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Intensive insulin therapy: Part I. Basic principles.

Intensive insulin therapy is a complete program of diabetes management. A multicomponent insulin regimen is just one element of this approach. Intensive insulin therapy does not necessarily strive for euglycemia, since patients require individualized glycemic goals. When prescribing insulin, the family physician should be familiar with several important pharmacokinetic issues. Insulin species, insulin absorption, injection site and timing of premeal insulin all affect glycemia. The relationship between diabetic complications and blood glucose control is also important. Although many previous studies have been flawed, evidence suggests that meticulous diabetes control decreases the risk of microvascular complications and neuropathy. Unfortunately, studies have shown no improvement in advanced retinopathy or advanced nephropathy with improved glycemic control. The major cost of improved glycemic control is an increased risk of hypoglycemia.