Intensified insulin therapy

Intensive treatment of type 1 diabetes

There have been amazing advances for the treatment of type 1 diabetes. As clinicians proceed into the twenty-first century, it is appropriate to reflect both about accomplishments and about the prospects of improved therapeutic options. Regarding the former, perhaps no advance can be compared to the discovery of insulin. Since then, the improvements in therapy have appeared to be too slow for physicians, patients, and their families. In actuality, over the past 20 years, the pace for the development of new tools for the treatment of this once fatal disease has been remarkable. The treatment of type 1 diabetes has evolved with advances in the treatment of microvascular, neuropathic, and macrovascular complications. The future is even more promising, with the possibility of even preventing the disease before the development of hyperglycemia. The challenge for the present is teaching all individuals involved with the management of patients with type 1 diabetes to manage the condition as effectively as possible.

Use of uncooked cornstarch to avert nocturnal hypoglycemia in children and adolescents with type I diabetes

Intensive management of type I diabetes mellitus may lead to a significant increase in hypoglycemia. This study evaluated the use of uncooked cornstarch to avert hypoglycemia in 13 patients, ages 3.0-17.5 years, with diabetes and a history of nighttime hypoglycemia. The usual bedtime snack (Standard Snack Period) was given for 14 days followed by 14 days in which 25%-50% of the carbohydrate content was given as uncooked cornstarch in milk (Test Snack Period). Blood glucose levels were obtained at 0200 and before breakfast during the 28-day study. No difference was found between the mean (+/- SD) before breakfast blood glucose levels during the two periods; however, the mean (+/- SD) number of hypoglycemic episodes (blood glucose < 60 mg/dL or 3.3 mmol/L) was reduced significantly during the Test Snack Period at both 0200 (p < 0.025) and before breakfast (p < 0.01) compared to Standard Snack Period (Standard Snack 2.00 +/- 2.12 versus Test Snack 0.61 +/- 0.87 at 0200, Standard Snack 2.61 +/- 2.25 versus Test Snack 0.69 +/- 1.03 before breakfast). In addition, in four children who were evaluated with every-2-h glucose levels through the night, stable glycemia was achieved after cornstarch ingestion. Our results suggest that uncooked cornstarch may be useful to decrease the frequency of nocturnal hypoglycemia in type I diabetes patients. This low-cost, simple intervention might be considered as an adjunctive therapy to diminish the risk of intensive diabetes management.