Strategy for self-monitoring of diabetic control

Abstract

Treatment of diabetes must aim at normal metabolism. Sporadic measurements of any known parameter is not a sufficient guarantee but continous regular self-monitoring is necessary. At least [ill]insulin dependent diabetes it seems reasonable that we should monitor the free insulin levels, but that still belongs to the future. As blood glucose gives us a good reflection of the hormonal and metabolic balance, this is a relevant parameter to follow. Glycosylated proteins, mainly hemoglobin, give only retrospective information of moderate value for the practical management of the disease. Furthermore, one should be aware of the different weak points of glycosylated hemoglobin which does not tell the only, total truth about glucose balance. Self-monitoring of blood glucose is a very valuable tool, especially when used in a systematic way. To get information covering the whole day every day tests for glucosuria have still a place, especially among children and young adults with rather short duration of diabetes. With a sensible approach it is possible to get good compliance among most patients. A combination of blood and urine glucose selfcontrol creates opportunities for a good metabolism in diabetes.Several studies both experimental and clinical (Ca¬ nili et al 1976; Skyler 1979) have given strong support for the importance of good metabolic control in pre¬ venting diabetic microangiopathy. Even without such proofs it is self-evident that people with diabetes shall have the same kind of metabolism as healthy people as long as nobody has shown that diabetics need an abnormal metabolism. The question is ra¬ ther: Which of all abnormal hormonal and metabolic parameters should first of all be normalized if we cannot normalize all, but have to choose? How do we know whether this goal can be reached? InsulinThe aim of diabetes treatment before the discovery of insulin was mainly to normalize the carbohydrate metabolsim as that seemed to the main error. How¬ ever, curiously enough this attitude has remained unchanged even after the insulin discovery. Thus the interest has been focused on blood glucose levels and to some extent on fat metabolism. If the main error in type I diabetes actually is the insulin deficiency or inadequate insulin levels, the main aim should reasonably be to normalize the insulin levels, but during decades this has become a secondary aim.Most treatment programmes have more or less in vain concentrated upon how to correct life of dia¬ betics including food an exercise habits to suit an abnormal insulin level. It seems reasonable that we should monitor the free insulin levels, but for the moment we know too little about what is physiolo¬ gical levels, and the less where and how to measure