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.
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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.
    Full-text · Article · Jan 2014 · Diabetes research and clinical practice
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