METHODS OF INSULIN SUBSTITUTION IN CHILDREN AND ADOLESCENTS WITH TYPE-I DIABETES

The metabolic target of diabetes treatment in children and adolescents is to achieve a near-normal blood glucose concentration with an HbA(1c)-level below the triple standard deviation of the norm and a low incidence of severe hypoglycaemia. The most important therapeutical measure is the insulin substitution. This should conform to the physiological secretion pattern of healthy people with a normal metabolism. Conventional insulin therapy does not meet these requirements. If the share of intermediate-acting insulin is 70% and the share of short-acting insulin is 30%, food intake must be adapted in line with the preset effect of the insulin. Therefore the patient is obliged to follow an exactly laid down ''insulin diet regime''. Intensified insulin therapy is carried out with a specified prandial and basic insulin substitution. With a share of short-acting insulin amounting at. 70 % and the intermediate-actine insulin share at 30 % the effect of insulin is adjusted to the planned carbohydrate intake. Time and amount of food intake can be chosen by the patient himself. Several prospective. randomized long-term studies have proved the superiority of the intensified insulin therapy. It is indisputable that an almost normal blood glucose concentration with a law KbA(1c)-level is more likely to be achieved than with conventional insulin therapy. It is controversial whether a better adjusted metabolism with the intensified therapy is likely to cause a higher incidence of severe hypoglycaemia. Own findings and the result of a metaanalysis of several long-term studies do not show a significant relation between a low HbA(1c)-level and frequent events of severe hypoglycaemia. The success of metabolic control varies during childhood and adolescence. Especially during the remission period, it is possible to achieve good metabolic control in most toddlers and young school children. The successful treatment of adolescents between 14 and 20 yrs is not easy. Individually different somatic, psychosocial and pedagogical problems render the diabetes therapy in this age group difficult.