KATHY is a young woman. She watches her diet and her weight, gets plenty of exercise, and follows her doctor’s instructions. She also gives herself insulin injections every day. Kathy is one of many millions of people who have diabetes.

In spite of all her precautions, Kathy admits: “I never can tell what my blood sugar will be. One afternoon it may be 300. The next day, on the same schedule, it may be 50 and I’m going into insulin shock.” Not long ago she developed a nonhealing infection and spent weeks in a hospital.

In Kathy’s case, the disease is called Insulin Dependent Diabetes Mellitus, or Type I diabetes. The problem here lies in the inability of the pancreas to make insulin. Recent evidence indicates that this type of diabetes may be caused, at least sometimes, by viral infections. The person with this type usually contracts it at a young age (under 30), is usually thin, and needs insulin shots to live.

Treating Type I Diabetes

Kathy’s diabetes, Type I, is much more serious, though less common. It would seem that the solution to Type I is simple​—just replace the insulin. However, though insulin shots can keep a diabetic alive, they cannot account for the minute-to-minute fluctuation of insulin level that the body needs.

In order to minimize the complications of diabetes, such as blindness and kidney trouble, it is important to reduce the amount of sugar in the blood and in the urine. The need is to imitate the body’s normal and frequent fluctuations of insulin. But the question is just how to do that. The treatment is two-fold: (1) preventive maintenance and (2) insulin replacement.

With preventive maintenance, steps must be taken to minimize the daily fluctuations in the body’s need for insulin. A vital factor is the food that the person eats, for this is what the digestive system turns into blood sugar. The prudent person with Type I diabetes soon learns that he must have a well-regulated diet. This includes the more complex carbohydrates, as well as fats and proteins. This diet avoids sugar, honey, pastries, sugar-laden soft drinks, and similar sweets. These carbohydrates swiftly find their way into the bloodstream.

This diet must be presented to the body at regular intervals. If the diabetic becomes careless, eating whatever appeals to him at any time, the levels of insulin and blood sugar quickly get out of balance. This leaves the person open to quick and severe illness or to the long-term complications of the disease.

Exercise lowers blood sugar. So the conscientious Type I diabetic includes exercise in the daily routine, being careful to have available a quick source of sugar (such as hard candy) in case the exercise drives the blood sugar too low. That can lead to diabetic shock. Emotions, too, can wreak havoc with the blood sugar and may be a cause of poor self-control regarding the diet. Infection and illness must be quickly treated, since they can cause blood-sugar levels to swing widely.

Yet, in spite of taking all these factors into account, the patient with Type I diabetes, like Kathy, may still have trouble stabilizing blood sugar. What then?

The second main aspect of treatment is the use of insulin injections. When insulin was developed over 60 years ago, it was lifesaving for many diabetics. And later development of one-a-day shots was initially perceived as a great advantage.

Though the daily injections are more convenient, there is some concern about possible long-term complications, such as hardening of the arteries. Thus, some are recommending more frequent injections of short-acting insulin to control the blood sugar more tightly during the course of the day. Several recent developments have made this not only possible but also practical.

One advance for home monitoring of blood sugar has been labeled “the first truly significant therapeutic advance since the discovery of insulin.” Using a simple portable machine, the diabetic may check his own blood sugar several times a day. Thus he can make his own frequent adjustment of insulin dosage and can come closer to constant normal blood-sugar levels.

One disadvantage of home monitoring is that the diabetic must prick his finger for the blood test. But there are special lancets for this, and those experienced in the procedure say it really is not bad. Another disadvantage is the cost of the machine. However, that expense should come down with improved technology.

Other advances include the development of inexpensive, disposable, very sharp insulin needles. These have rendered the insulin injections less painful. Also, the insulin available today need not be refrigerated; thus serious inconvenience is avoided on trips.

Insulin that is equivalent to human insulin has now been marketed and is often recommended for newfound Type I diabetics. New also are the pressurized, needleless insulin injector and the insulin infusion pump. The pump is a portable insulin injector that the patient wears on his belt. It constantly injects insulin through a needle in the abdominal cavity. The infusion pump, although in use today, is considered by many doctors to be somewhat dangerous and should be used only under the supervision of a specialist.

Regarding children who are Type I diabetics, a recent trend has been to be less concerned about diet. Some feel that they can eat a relatively normal diet and then cover that diet with whatever insulin is necessary. Of course, such children still should not eat many sweets. The real basis for their living a relatively normal life seems to be close blood-sugar monitoring and frequent insulin adjustment.