INTENSIVE INSULIN MANAGEMENT

The basics

Boy, Intensive Insulin Management is a mouth full! Sounds really difficult and something I can't do. That's not true! Intensive Insulin Management (which we will shorten to IIM) is very simple, and logical as long as you follow certain rules. This article will discuss why IIM is important, and explain the rules. The decision to use IIM or not is yours.

Diabetes is unlike any other disease, it is a self managed disease which the diabetic has the opportunity to manage it, or not. Most diabetics select the "not" by default. They usually are NOT told about IIM. That's really a serious mistake for the diabetic who will suffer the consequences.  What are the consequences - increased complications from diabetes such as eye problems, kidney disease, nerve disease, and heart disease.

What do these complications mean to you, the diabetic ? Increased risk of: going blind, having to use a machine to replace your kidney,  heart disease, and loss of limbs. If you DON'T want these omplications, then read on to find out what IIM is and those who should not try it.

What is IIM? It is an attempt to duplicate what the body does for a non-diabetic, adjust the amount of Insulin based upon exercise, food intake, and current blood glucose.

What do I have to do to achieve IIM? It requires testing of your Blood Sugar prior to each meal, and adjusting the amount of Regular Insulin based upon:
Blood Sugar, the amount of food you are about to consume, and any exercise you think you are going to do. This is really not very difficult once you know the rules.

What are the rules? First, you need help to learn the rules. This is usually taught by a diabetes educator or your physician. The rules are customized for each patient. Here are the rules:
1. Have a Target Blood Sugar
2. Have a sliding scale of Regular Insulin based upon your Blood Sugar to achieve your Target Blood Sugar
3. Have an Insulin Ratio to adjust your Regular Insulin based upon the food you are about to consume.
4. Take exercise into consideration.

Sounds simple and it is! There is a learning period to fine tune the 4 rules. Once that is done, it is pretty easy.

What problems do people have using IIM? The major one is more frequent low Blood Sugars. The reason for this, is we want to keep our Blood Sugar as close to normal as possible. This is not easy since you can take the same amount of Insulin one day and have one Blood Sugar, and another day the response may be very different!

Is this a reason not to use IIM? Yes- for some people. If you can NOT detect low Blood Sugars and the result is a coma, IIM is not for you! However, just because you have low Blood Sugars is not a reason to discard IIM. Sure, Insulin Reactions (Low Blood Sugars) are not fun, in fact they can be scary since you always worry are you going to come out of it. However, look at your options- increase chance of blindness or going on dialysis.  For me it was an easy choice since I work around dialysis patients and have no desire to go on dialysis. But the choice is yours. Talk to your doctor and diabetes educator to get more information. But at least make sure YOU make the decision - it is your body and your life.

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