Question:
1. What is "conventional therapy"? Is this also "split mix" where
you take Regular and NPH at breakfast, and the same at dinner?
2. What is "intensive insulin therapy"? Ignoring the insulin pump,
is this Ultralente taken 2x a day and Regular insulin at mealtimes.
Where the regular is adjusted using a "sliding scale?" Or instead
of Ultralente, did the "intensive" group use NPH at bedtime.
3. Or can split-mix be used for "intensive insulin therapy?"
I realize the same insulin therapys don't work the same on everybody,
but why do most people seem to use #1? And also, why whenever I see
a new doctor (I'm on #2), they try to switch me over to #1?
Answer:
I wasn't involved, but the UW Med Center where I now go was. I can tell
you what they told me: Essentially I think your #1 and #2 are pretty much
on target. The crucial issue, though, was monitoring and responding.
Those in the experimental group were expected to test their blood sugar
multiple times during the day and, if the numbers were out of the desired
range, respond to that by taking more insulin or what have you. The
control group on the other hand was expected NOT to test multiple times a
day (no more than once a day I was told) and instead simply rely on their
established regime. As for #3, I'm not sure you could use the split-mix
as an intensive regime -- though no doubt someone will prove me wrong --
simply because there's no easy way to respond to your sugars. If you come
in high at lunch because you ate something odd at breakfast, there's no
mechanism -- i.e., you can't take more insulin -- to cover that.
Because #1 has been around longer and, as Homer Simpson says, "In times
of trouble, go with what you know." (There are also some very valid
reasons for some people to NOT go on an intensive regime.)
