Outpatient management of diabetes mellitus

Outpatient encounters form the mainstay of managing type I diabetes mellitus in children and adolescents. Management philosophy rests on the premise that normal physical and emotional growth is attainable and long-term complications minimized by maintenance of metabolic (glycemic) control. Management principles involve a coordinated team approach of physician, nurse-educator, and dietitian interacting with the family unit to educate them in the appropriate use and adjustment of insulin regimens, to recognize and treat the Somogyi and dawn phenomena, adjustment of nutritional needs, short- and long-term monitoring via home blood glucose and glycosylated hemoglobin measurements, and clues from the history and physical examination that permit anticipatory or reactive steps to achieve the treatment goals.