Most type 1 DM patients achieve, at best, only suboptimal control of blood glucose levels. Around 25% of adult type 1 diabetic patients exhibit persistent poor glycemic control. Lower socioeconomic status and psychologic factors including lack of motivation, emotional distress, depression and eating disorders have been associated with poor control. Clinical experience over decades and data from the Diabetes Control and Complications Trial (DCCT) emphasize the role of diabetic education in the attainment of good glycemic control. Constant teaching, encouragement and support of these patients combined with open access to diabetes specialist nurses (DSNs) are fundamental to this goal. Methods of improving glycemic control include strategies that facilitate self-management, such as motivational strategies, coping-orientated education and psychosocial therapies, and intensification of insulin injection therapy or CSII. One self-empowering intensive educational program called DAFNE (Dose Adjustment for Normal Eating) originally developed in Germany has consistently been shown to lead to an improved quality of life, greater freedom of choice of food and a fall in HbA1c levels.
This program has been taken up enthusiastically in many centers.
However, there are patients who remain supremely resistant to such measures. Patients with major metabolic instability, referred to as 'brittle' diabetics, are usually young women who are mildly overweight and who tend to spend several weeks each year in hospital. Although there are many theories as to the cause of such brittleness, for example, defective insulin absorption or inappropriate insulin regimens, there is a growing conviction that psychologic disturbance is the root cause. Not unexpectedly, motivation appears to be a key factor in achieving good blood glucose control. This is best exemplified in cases of diabetic pregnancy where virtually all mothers-to-be manage to achieve near normoglycemia.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...