[Current aspects in therapy of insulin-dependent diabetes mellitus in children and adolescents].
It has been shown in recent years that optimal treatment delays or prevents diabetic late complications. The goal for therapy is therefore near norm-glycemia. The precondition is intensive education of the patient and the parents, as well as exact diet with known amounts of carbohydrates, multiple insulin injections and home blood glucose monitoring. We propose two different schemes for insulin therapy according to age: conventional insulin therapy in the younger child, and intensified insulin therapy with the insulin pen in adolescents. Conventional insulin therapy consists of two daily injections--before breakfast and before supper--of a mixture of short acting and long acting insulin. With the conventional insulin regime a rigid schedule of insulin injections and meals is required for optimal treatment of type I diabetes. This, however, is not accepted by adolescents since it conflicts with their age-related tendency for self-autonomy. In consequence, glucose metabolism deteriorates and HbA1 levels increase. Puberty is a period of high risk for the development of diabetic angiopathy, which determines quality of life and life expectancy. An approach to resolution of this dilemma is to adjust the insulin regime to the life-style of an adolescent rather than vice versa. Up to now, more than 30 adolescents with type I diabetes have been switched to intensified insulin therapy using the insulin pen. During a short hospital stay (5 days) they underwent an intensive teaching program of self control, insulin dose adjustment and nutrition with special attention to the management of unexpected situations such as additional or omitted meals, traveling and sports. Compliance improved markedly.(ABSTRACT TRUNCATED AT 250 WORDS)
Schönle
E J
EJ
Universitäts-Kinderklinik, Zürich.
D000293:Adolescent; D000328:Adult; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D010349:Patient Compliance; D010353:Patient Education as Topic; D000297:Psychology, Adolescent
D007328:Insulin
Moderne Aspekte der Therapie der insulinabhängigen Diabetes mellitus bei Kindern und Jugendlichen.