Careful insulin regulation reduces diabetes problems


July 27, 1993|By Colleen Pierre, R.D. | Colleen Pierre, R.D.,Contributing Writer

Intensive treatment of diabetes allows a wider range of food choices, yet dramatically reduces its devastating side effects.

Results of the 10-year Diabetes Control and Complications Trial (DCCT) were presented at the national meeting of the American Diabetes Association in June. Study results showed the following:

* Diabetes is the most common cause of adult blindness in the United States. Intensive treatment reduced the need for laser eye surgery by 50 percent.

* Diabetes produces nerve damage resulting in foot and leg amputations for 25,000 patients each year. Intensive treatment reduced nerve damage by 60 percent.

* Diabetes is also our most common cause of kidney failure. Intensive treatment reduced early kidney damage by 42 percent, and severe kidney damage by 51 percent.

The DCCT studied patients with insulin-dependent diabetes mellitus (IDDM), also known as Type I diabetes, which usually develops in people under age 30. This type accounts for about 10 percent of the 14 million people with diabetes in our country.

During the study, patients were taught to monitor their own blood sugar levels several times a day and adjust insulin levels to account for changes in eating and exercise.

At a Cleveland meeting, one patient sporting a "Diabetic from Hell" tie reported he'd once eaten a whole medium pizza (not standard on a diabetes diet), yet kept his blood sugar close to normal by adjusting his insulin pump dosage.

This new information is expected to translate into benefits for the 90 percent of patients who suffer from Type II or Non-Insulin Dependent Diabetes (NIDDM) as well.

NIDDM usually develops after age 40, and often accompanies weight gain, especially in families with a history of diabetes.

Registered dietitian Sue Thom is a certified diabetes educator and spokeswoman for the American Dietetics Association. She says that current research is focused on getting NIDDM patients started on oral medication and insulin more quickly than in the past, in order to stabilize blood sugar levels and prevent complications.

She also points out, however, that most NIDDM patients can achieve significant reduction in blood sugar, triglycerides, cholesterol and blood pressure with a weight loss of only 5 percent to 10 percent of body weight.

She says, too, that her patients are far more successful when she suggests 15 minutes of daily walking, along with an 1,800-calorie diet, rather than the traditional 1,200-calorie-weight-loss diet.

According to Ms. Thom, the general nutritional guidelines for managing diabetes include:

* Achieving normal blood sugar levels and normal cholesterol and triglyceride levels. These are equally important since 75 percent of diabetes patients die of heart disease.

* For patients with Type I diabetes, consistency of eating to match insulin levels. This is expected to change, since insulin levels can now be more closely matched to eating. For patients with Type II diabetes, reduce weight by 5 percent to 10 percent.

* The DCCT was a project of the National Institute of Diabetes and Digestive and Kidney Disease, a component of the National Institutes of Health.

An information kit on the DCCT is available from the National Diabetes Information Clearinghouse, Box NDIC, Bethesda, Md. 20892.

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