Outpatient self-management of severe diabetes.

We initiated a five-point program to decrease acute and chronic complications in 25 unstable, insulin-dependent diabetics (study group A). The five points were home monitoring of blood glucose, use of multiple injections of a complex insulin mixture, strict dietary control with high protein feedings, carbohydrate loading before exercise, and use of purified insulin preparations. There was an 80% decline in detected hypoglycemic reactions over the succeeding six months. The hospitalization rate fell from 3.4 times per year to 0.64 times a year. An additional five extremely unstable diabetic patients (study group B) were treated with the same program except for the use of an open-loop continuous infusion system for insulin. Although results in this group were favorable in terms of improving glucose homeostasis, mechanical, physical, and psychologic problems can limit usefulness current devices.