Insulin therapy

Optimal glycemic control in type 1 diabetes mellitus (T1DM) requires Intensive Insulin Therapy. Implementation of intensive therapy should be early and prolonged as suggested by the results of Diabetes control and complications trial and Epidemiology of Diabetes Interventions and Complications (EDIC) study. Proper implementation of intensive therapy requires a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment as shown by the Dose adjustment for normal eating (DAFNE) randomized controlled trial. Pen injectors appear to be feasible for routine use although pumps may be required in special situations. Various types of insulin are available in the market, including newer analogs (Iispro, aspart, glargine). Although insulin analogs seem to be more physiological, controlled studies suggested either similar efficacy to regular insulin or only a minor benefit in favor of insulin analogs. The primary concern in developing countries like India is the cost-benefit ratio of short acting insulin analogs in the treatment of diabetic children but this still remains unclear. It would be premature to recommend switching patients to newer analogs especially those who are well controlled, especially when the long-term data is still awaited. The choice of post-meal short acting insulin in toddlers may be decided by the care provider if deemed appropriate. Noninvasive insulin deliveries are now in development. It does appear that the most clinically viable non-invasive system to date may be pulmonary delivery.