Self-management: an approach to patients with insulin-dependent diabetes mellitus.

Patients have been shown to be able to monitor their blood glucose and administer insulin to optimize and normalize blood glucose levels. There are now three reflectance meters available whose measurements correlate well with laboratory measurement of blood glucose, with a correlation coefficient between 0.92 and 0.97. A stepwise approach toward blood glucose control has been found to be most valuable. The initial phase of the program involves patients performing blood glucose measurements before and 1 h after each meal, in addition to times when patients feel hypo- or hyperglycemic. This phase of the program demonstrates the vagaries of glucose control and emphasizes to the patients the dichotomy between symptoms and actual glucose levels. The patient is also taught during this period the risk factors associated with hyperglycemia that may contribute to vascular disease in the future. Subsequently, insulin is adjusted so that patients are given an insulin regimen that will coordinate peaks of insulin with peaks of blood glucose associated with a meal pattern. Patients are taught by health professionals and in a group setting to calibrate insulin calories and exercise depending on blood glucose readings. Such a program is received enthusiastically by patients and physicians. The major disadvantage lies in the cost of the meter and the reagent strips. Nevertheless, such programs may be cost effective because of the avoidance of diabetes-related hospitalizations.