Defensive medicine in diabetic nephropathy

Conventional insulin treatment fails to prevent the development of disabling and fatal complications in most patients with Type I diabetes. Improved metabolic control is achievable today with fractional insulin doses, or wearable pumps permitting continuous subcutaneous insulin infusion. None of the euglycemia regimens in hand for 1984 are easy or successful uniformly. Careful insulin administration by pumps or in fractional daily doses demands that the patient make expensive and time-consuming multiple finger stick blood glucose measurements each day. But, considering the high stakes involved in the gamble to permit suboptimal glucose regulation, it seems no longer rational to regard hyperglycemia as any more inevitable in the diabetic, than was "laudable pus" in the post-operative patient of yesteryear. Nearly constant euglycemia can be attained in many informed Type I diabetics. There are few complications in a tight control regimen, and patients feel better when their blood glucose level approaches the normal range most of the time. Should the long-term control versus complications trials now beginning show that the effort to maintain euglycemia was futile, little will have been lost. But, by stark contrast, if the euglycemia regimen is efficacious, how shall we console this generation of diabetics who, under "poor" glucose regulation, were the last to progress to uremia and blindness when trials now in progress are completed?