In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that most patients with stage III or stage IV nephropathy consume limited amounts of protein. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with type 1 and type 2 diabetes, especially for those in early stages of nephropathy. Intensive management is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes frequently testing blood glucose, administering insulin frequently throughout the day on the basis of food intake and exercise, following a diet and exercise plan, and frequently consulting a health care team.
Some people use an insulin pump to supply insulin throughout the day.
A number of studies have pointed to the beneficial effects of intensive management. The DCCT, conducted from 1983 to 1993, involved 1,441 participants who had type 1 diabetes. In the Minnesota Medical School trial, researchers examined kidney tissues of people with long-standing diabetes who received healthy kidney transplants. After 5 years, patients who followed an intensive regimen developed significantly fewer lesions in their glomeruli than did patients not following an intensive regimen. This result, along with findings of the DCCT and studies performed in Scandinavia, suggests that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of diabetic nephropathy.