Insulin Therapy in Children and Adolescents

Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT 06520-8064, USA.
Endocrinology and metabolism clinics of North America (Impact Factor: 3.4). 03/2012; 41(1):145-60. DOI: 10.1016/j.ecl.2012.01.002
Source: PubMed


Insulin therapy is the mainstay of treatment in children and adolescents with type 1 diabetes (T1D) and is a key component in the treatment of type 2 diabetes (T2D) in this population as well. A major aim of current insulin replacement therapy is to simulate the normal pattern of insulin secretion as closely as possible. This aim can best be achieved with basal-bolus therapy using multiple daily injections (MDI) or continuous insulin infusion (CSII) pump therapy. Only a few years ago, options for insulin formulations were limited. There are now more than 10 varieties of biosynthetic human and analogue insulin.

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    • "En cuanto al grado de independencia para la autoinyección, los resultados alcanzados muestran una mayor dificultad entre los sujetos de menor edad. En similitud a lo descrito por Tamborlane y colaboradores (2012) 18 , la técnica de autoinyección la realizaban correctamente, lavándose las manos con agua y jabón, rotando las zonas de inyección según horarios así como purgado y conservación correctos de la insulina. De acuerdo con Malik y Taplin (2014) 19 , la realización correcta de la técnica por niños y adolescentes implica en ellos una previa asimilación de conceptos sobre la importancia y beneficios en salud derivados de su realización correcta . "
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    ABSTRACT: Introduction: Large researches have tried to verify the efficiency of the educational intervention in patients suffering from type 1 diabetes (T1D). Objectives: Analyzing the initial knowledge about diet habits and physical exercise, confirming a possible improvement of the level of this knowledge after the educational intervention and verifying the acquisition of skills related to self-analysis and self-injection. Methodology: 32 subjects with T1D, from 4 to 14 years old in Melilla were included. The knowledge about diet and physical exercise were analyzed using a questionnaire. Diet habits were evaluated using the KrecePlus questionnaire. An educational intervention was offered and that knowledge was analysed again, as well as the skills acquired about self-analysis and self-injection with a new questionnaire. Results: After the intervention, the knowledge about diet and physical exercise significantly improved (p < 0,0001). The results also showed an improvement in diet habits and physical exercise. The study of self-analysis and self-injection skills evidenced that the subjects were independent in the processes of blood glucose self-analysis and insulin self-injection. Conclusion: An educational intervention developed by a nurse is an effective procedure to improve and increase the knowledge about diet, physical exercise and about the disease in diabetic type 1 diabetic, as well as an incentive to acquire healthy habits about diet and physical exercise.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 09/2014; 30(n03):585-593. DOI:10.3305/nh.2014.30.3.7357 · 1.04 Impact Factor
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    • "Intensive insulin treatment is an important advancement in diabetes management that can facilitate optimal glucose control in both adults [1] and children [2] with type 1 diabetes. Despite this, both continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) are still far from being effective in all patients. "
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    ABSTRACT: This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections. We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months. At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14±0.41% at 6 months vs. 7.35±0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95±0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018). CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.
    Diabetes research and clinical practice 01/2014; 103(3). DOI:10.1016/j.diabres.2013.12.026 · 2.54 Impact Factor
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