Intensive insulin therapy assists people with diabetes to achieve tight control of blood sugar levels. As a result, it reduces several diabetes complications, and helps to improve long-term health. A study published in the New England Journal of Medicine (NEJM) revealed the impact this treatment has on diabetes. The researchers found that intensive insulin therapy:

  • Reduced the average risk of retinopathy by 76 percent and slowed it by 54 percent.
  • Decreased the occurrence of microalbuminuria (urinary albumin excretion of 40 mg per 24 hours) by 39 percent.
  • Decreased the occurrence of albuminuria (urinary albumin excretion of 300 mg per 24 hours) by 54 percent.
  • Reduced clinical neuropathy or nerve damage by 60 percent.

However, intensive insulin therapy requires strict management and causes serious side effects, which you should be aware of before opting for this treatment.

What is Intensive Insulin Therapy?

Intensive insulin therapy is a more aggressive treatment for achieving normal or close-to-normal blood glucose levels. Working with your doctor, you set goals to achieve blood glucose levels within a specific range before and after meals. You also try to reach a hemoglobin A1C (your average glucose levels over a few months) of less than seven percent.

Intensive insulin therapy requires more frequent blood sugar testing and insulin injections - typically before each meal and at bedtime. You must also make dietary and exercise changes to help control your blood sugar levels.

What Are the Risks of Intensive Insulin Therapy?

The NEJM study showed that the main adverse effect of intensive insulin therapy was a two-to-threefold increase in severe hypoglycemia (low blood sugar). Hypoglycemia may cause you to feel faint, hungry, sweaty, shaky, confused or disoriented. You may also experience heart palpitations or, in severe cases, suffer a coma.

Intensive insulin therapy also causes weight gain, which has adverse effects on your diabetes. And in critically ill patients in intensive care units, intensive insulin therapy resulted in a higher risk of mortality.

Making the Decision about Intensive Insulin Therapy

Ultimately you and your medical team will make the decision about the best course of treatment for your diabetes. However, when weighing if you should try intensive insulin therapy, consider the commitment involved.

If you are new to blood glucose monitoring, regularly miss injections, have trouble adjusting your diet or exercising, or are prone to low blood sugar, intensive insulin therapy may not be for you. It is also not recommended for children, older adults, or people with cardiovascular disease or severe diabetes.

In the past, intensive insulin therapy was mostly recommended for people with type 1 diabetes. Now doctors may recommend it in the early stages of type 2 diabetes to further reduce the risk of diabetes complications and improve long-term health.

In a NICE-SUGAR study published in the Canadian Medical Association Journal researchers concluded that intensive insulin therapy should be reconsidered in critically ill patients, as it increases their risk of hypoglycemia by six times compared to conventional insulin treatment.

Also, if you are obese and have insulin-resistant type 2 diabetes, weight loss may be more effective than intensive insulin therapy.

Study References

Journal Name: New England Journal of Medicine, Volume 329 Number 14, pp. 977-986

Study Date: September 30, 1993     

Study Name: The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus


Authors: The Diabetes Control and Complications Trial Research Group

Journal Name: Canadian Medical Association Journal, Vol.180 (8).

Study Date: March 24, 2009

Study Name: Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data


Authors: Donald E.G. Griesdale, MD MPH, Russell J. de Souza, RD MSc, Rob M. van Dam, PhD, Daren K. Heyland, MD, Deborah J. Cook, MD MSc, Atul Malhotra, MD, Rupinder Dhaliwal, RD, William R. Henderson, MD, Dean R. Chittock, MD MS(Epi), Simon Finfer, MBBS and Daniel Talmor, MD MPH