tight blood sugar levels, any change in your daily routine — such as exercising more than usual or not eating enough — may cause low blood sugar (hypoglycemia).

  Be aware of early signs and symptoms of low blood sugar, such as shaking, irritability, hunger and confusion, and respond quickly. Always carry glucose tablets with you to treat low blood sugar. Or if available, drink a glass of orange or apple juice or have a few pieces of hard candy.

• Weight gain. Sometimes, the use of insulin leads to weight gain. To limit weight gain, closely follow your exercise and meal plans.

Is intensive insulin therapy right for you?

Intensive insulin therapy is recommended for most people who have type 1 diabetes and for some people who have type 2 diabetes — but it isn’t right for everyone.

Intensive insulin therapy may not be for you if:

• You struggle with frequent or severe bouts of low blood sugar
• You don’t feel the effects of low blood sugar (hypoglycemia unawareness)
• You are an older adult
• You have memory troubles
• You have long-standing type 2 diabetes
• You have heart disease, blood vessel disease or severe diabetes complications
• You aren’t willing or able to monitor blood sugars and inject insulin several times a day

You and your health care team can weigh the potential risks and benefits of intensive insulin therapy to decide if it’s right for you.