What is Diabetes Management?
Before
the discovery of insulin in 1921, everyone with type 1 diabetes
died within a few years after diagnosis. Although insulin
is not considered a cure, its discovery was the first major
breakthrough in diabetes treatment.
Today,
healthy eating, physical activity, and taking insulin via
injection or an insulin pump are the basic therapies for
type 1 diabetes. The amount of insulin must be balanced
with food intake and daily activities. Blood glucose levels
must be closely monitored through frequent blood glucose
checking.
Healthy
eating, physical activity, and blood glucose testing are
the basic management tools for type 2 diabetes. In addition,
many people with type 2 diabetes require oral medication,
insulin, or both to control their blood glucose levels.
People
with diabetes must take responsibility for their day-to-day
care. Much of the daily care involves keeping blood glucose
levels from going too low or too high. When blood glucose
levels drop too low--a condition known as hypoglycemia--a
person can become nervous, shaky, and confused. Judgment
can be impaired, and if blood glucose falls too low, fainting
can occur.
A
person can also become ill if blood glucose levels rise
too high, a condition known as hyperglycemia.
People
with diabetes should see a health care provider who will
help them learn to manage their diabetes and who will monitor
their diabetes control. An endocrinologist is a doctor who
often specializes in diabetes care. In addition, people
with diabetes often see ophthalmologists for eye examinations,
podiatrists for routine foot care, and dietitians and diabetes
educators to learn the skills needed for day-to-day diabetes
management.
The
goal of diabetes management is to keep blood glucose levels
as close to the normal range as safely possible. A major
study, the Diabetes Control and Complications Trial (DCCT),
sponsored by the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), showed that keeping blood glucose
levels close to normal reduces the risk of developing major
complications of type 1 diabetes.
This
10-year study, completed in 1993, included 1,441 people
with type 1 diabetes. The study compared the effect of two
treatment approaches--intensive management and standard
management--on the development and progression of eye, kidney,
and nerve complications of diabetes. Intensive treatment
aimed to keep hemoglobin A1C as close to normal (6 percent)
as possible. Hemoglobin A1C reflects average blood glucose
over a 2- to 3-month period. Researchers found that study
participants who maintained lower levels of blood glucose
through intensive management had significantly lower rates
of these complications. More recently, a followup study
of DCCT participants showed that the ability of intensive
control to lower the complications of diabetes has persisted
8 years after the trial ended.
The United
Kingdom Prospective Diabetes Study, a European study completed
in 1998, showed that intensive control of blood glucose
and blood pressure reduced the risk of blindness, kidney
disease, stroke, and heart attack in people with type 2
diabetes.