Meticulous glucose control in diabetic persons using insulin

The one advantage a physician has in designing a regimen to control glucose values in a patient with IDDM is that the physiologic mechanism underlying IDDM is homogeneous: All patients are deficient in insulin and tend to be responsive to physiologic amounts of exogenous insulin. Although patients with NIDDM are inherently more stable, the optimal therapy is less clear and physiologic abnormalities must be considered on a case-by-case basis. Maintaining a balance between food intake, exercise, emotions, hormonal changes, and insulin, however, is an ongoing challenge. Only a fraction of IDDM patients are able to achieve excellent control over a long period of time, but it is generally not possible to predict which patients will be able to achieve these goals. Physicians must be patient and persistent in helping patients adhere as closely as possible to a strict diabetic regimen. Psychological, social, and emotional factors must be considered at every visit. Concern over high glucose levels may cause physicians to overlook important emotional events or a family upset that is causing the patient to be less concerned about blood glucose values. If a patient is having trouble adhering to a regimen, the physician should do a complete history and physical examination, with an appropriate differential diagnosis to help address the broad scope of the problem. For most diabetic persons who administer insulin, split, mixed doses given several times throughout the day allow the patient to use a lower total dose and minimize risk of hypoglycemia while improving the potential for glucose control.(ABSTRACT TRUNCATED AT 250 WORDS)