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Original Articles

Intensive Insulin Therapy for Treatment of Type I Diabetes

  1. Irl B Hirsch, MD,
  2. Ruth Farkas-Hirsch, MS, RN, CDE and
  3. Jay S Skyler, MD
  1. Behavioral Medicine Research Center, Departments of Medicine, Pediatrics, and Psychology, University of Miami School of Medicine Miami, Florida; and Division of Metabolism and Endocrinology, Department of Medicine, Washington University School of Medicine St. Louis, Missouri
  1. Address correspondence and reprint requests to Jay S. Skyler, MD, Professor of Medicine, Pediatrics, and Psychology, Behavioral Medicine Research Center, University of Miami, P.O. Box 016960 (D-110), Miami, FL 33101.
Diabetes Care 1990 Dec; 13(12): 1265-1283. https://doi.org/10.2337/diacare.13.12.1265
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Abstract

Intensive insulin therapy is best defined as a comprehensive system of diabetes management with the patient and management team as partners. The system is directed at improvement of glycemia and patient well-being. Glycemic targets should be individually defined. Frequent self-monitoring of blood glucose, probably at least four times per day, is essential for meticulous control. The benefits include improved psychosocial functioning and the potential of lessening the risks of chronic complications of diabetes. The risks relate to problems associated with hypoglycemia, which are increased if meticulous glycemic control is sought. One of the important elements of intensive therapy is a multiple-component insulin program designed to provide effective insulinemia coinciding with each major meal and continuous basal insulinemia throughout the 24-h day. This may be achieved with continuous subcutaneous insulin infusion (CSII) or multiple injections with various insulin regimens, although CSII may offer real advantages in terms of the pharmacokinetics of insulin delivery. Other pharmacokinetic issues to be considered involve selection of injection sites, timing of premeal insulin, and mixing insulins. Many studies have shown that, albeit with effort, excellent glycemic control can be achieved by various intensive insulin-therapy regimens. The implementation of a program of intensive therapy involves patient self-management in terms of altering insulin dosages, food intake, and/or activity in an attempt to achieve the target level of glycemia selected. In motivated patients willing to embark on such a course of therapy, intensive insulin therapy can be worthwhile. It should be considered for all patients with type I (insulin-dependent) diabetes mellitus.

  • Copyright © 1990 by the American Diabetes Association

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December 1990, 13(12)
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Intensive Insulin Therapy for Treatment of Type I Diabetes
Irl B Hirsch, Ruth Farkas-Hirsch, Jay S Skyler
Diabetes Care Dec 1990, 13 (12) 1265-1283; DOI: 10.2337/diacare.13.12.1265

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Intensive Insulin Therapy for Treatment of Type I Diabetes
Irl B Hirsch, Ruth Farkas-Hirsch, Jay S Skyler
Diabetes Care Dec 1990, 13 (12) 1265-1283; DOI: 10.2337/diacare.13.12.1265
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