Insulin regimens and insulin adjustments in diabetic children, adolescents and young adults: personal experience.
Because recent multicenter studies, even those performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of glycated hemoglobin (HbA1c) are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. The "good" treatment is signed by good HbA1c associated with good quality of life, and is not necessarily exportable without adjustment to the local way of life. HbA1c must be under 7%, if the upper normal limit is about 6%, which is possible, in our experience, even in diabetic children and adolescents. Our "recipes" are summarized. The number of daily insulin injections, 2 or 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided; only the objective result is important.
Dorchy
H
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Diabetology Clinic, University Children's Hospital Queen Fabiola, Avenue J.J. Crocq, 15, B1020 Bruxelles, Belgium. hdorchy@pop.ulb.ac.be
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D006442:Glycated Hemoglobin / Q000032:analysis; D017408:Guidelines as Topic; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D019518:Postprandial Period; D013177:Sports
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin