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Children with type 1 diabetes need intensive insulin therapy to help them achieve better long-term blood-glucose control and avoid complications later in life, according to Swedish researchers writing in the October 2001 issue of Diabetes, Nutrition & Metabolism.
Dr. Ludvigsson and a colleague from Linkoping University argue that, as long as education and psychological and social support are provided, children with type 1 diabetes should be treated either with multiple daily injections of insulin or with continuous infusion via an insulin pump, combined with blood-glucose monitoring. Doctors note that insulin regimens are likely to differ from child to child and to vary day by day even for the same child, depending on the child's lifestyle and on which types of insulin are available.
Insulin types that are useful for children include short-acting insulin (both Regular and insulin analogs), intermediate-acting insulin (NPH and Lente) and the new long-acting insulin glargine (Lantus). Insulin glargine can help to provide basal insulin, write the doctors.
According to these researchers, the argument that intensive treatment results in more cases of low blood glucose—a concern expressed in the Diabetes Control and Complications Trials—is no longer tenable.
Rather, they say, a flexible dosing system that most closely matches the body's normal insulin response results in fewer episodes of low blood glucose than a fixed insulin regimen, which usually consists of a twice-daily split-mixed dosage.
Both the child and the parents should be educated when the child is diagnosed, and an intensive insulin regimen should begin as soon as possible after diagnosis, the doctors state.
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