Monday medical: Diabetes can be managed

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In 1984, a study called the Diabetes Control and Complications Trial was conducted throughout North America. The study was finished early because researchers found clear evidence that using "intensive management" to keep blood glucose levels as close to normal as possible, for as much of the time as possible, decreases the risk and slows the progression of diabetes complications.

Since the DCCT, additional studies have confirmed these findings for people with Type 2 diabetes. Health care professionals are teaching patients that keeping blood glucose levels as close to normal as possible, for as much of the time as possible, is the best thing they can do for their long-term health.

The DCCT's "intensive management" refers to managing Type 1 diabetes with multiple daily injections of insulin or use of an insulin pump and frequent blood glucose monitoring. Today, we call it "physiologic management" of diabetes, which means doing for the body what it would do for itself if it could.

Physiologic management of diabetes involves finding the combination of medications that works best to mimic a functioning pancreas. Because a functioning pancreas would produce insulin continuously and in response to food, people with Type 1 diabetes need to replace this insulin. Some people with Type 2 diabetes take insulin, and many of them take medications to help their bodies produce and/or use insulin more efficiently.

There are several types of insulin and diabetes medications available. People who take insulin and are ready to follow physiologic management can take multiple daily injections or use an insulin pump. Multiple daily injections include a combination of long-acting insulin once or twice a day and short-acting insulin with meals.

An insulin pump is a small device that is programmed to deliver insulin continuously and in response to food or high blood-glucose levels. Insulin pumps can be programmed to give more or less insulin depending on activity level or food intake.

Medications for physiologic management of Type 2 diabetes include those that help the body use insulin more effectively, help the pancreas produce more insulin at mealtimes and keep the blood glucose levels from rising. Patients should talk to health care professionals about which medications or combination of medications to take.

Blood glucose monitoring and Hemoglobin A1C testing are critical components of physiologic management of diabetes. Blood glucose monitoring helps people with diabetes make management decisions on a daily basis.

Hemoglobin A1C is the "gold standard" for diabetes management because it measures the average blood glucose level during the past three months. This shows people with diabetes the "big picture" and helps them work to make necessary changes.

Using the tools available, such as monitoring and medications, gives people with diabetes the opportunity to live healthier lives.

Jane K. Dickinson, RN, PhD, CDE, is the Diabetes Education Program Director at Yampa Valley Medical Center. She has had type 1 diabetes for 29 years and wears an insulin pump.

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