Intensive Care as the Best Technology?

With new technologies emerging every day, Type 1 diabetics, especially the elderly, may be overwhelmed with these new discoveries and may have difficulties finding what technology is best for them. It is important for us to remember that sometimes the best technology is simply intensive care, meaning that the patient is an active and determined participant in their care. There are two methods of taking care of diabetes, the standard approach and the intensive approach. With tools such as nutritional information, diet/nutrition books, insulin, exercise, etc, patients are able to live much longer than they did before. 

         A study conducted for the Diabetes Control and Complications Trail (DCCT) in 1993 lasted 10 years and followed 1,441 people with Type 1 diabetes. The group was split in two, with one group having standard control and one group having intensive or "tight" control over their diabetes. The results showed that those with "tight" control of their diabetes- having an A1C (average blood sugars over a 3 month period of time) of between 6-7%, consisting of blood glucose levels of 70-130mg/dl before meals and less than 180mg/dl two hours after eating- had less complications in certain areas of health and these complications were minimized even 10 years after the study. 

Areas in which complications were minimized consist of:

-eye disease

-kidney disease

-nerve disease

        People using intensive care had 3/4 less eye diseases, 1/2 less kidney diseases, and 2/3 less nerve diseases. Moreover, those who already had these diseases and who transitioned to intensive care were much less likely to see their existing complications get worse. This is VERY important for elderly diabetics who have perhaps been using older technology and more standard methods their whole lives and as a result, have already begun to see certain complications from diabetes. This is why many argue that for the elderly, transitioning to intensive care- as opposed to continuing standard care or moving to new, difficult to manage, and confusing technologies- is extremely beneficial. 

Here is a synthesis of what consists of intensive care and how one can use it in their daily lives:

-multiple daily injections before meals as well as an long lasting injection that gives insulin throughout the day.

-multiple blood glucose testing: at least once before every injection and preferably 2-3 hours after every meal.

-documentation of diet and exercise (to see patterns)

-have scheduled eating times to make insulin injections regular times apart.

-create a team of doctors consisting of: primary care physician, endocrinologist, dietician, diabetes educator etc.

In conclusion, in some cases, especially the elderly, I would recommend the use of intensive care. Often this is what will help the patient expand their life and reduce complications that diabetes causes. It can be considered the best technology

References:

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html

http://www.agingcare.com/Featured-Stories/95735/Managing-Your-Elderly-Relative-s-Diabetes.htm