MANAGEMENT DILEMMAS IN THE INDIVIDUAL WITH CYSTIC-FIBROSIS AND DIABETES

As their life expectancy has improved, patients with cystic fibrosis ( CF) have experienced an increasing incidence of diabetes. Hyperglycemi a may adversely influence weight, pulmonary function, and development of microvascular complications. Strict control of blood glucose has no t universally been sought, however. A program of multiple daily insuli n injections and self-monitoring of blood glucose with an aim of normo glycemia is described in this article. The typical cystic fibrosis die t is variable in quantity and features a preponderance of simple carbo hydrates; this is contrary to the usual diabetes meal plan. We describ e the use of a flexible meal-planning system to establish individualiz ed carbohydrate targets with specific insulin boluses titrated to each meal to control postprandial blood glucose excursions. Records of 22 patients followed for more than I year are reviewed. Mean (+/-standard error of the mean) glycosylated hemoglobin was reduced from 11.3+/-3. 1% (at baseline) to 8.1+/-1.8% (at 1 year). Mean percent of ideal body weight also increased from 95.4+/-15.2 to 100+/-17.1. We conclude tha t strict metabolic control is an attainable goal in patients with cyst ic fibrosis and is associated with positive weight gain.