[Functional insulin therapy]

This concept has been developed since 1983 in Germany and Austria. It is of greatest interest with regard to a pedagogical approach of insulin therapy in type 1 diabetic patients. The goal of functional insulin therapy is to separate basal and prandial insulin requirements. The patients perform the following experimental sessions in order to establish their own insulin requirements: 24 h fasting to assess the basic insulin requirement, ingestion of test meals containing different amounts of carbohydrates to determine the individual carbohydrate-intake/insulin requirement relationship, determination of an individual correction algorithm to decrease an elevated blood glucose level (1.60 g/L). It involves patient's therapeutic education, frequent self monitoring blood glucose (6 to 8 daily controls), multiple daily insulin injections. This concept has to be adapted to patient's desire of self responsibility and autonomy. Functional insulin therapy improves metabolic control, decreases the frequency of mild and severe hypoglycaemia, it enhances self-esteem in diabetic patients.