Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-7

o 2-hour post prandial BG: 5.0-8.0 mmol/L • Specific glycemic goals should be established with the patient and consideration given to age, duration of diabetes, risk of hypoglycemia, presence or absence of cardiovascular disease, life expectancy, lifestyle and personal risk factors (6).

2 . Delay onset or reduce the progression of complications. 3. Improve quality of life as perceived by the individual.

• For example, weight loss or maintenance of healthy weight, exercise or activity without low BG levels, flexibility in food intake and timing of meals without compromising BG goals (see discussion on CHO: insulin ratios for more details on IT without excess weight gain). • For some people, avoiding the chronic complications of diabetes is integral to their definition of quality of life; for others, it may not be. • For many, quality is related to the burden of self-care that diabetes imposes. Diabetes is a psychologically and behaviourally demanding disease, and psychosocial factors are relevant to nearly all aspects of its care (8). A complex and poorly understood interplay of metabolic, social and psychological factors influence the development of psychological disturbances in adults and children with diabetes. Major depressive disorder, generalized anxiety disorder and eating disorders are more common in people with diabetes, compared to the general population (9). • Surveys among DCCT participants showed that IT regimens did not have a negative effect on quality of life (10). Subsequent studies have attempted to demonstrate an improved quality of life, but results have been variable and inconsistent (11,12). 4. Avoid severe episodes of hypoglycemia (i.e. requiring the help of another person to treat) • Were it not for the risks of hypoglycemia, optimal glucose control with an A1C of <6% would likely be feasible and applicable to everyone with diabetes. Hypoglycemia is the major limiting factor in the achievement of optimal goals and may still be the “Achilles heel” of diabetes therapy today (13,14). Consequently, the prevention or management of acute complications such as severe hypoglycemia may be of more immediate concern to the person with diabetes than the longer-term risks associated with uncontrolled high BG. • Hypoglycemia and acute hyperglycemia are annoying, potentially life-threatening and, yet, inevitable (to some degree) events in living with diabetes given the current treatment tools and state of the science. Mild to moderate lows can impair quality of life, and lead to fear of future hypoglycemia (15). The incidence of extreme fear of lows,