Ambulatory long-term treatment of childhood diabetes mellitus

Increasing evidence is accumulating to show the beneficial effect of a good balance of diabetes in protecting against diabetic microangiopathy. The pediatrician's responsibility is to recommend and supervise the best use of the three basic cornerstones of the longterm-treatment, insulin, diet and exercise. The review deals with insulin therapy focusing on insulin treatment "tailored" to the stage of the disease. Twice-daily insulin is in most cases preferable to a once-daily regimen. The risk of over-insulinization is stressed. An essential part of long-term treatment is to instruct the child and/or the parents repeatedly on the various aspects of diabetes, particularly the meal plan, and to pay enough attention to psychic factors.