Fine-tuning insulin therapy

It is now possible to mimic normal insulin action more precisely than ever before with physiologic treatment programs using self-monitoring of blood glucose levels and newer insulins with more predictable action. Physiologic programs are more effective for both insulin-dependent (type I) and non-insulin-dependent (type II) diabetes mellitus. With type I diabetes, conventional fixed-dose programs are often quite effective, but some patients may prefer the greater flexibility of intensive insulin therapy. Studies are under way that should provide further guidance on use of intensive insulin therapy. The decade of the 1990s should see additional improvements in insulin preparations and in methods of delivery and monitoring, so that patients can be treated with programs that are not only safer but more physiologic, more comfortable, and more effective in maintaining long-term good health.