Q: Recently, the newspapers reported that diabetics who maintained low blood-sugar levels reduced their likelihood of developing complications involving the kidneys and eyes. My doctor has been satisfied with my treatment during the eight years I have used insulin. My blood sugars are always around 200 when I check them each morning, and I wonder whether I need more insulin.
A: For many years, it has been evident that control of blood sugar could prevent acute complications of diabetes, such as infections and diabetic coma (ketoacidosis). Although many studies suggested that excellent control of blood sugar would also prevent some of the late complications, such as those you mention, the first compelling support for rigid control came in June when the Diabetes Control and Complications Trial reported that intensive treatment of diabetes slowed the development of eye, kidney and nerve damage.
Many doctors had been hesitant to prescribe large doses of insulin because of the increased risk of hypoglycemia and uncertain benefits. You should definitely ask your doctor about measures for more strict control; consistent blood sugars of 200 and above are too high.
Unfortunately, many doctors were so intent on controlling the blood sugar levels in diabetics that they have not devoted enough attention to other factors that predispose to such large vessel disease: high cholesterol and triglyceride levels, low HDL cholesterol, high blood pressure and cigarette smoking.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.