Deft Management of Type 1 Diabetes Helps Lower Complications

There is good news for people with type 1 diabetes. A new study has found that tight management of the disease reduces risk for serious complications, such as blindness, kidney failure, and heart disease.

Type 1 diabetes is a lifelong disease that occurs when the body does not produce enough insulin, a hormone needed to control blood sugar levels.

More Intensive Treatment Equaled Fewer Complications

Researchers compared diabetes complications in people enrolled in a long-term study that started in the 1980s. Of some 1,400 people who were ages 13 to 39 years, half were asked to follow their usual treatment. The other half were asked to follow more intensive treatment by taking insulin more often and monitoring their blood sugar levels more, too. Their goal was to have a hemoglobin A1c (HbA1c) level of around 6 percent.

HbA1c is a test that measures blood sugar control over the past two to three months.

After an average of six and a half years, the usual treatment group had HbA1c levels of about 9 percent, while the intensive group had lowered their A1c levels to about 7 percent.

Intensive therapy was then recommended for all volunteers, who were followed for an additional 13 years and treated by their own health care providers. After this time, those who were in the original intensive therapy group had far fewer complications than their peers in the usual therapy group. For example, only 21 percent of those in the intensive therapy group developed diabetic eye disease versus 50 percent in the usual care group. Kidney disease occurred in 9 percent versus 25 percent. And heart disease was diagnosed in 9 percent versus 14 percent.

However, lower HbA1c levels can cause low blood sugar, or hypoglycemia. Severe hypoglycemia that resulted in either a coma or seizure occurred in 16 percent of the intensive group but only 5 percent of the usual care group.

Avoid Complications Through Preventive Care

Although no cure for type 1 diabetes exists, there is much that you can do to help prevent its potential complications:

• Check your glucose level as directed by your health care provider. Tests are usually done before meals, at bedtime, and before and after exercising. But more frequent testing may be needed if you are sick or under stress.
• Get regular exercise. It helps control the amount of sugar in your blood. It also will help you maintain a healthy weight.
• Plan your meals to allow insulin and food to work together to regulate your blood sugar levels. The American Diabetes Association and the American Dietetic Association have information on how to plan healthy, balanced meals. You can also talk with a registered dietitian or nutrition counselor if you need more help.
• Check and care for your feet on a regular basis. Otherwise, you may not notice if you have a foot injury.
• See your health care provider or diabetes educator as recommended.
• Visit your ophthalmologist at least once a year and your dentist every six months. Tell your dentist and hygienist that you have diabetes.
• Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.
  

In addition, be watchful for symptoms of low blood sugar. They are headache, hunger, nervousness, shaking, sweating, and weakness. If these symptoms occur, eat or drink something with sugar and test your glucose levels. If the symptoms don't go away within 15 minutes, eat more sugar and test your glucose level again. 

If your symptoms continue to worsen, however, you will need a shot of glucagon, a hormone that increases the blood sugar level. Glucagon usually works within 15 minutes. If you are not better in 15 minutes or you don't have glucagon, call 911 right away.

Check with your health care provider for more information about treating your diabetes.