Long-term studies like the UK Prospective Diabetes Study (UKPDS) and the Diabetes control and complications trial (DCCT) showed that intensive insulin therapy achieved blood glucose levels closer to non-diabetic people and that this was associated with reduced frequency and severity of blood vessel damage.
Damage to large and small blood vessels (macro- and microvascular disease) is central to the development of complications of diabetes.
Insulin levels rise immediately as we begin to eat, remaining higher than the basal rate for 1 to 4 hours.
One method of intensive insulinotherapy is based on multiple daily injections (sometimes referred to in medical literature as MDI).
Some people on an MDI regimen also use injection ports such as the I-port to minimize the number of daily skin punctures.
This is connected by thin, disposable, plastic tubing to a needle-like cannula inserted into the patient's skin and held in place by an adhesive patch.
This steady infusion is termed the basal rate and is designed to supply the background insulin needs.
Each time the patient eats, he or she must press a button on the pump to deliver a specified dose of insulin to cover that meal.
Some people prefer injections because they are less expensive than pumps and do not require the wearing of a continually attached device.
The two primary advantages of intensive/flexible therapy over more traditional two or three injection regimens are: Major disadvantages of intensive/flexible therapy are that it requires greater amounts of education and effort to achieve the goals, and it increases the daily cost for glucose monitoring four or more times a day.
This cost can substantially increase when the therapy is implemented with an insulin pump and/or continuous glucose monitor.
When implemented correctly, flexible regimens offer greater ability to achieve good glycemic control with easier accommodation to variations of eating and physical activity.
[3] Over the last two decades, the evidence that better glycemic control (i.e., keeping blood glucose and HbA1c levels as close to normal as possible) reduces the rates of many complications of diabetes has become overwhelming.
An injection port is a small disposable device, similar to the infusion set used with an insulin pump, configured to accept a syringe.