Diabetes: Is tight control for you?
Tight control can be a good way for some people with diabetes to keep the disease in check. But it's not easy, and it's not for everyone. Before starting a tight control program, you'll need to talk with your doctor about the pros and cons.
If you have diabetes, you probably spend a good amount of time thinking about control.
Control your blood sugar. Control your diet. Control your insulin.
You may also want to think about tight control.
Two decades of research has shown that intensive management, or tight control, of type 1 diabetes reduces the likelihood of a number of complications associated with the disease.
And although tight control means you'll spend more time thinking about your diabetes, you also might spend less time worrying about it.
What is tight control?
Tight control keeps your blood glucose levels low by mimicking the job your pancreas should be doing.
"The principal of tight control is to replace insulin in as much of a natural way as possible," says William Herman, M.D., a lead investigator in the Epidemiology of Diabetes and Its Complications (EDIC) study, a follow-up to the 10-year Diabetes Control and Complications Trial (DCCT).
That means paying close attention to what makes your blood sugar rise and fall, and compensating with insulin injections either manually or with an insulin pump. It may mean three or more insulin doses daily and multiple checks of your blood glucose levels.
By comparison, people not on tight control might inject insulin only once or twice a day, and not make daily adjustments in insulin dosage. They also check their glucose levels less frequently.
According to Dr. Herman, important elements of tight control include:
- Maintaining a consistency in both the amount and timing of your carbohydrate intake.
- Measuring your blood sugar before each meal.
- Taking a dose of insulin based on both blood sugar level and the food you're eating.
- Making insulin adjustments as necessary for physical activity.
"It is intensive every day and it doesn't stop, so it involves a lot of self-management," says Dr. Herman. "It requires a lot of behavioral changes, knowledge, and a degree of discipline and regimentation."
The payoff is better health, as the DCCT and EDIC studies have shown.
Benefits of tight control
It isn't known exactly why high levels of glucose cause so many problems for people with diabetes, according to the American Diabetes Association. But the DCCT showed that keeping glucose levels low—similar to the levels found in people without diabetes—significantly lowers the likelihood that many of those problems will appear.
Benefits of tight control in the DCCT study included:
- 76 percent reduced risk for diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness in people with diabetes. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 24,000 people with diabetes lose their eyesight every year.
- 50 percent reduced risk for development and progression of kidney disease. Diabetic kidney disease is the No. 1 health threat for people with type 1 diabetes, according to the NIDDK.
- 60 percent reduced risk of neuropathy. This is the nerve damage to the feet,legs and otherpartsof thebody thatcan lead toamputation.
For pregnant women,tight control means a lower risk for birth defects.
Preliminary research suggests tight controlmight also lower the risk of developinghigh bloodcholesterol and other factorsthatcan cause heart disease.
Another benefit of tight control may be less anxiety about diabetes, says Dr. Herman, "because people understand how their diet, physical activity and insulin are working together. They feel more in control."
Disadvantages of tight control
Keeping a tight rein on glucose levels does raise the risk for hypoglycemia—episodes when blood sugar levels become too low. People on tight control in the DCCT were three times more likely to have hypoglycemic reactions than those on conventional therapy.
Another side effect of tight control is weight gain, because the body uses calories and sugar more efficiently.
Tight control also can be more expensive, in both medical visits and supplies. But since it reduces more costly complications in the long run, says Dr. Herman, many insurance companies now provide necessary coverage.
Weighing the pros and cons
Tight control isn't for everyone.
For instance, it isn't recommended for children under 13, older adults and people who already have complications from diabetes.
It can, however, be helpful to some people with type 2 diabetes who take insulin.
It's important to have a health care team in place and receive training ore attempting tight control. Ask your doctor for more information about tight control and whether it might be beneficial for you.