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Selection of Patients for Intensive Insulin Therapy

John E. Gerich, MD
Arch Intern Med. 1985;145(8):1383-1384. doi:10.1001/archinte.1985.00360080053004.
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During the last ten years, there has been a substantial accumulation of evidence indicating that poor metabolic control plays an important role in the development of the so-called long-term complications of diabetes (retinopathy, neuropathy, nephropathy, and premature atherosclerosis).1 On the basis of this evidence, the American Diabetes Association has recently recommended that "it is logical and prudent to reduce blood glucose levels to normal if such attempts are not grossly disturbing to the lifestyle of the patient."2 Self-monitoring of blood glucose levels,3 mimicking of normal insulin secretory patterns by preprandial administration of insulin—so-called intensive insulin therapy,4 and use of glycosylated hemoglobin determination for objective evaluation of long-term control5 have made achievement of near normoglycemia a practical goal for most patients taking insulin.

In intensive insulin programs, meal-related and overnight insulin requirements are usually met either by use of pumps (continuous subcutaneous insulin infusion) or by


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