Management of type 1 diabetes mellitus in children

Abstract

Children with type 1 diabetes (DM1) are treated with subcutaneous insulin, either using injections or a continuous insulin infusion pump, to maintain normal blood glucose levels. Poor or inadequate control of blood glucose is associated with complications of diabetes such as retinopathy, nephropathy, neuropathy, and an increased risk of cardiovascular disease. Many different insulin regimens are used in order to achieve a balance of adequate glycemic control and an acceptable routine for the child and their family. The current standard of care is to give insulin in a minimum of three times daily (TID) insulin injections. More frequent multiple daily injections (basal-bolus regimen) or an insulin pump offers the advantage of increasing flexibility and the ability to more finely adjust insulin dosing. These insulin regimens have been used with rapid acting insulin analogues. Recently, long acting insulin analogues have been introduced that have been shown to have less variability and to decrease the risk for hypoglycemia. Aspects of type 1 diabetes management in children will be reviewed including: current treatment options available, insulin regimens and insulin delivery methods, structures and mechanism of action of the new insulin analogues. The use of new insulin analogues will be discussed in children with type 1 diabetes and specifically the impact on metabolic control, frequency of hypoglycemia and weight. © 2010 Nova Science Publishers, Inc. All rights reserved.