Improving glucose control in a patient who has chronically unstable type 1 diabetes is an extremely intensive exercise for both patient and physician. Lessons learned in managing type 1 diabetes in adolescents generally apply to the disorder in children and adults also.
- The current treatment methods for type 1 diabetes are far from perfect; acknowledging this with the patient will aid compliance in the treatment of chronically unstable disease.
- Agreement should be reached between the patient and doctor about the need for regular measurement and recording of blood glucose levels.
- A list of management and lifestyle difficulties should be compiled by the patient and doctor together and the problems then addressed individually.
- Using the ‘pattern recognition’ approach to insulin choice and dosing should achieve fewer fluctuations in blood glucose levels than using the ‘top-up’ approach.
- Emotional, stress and educational problems are common causes of chronically unstable type 1 diabetes and should be identified and treated.
- The treating doctor’s skills and attention to detail will be sharpened if he has experience of the devastating long term complications of diabetes.