Prevention of adverse events in juvenile diabetes

The most severe adverse event of juvenile diabetes is death. Still these days it happens that children with diabetes die from diabetes before having received any treatment at all, sometimes probably undiagnosed. We have to improve the awareness and knowledge, both in the general population and also among health care staff and physicians. Retarded growth and development was seen earlier, but is now rare. But long-term complications affecting primarily blood vessels and nerves are still a real threat and may develop already after a few years. Unless diabetes is well treated, the disease is as dangerous as ever before. We know that a good metabolic control prevents complications, but not how to reach such control in many patients. Severe hypoglycemia has been feared to limit our possibilities to reach good metabolic balance. However, near-normal HbA1c must not be accompanied by increasing incidence of severe hypoglycemia. Too many patients are never offered an insulin treatment as physiological as possible. Adequate use of basal and bolus insulin is a prerequisite. Continuous adjustments should be monitored on the basis of glucose profiles, but without effective education and psychosocial support the treatment tends to fail. Intense treatment of diabetes may become a heavy burden, an "adverse event" in itself, for the patient and the parents of a diabetic child. Psychosocial support is often needed. Realistic information already from the onset of the disease is important, together with optimism, encouragement and not only criticism. Short-term goals and realistic agreements may help the patient to accept the disease. Independence and capacity to manage the treatment successfully contribute to a good metabolic control and also improves quality of life. Children with diabetes cannot expect a "normal" life, but they should be able to expect a long, active, exciting and happy life.