How to Achieve Tight Type 1 Blood Glucose Control

Is Intensive Insulin Therapy Right for You?

When it comes to treating type 1 diabetes, keeping tight blood glucose control—that is, keeping your blood glucose levels as close to your goal range as possible—can prevent long-term diabetes complications such as eye damage, kidney damage, nerve damage, heart attacks, and strokes. But what exactly does having tight control (also known as intensive insulin therapy) mean in your daily life? Read on to find out about the basics of tight control.

insulin injectionsTight Control and the Diabetes Control and Complications Trial (DCCT)

Tight control is considered an aggressive treatment. It started with a major study called the Diabetes Control and Complications Trial, which ran from 1983 to 1993.1 The study included 1,441 people with type 1 diabetes. Researchers followed these participants for several years; they closely looked at intense therapy vs the standard diabetes therapy. What they found was that intense therapy limited long-term diabetes complications.

Benefits of Having Tight Blood Glucose Control

There are some immediate benefits as well as some long-term benefits of having tight control.

Some short-term benefits are that you'll notice you have more energy and feel better overall. The long-term benefits of tight control are that it can help prevent macrovascular complications (eg, heart disease) and other diabetes-related complications, and it can reduce the risk of having a baby with birth defects (important if you're planning on having a baby).

Risks of Having Tight Blood Glucose Control

Although there are many benefits of achieving tight control, there are some risks, too. Hypoglycemia (low blood glucose levels) is one of the major risks when it comes to tight control. Any change to your daily routine can cause hypoglycemia, but tight control can make it more likely.

Another risk of tight control is weight gain. However, if you follow your exercise routine and diabetes meal plan, it can help you keep a healthy weight. Work with your registered dietitian to help you adjust the amount of calories you require each day to aid in maintaining or losing weight.

How Achieving Tight Control Affects Your Daily Life

Tight control impacts your daily life because you need to pay extremely close attention to your lifestyle. But with a little practice and some work, achieving tight control will become a part of your routine.

The following are the determined goal blood glucose levels for tight control:

  • Before meals: between 70 and 130 mg/dL
  • Two hours after starting a meal: 180 mg/dL
  • A1c: less than 7%

Here's what you'll need to do to reach goal blood glucose levels for tight control:

  • Adjust your insulin doses according to your blood glucose levels and carbohydrate intake: You will most likely have to change how often you take insulin, especially based on what you eat and how active you are. You'll need to carefully determine how much bolus and basal insulin you need. Work with your health team to determine your needs.

    In general, you have 2 options for how to take insulin: You can take multiple daily injections, or you can use an insulin pump. Choose the option that fits your lifestyle best.
  • Check your blood glucose levels more often: You'll most likely need to test your blood glucose levels more frequently than you're used to. Be sure to carefully keep track of your results.
  • Follow your meal plan and exercise plan closely: Food and exercise directly affect your blood glucose levels. It's a good idea to keep a food and exercise log to help you reach goal blood glucose levels.

Keep in mind that it may not be possible to be in a "perfect" range all the time. In fact, that's not even required: The DCCT showed that lowering your A1c levels by even a small amount goes a long way in preventing long-term diabetes complications.

Is Tight Control Right for You?

It's important to note that elderly people and children with diabetes should not try tight control. Also, people who have severe diabetes complications, such as heart disease, should not try tight control.

But if you have type 1 diabetes and are generally healthy, tight control may be a treatment option for you. Your diabetes treatment team can help you decide whether intensive insulin therapy is right for you, but ultimately, it's your decision.

Updated on: June 8, 2017
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'Think Like a Pancreas' by Gary Scheiner (DeCapo Press)