Insulin intensive therapy

Intensive therapy in patients with type 1 and type 2 diabetes reduces microvascular complications, including nephropathy. Intensive therapy can include insulin or oral drugs and involves blood sugar testing at least... 

Insulin delivery by a pump may be superior to glargine insulin. Continuous subcutaneous insulin infusion was compared with intensive therapy with insulin glargine plus insulin lispro in 19 patients (224). The patients who received insulin glargine were exposed to glucose concentrations under 3.9 mmol/1 overnight for three times as long as those who used continuous subcutaneous insulin infusion. 

Hermansen K, Ronnemaa T, Petersen AH, Bellaire S, Adamson U. Intensive therapy with inhaled insulin via the AERx insulin diabetes management system. Diabetes Care 2004 27 162-7. 

Ciofetta M, Lalli C, Del Sindaco P, Torlone E, Pampanelli S, Mauro L, Chiara DL, Brunetti P, Bolli GB. Contribution of postprandial versus interprandial blood glucose to HbAlc in type 1 diabetes on physiologic intensive therapy with lispro insulin at mealtime. Diabetes Care 1999 22(5) 795-800. 

Rare complications are lipoatrophy or hjrpertrophy and insulin edema. Insulin has to be given by injection, with pumps or specific devices for intensive therapy, which all generate specific problems. Other ways of administrating insulin are still experimental. 

Nathan D, The importance of intensive supervision in determining the efficacy of insulin pump therapy. Diabetes Care 1983 6 295 7. 

Improving giycaemic control may not only reduce the rate of non-enzymatic glycosyiation and monosaccharide autooxidation, but lower polyol pathway activity. In addition, it should have a beneficial effect on other haemodynamic and hormonal factors involved in the development of diabetic vascular disease. However, in studies of diabetic retinopathy, rapid control of glucose levels by intensive insulin therapy has been shown to worsen vascular disease initially and it could be postulated that a sudden improvement in retinal blood flow promotes further free-radical damage as part of a reperfusion-ischaemic injury. 

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