How is intensive therapy different than conventional therapy?
What we used to call intensive therapy is now accepted as the standard of care. It involves trying to match insulin levels, or the insulin that is given by the patient, to the insulin requirement. This requires that patients with type 1 diabetes test their blood sugar, usually at least three times a day, using a finger stick device. With that information in hand, they can choose an insulin dose before each meal, for example, that will match what they need in order to keep the blood sugar in good control. What we're aiming for is to keep their average blood sugar as close to non-diabetic range as we can.
The Diabetes Control and Complications Trial demonstrated that if patients maintained this kind of glucose control, we could decrease the occurrence of eye disease, kidney disease and nerve disease that leads to amputations by about 75 percent. So we've known now since 1993, when the DCCT ended, that intensive therapy was really the way to go.
What are drawbacks of intensive therapy?
Intensive therapy really places an enormous burden on the patients. It involves lots of finger-stick blood testing and usually people take at least three injections a day or treat themselves with an insulin pump. They have to be conscientious about their diet and their activity levels, and they have to be taught to choose the right doses for a given meal.
In addition, there is a risk with intensive therapy. Because it is not a perfect system of treatment, sometimes the blood sugar can drop too low, and people can experience "hypoglycemia," or a low blood sugar reaction. These reactions can sometimes make people feel sweaty and weak. Sometimes they can get so severe that they can cause loss of consciousness or a seizure.
