University of Virginia Health System

Thorough 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.

More Intensive Treatment Equaled Fewer Complications

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

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

After being followed for an average of six-and-a-half years, the group continuing their standard treatment had HbA1c levels of about 9 percent, while the intensive treatment group had lowered their HbA1c 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 healthcare providers. After this additional treatment time, patients in the original intensive therapy group had far fewer complications than patients who started in the standard therapy group.

For example, only 21 percent of patients in the intensive therapy group developed diabetic eye disease, compared with 50 percent in the standard care group. Kidney disease occurred in 9 percent of patients originally receiving intensive therapy, compared with 25 percent of patients originally receiving standard therapy. And heart disease was diagnosed in 9 percent of patients originally receiving intensive therapy, compared with 14 percent of patients originally receiving standard therapy.

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 standard care group.

Avoid Complications Through Preventive Care

Although no cure for type 1 diabetes exists, there are several steps you can take to prevent potential complications:

• Check your glucose level as directed by your healthcare 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 healthcare 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, you will need a shot of glucagon, a hormone that increases your 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.

To learn more about treating and managing diabetes or finding a diabetes specialist, visit www.uvahealth.com.

Always consult your physician for more information.