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Although advanced complications are rare in youth, the demonstration of metabolic memory in follow-up studies of the DCCT cohort, demands implementation of tight glycemic control in all individuals with T1D as early as possible alter diagnosis. This is particularly difficult in the pediatric population owing to the increased risk for hazardous hypoglycemia, fluctuating insulin requirements due to exercise, illness, variable carbohydrate intake, as well as psychosocial and physiological issues related to age, puberty and weight gain. Furthermore, adolescents with T1D have higher average HbA1c levels compared to those in the adult population. For the moment better outcomes for children and teens with T1D depend in large part of the ability to more appropriately tailor the insulin regimen for each individual. The presentation will review: use of insulin analogs, newer monitoring systems and delivery devices. A. Insulins Different centers use different approaches to insulin therapy, with increasingly more using basal-bolus approaches with either multiple daily insulin injections (MDI) or CSII. MDI has traditionally comprised NPH or Ultralente given once or twice daily as the basal insulin with regular human insulin boluses before meals. With the availability of both fast -and very long- acting insulin analogues, MDI now mainly uses insulin glargine (Lantus) or detemir (Levemir) as the basal insulin and insulin lispro (Humalog) or aspart (Novorapid/Novolog) as the premeal boluses. CSII employs fast-acting insulin analogues in a continuous basal rate with premeal boluses. When basalbolus routines are meticulously used together with the other aspects of management, at least a proportion of individuals with T1D are able to maintain near normal glycemic control.

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2006-10-12   |   2,271 visitas   |   Evalua este artículo 0 valoraciones

Vol. 4 Núm.1. Febrero 2006 Pags. 43-44 Rev Venez Endocrinol Metabol 2006; 4(1)