Insulins and oral hypoglycemic medications

The management of childhood diabetes is rapidly evolving, reflecting both the recognition of new types of diabetes in pediatrics and the availability of new insulins. Over the past two decades there have been increasing numbers of children affected by type 2 diabetes, maturity onset diabetes of youth (MODY), and medical diabetes secondary to medication usage (e.g. prednisone) or disease process (e.g., cystic fibrosis). These forms of diabetes require familiarity with medications other than insulin and an understanding of appropriate treatment strategies. Simultaneously, after years of little change, there has been the relatively rapid introduction of new insulins (e.g., lispro, aspart, glargine) and more sophisticated means of insulin delivery (e.g., pumps, pens, inhalers). Taken as a whole, these trends present a challenge to the pediatric diabetes specialist. In this article, the medications that are now frequently used in diabetes treatment are reviewed, including the indications for use, the usual dose, dose adjustment strategies, common side effects and anticipated outcomes. The diabetes literature on the new insulins and diabetes medications is reviewed, with an emphasis on the limited pediatric data. The goal is to familiarize the practicing pediatric diabetes specialist with these medications and their usage.