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Intensive Diabetes Therapy Reducing Long-Term Complications Omaha NE

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Cyrus V Desouza, MD
(402) 559-6205
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Male
Education
Medical School: St John'S Med Coll, Bangalore Univ, Bangalore, Karnataka, India
Graduation Year: 1996

Data Provided by:
Deepika Santosh Reddy
(402) 559-4000
983020 Nebraska Medical Ctr
Omaha, NE
Specialty
Endocrinology, Diabetes & Metabolism

Data Provided by:
Lynn Renee Mack-Shipman, MD
(402) 559-6205
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Male
Education
Graduation Year: 2007

Data Provided by:
Kevin P Corley
(402) 559-9800
988095 Nebraska Medical Ctr
Omaha, NE
Specialty
Endocrinology, Pediatric Endocrinology

Data Provided by:
James Lane, MD
(402) 559-6205
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Male
Education
Medical School: Univ Of Mo-Kansas City Sch Of Med, Kansas City Mo 64108
Graduation Year: 1984

Data Provided by:
Kevin Patrick Corley, MD
(402) 559-7466
985390 Nebraska Medical Ctr
Omaha, NE
Specialties
Pediatrics, Pediatric Endocrinology
Gender
Male
Education
Medical School: Univ Of Il Coll Of Med, Chicago Il 60680
Graduation Year: 1972

Data Provided by:
Richard Eugene Lutz, MD
(402) 559-6800
985450 Nebraska Medical Ctr
Omaha, NE
Specialties
Pediatrics, Pediatric Endocrinology
Gender
Male
Education
Medical School: Univ Of Ks Sch Of Med, Kansas City Ks 66103
Graduation Year: 1984

Data Provided by:
Amy Schlichtemeier Neumeister, MD
(402) 559-8700
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Male
Education
Graduation Year: 2007

Data Provided by:
Jennifer Lynn Larsen, MD
(402) 559-4837
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Female
Education
Medical School: Univ Of Ia Coll Of Med, Iowa City Ia 52242
Graduation Year: 1979

Data Provided by:
Whitney Sears Goldner, MD
(402) 559-6205
983020 Nebraska Medical Ctr
Omaha, NE
Specialties
Endocrinology, Diabetes, & Metabolism
Gender
Female
Education
Medical School: Univ Of Ne Coll Of Med, Omaha Ne 68198
Graduation Year: 1998

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Intensive Diabetes Therapy Reducing Long-Term Complications

Intensive Diabetes Therapy Reduces Long-Term Complications.
Date: Tuesday, September 15, 2009
Source: Archives of Internal Medicine
Related Monographs: Diabetes Mellitus, Type 1
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Type 1 diabetes is a condition where the beta cells in the pancreas do not release insulin. This is called an absolute insulin deficiency. This means that the individual has hyperglycemia and begins to break down their fats and protein in order to meet the energy demands of the body. This breakdown of fats and protein makes the insulin dependent diabetic build up waste products called ketone bodies, which causes a condition called ketoacidosis. Insulin dependent diabetics need a constant supply of insulin to prevent ketoacidosis and maintain a stable blood sugar. Type 1 diabetes usually occurs in people younger than 30 years of age. It is thought that the disease is caused by something in a person's family history (genetic factor) that responds abnormally to the beta cells in the Islets of Langerhans. Islet cell antibodies have been found in 60-95 percent of persons with type 1 diabetes. Sometimes this unusual response by the body can be started by a virus, a vaccination, or a toxic fungus.

Initial symptoms of diabetes include frequent urination, thirst, weight loss despite an increased appetite, fatigue, and irritability. Dizziness, lethargy, irritability, loss of coordination, and perspiration are common during episodes of low blood sugar (blood glucose <60mg/dl). High blood sugar (blood glucose >250mg/dl) among insulin-dependent diabetics can lead to ketoacidosis which requires medical attention.

Intensive insulinotherapy is a therapeutic regimen for diabetes mellitus treatment. This newer approach contrasts with conventional insulinotherapy. Rather than minimize the number of insulin injections per day (a technique which demands a rigid schedule for food and activities), the intensive approach favors flexible meal times with variable carbohydrate as well as flexible physical activities. The trade-off is the increase from 2 or 3 injections per day to 4 or more injections per day, which was considered "intensive" relative to the older approach. In North America in 2004, many endocrinologists prefer the term "flexible insulin therapy" to intensive therapy and use it to refer to any method of replacing insulin that attempts to mimic the pattern of small continuous basal insulin secretion of a working pancreas combined with larger insulin secretions at mealtimes. Many people on multiple daily injection (MDI) regimens carry insulin pens to inject their rapid-acting insulin instead of traditional syringes. The other method of intensive/flexible insulin therapy is an insulin pump. It is a small mechanical device about the size of a deck of cards. It contains a syringe-like reservoir with about three days' insulin supply. This is connected by thin, disposable, plastic tubing to a needle-like cannula inserted into the patient's skin and held in place by an adhesive patch. The infusion tubing and cannula must be removed and replaced every few days.

The results of a 30 year study have found that early, intense diabetes management reduced the incidence of complications in people with type 1 diabetes. Researchers compared overall rates of eye, kidney and cardiovascular complications in people with type 1 diabetes. One group (intensive management) took insulin shots at least three times a day and took glucose readings at least four times a day with the goal of achieving a long-term average blood sugar or A1c reading of 7, which is close to the normal range. The second group had conventional care, which was basically enough treatment to control diabetes symptoms. People in this group had an average A1c reading of 9. Both groups stayed on their treatment regimens from 1983 to 1989, but were followed for a total of 30 years. Researchers found that those who had been in the intensive group had about half the rate of eye damage compared to those assigned to conventional diabetes management. They also had lower rates of kidney damage and fewer cases of heart attacks, strokes, chest pain or blocked arteries compared to those on conventional glucose management. The intensive management group was noted to have less than 1% become blind, require a kidney replacement or have an amputation because of diabetes during that 30 year time period. The authors suggested that the findings mean that if people had stayed on the intensive therapy, the benefits might have been even greater. Overall, this data indicates that serious complications in people with type 1 diabetes, especially when treated intensively, are much lower than previously reported. It also appears that intensive glucose control may work best when started early.1

1 Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, Nathan DM, Zinman B, et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005). Arch Intern Med. 2009;169(14):1307-16.

This information is educational in context and is not to be used to diagnose, treat or cure any disease. Please consult your licensed health care practitioner before using this or any medical information.
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