Nine years' personal experience of intensified diabetes control: infusion versus injections

The author, who had been an unstable diabetic since 1948, has attempted to maintain normoglycaemia since January 1977 after developing retinopathy and painful peripheral neuropathy. After 40 months of intensified conventional therapy (ICT), blood glucose fell from 13.0 +/- 2.0 (mean +/- S.D.) to 8.6 +/- 1.5 mmol/l (p less than 0.001), but with 36% of blood glucose tests still exceeding 10.0 mmol/l. After 6 years of continuous subcutaneous insulin infusion (CSII) mean blood glucose was 6.6 +/- 0.7 mmol/l (p less than 0.001) CSII/ICT, with only 10% of tests exceeding 10 mmol/l, smoother glycaemic profiles and excellent control overnight with no hypoglycaemia. These improvements under CSII were attributed to continuous varied insulin intake, which was instantly and unobtrusively adjustable, and more reliable food/insulin/blood glucose relationships. No infusion-site abscesses or serious ketoacidosis developed. Under both therapies glycaemic control was readily disrupted by exercise, minor dietary inaccuracies, relaxing of vigilance and unknown factors. Whenever the sense of commitment faultered there was a tendency to maintain higher glycaemic values to avoid distressing hypoglycaemia. Over the nine years, retinopathy progressed, foot pains regressed slightly but no fresh complications developed. Thus, intensified conventional management alone improved control, but CSII enabled the author to remain near-normoglycaemic for years (given sufficient motivation), with a less regimented lifestyle.