[Insulin-dependent diabetes: clinical aspects and therapy]

The risk for healthy sibs to develop type I diabetes is 3-5%. HLA Dr 3 und Dr 4 plus islet-cell antibodies predispose for the disease. Polyuria, polydipsia etc. plus a blood sugar greater than 200 mg/dl establish the diagnosis in symptomatic-and an OGT in asymptomatic patients. Initially non-ketoacidotic patients can be effectively treated with an insulin mixture of 1/3 regular + 2/3 NPH in a dose of 1 U/kg bw per day with 2/3 in the morning and 1/3 in the evening. Manifestation and duration of remission (= no glucose excretion, insulin less than 0.5 U/kg/day, measurable C-peptide) are related to initial decompensation. At present no therapy is available to prolong remission. The "tailored" therapy for diabetics of long duration is favoured: individual insulin mixtures of less than 1 U/kg/day in 2 divided doses, with 6 of more meals. Metabolic control should achieve a glucose excretion of less than 5% of the consumed carbohydrates, a 2-h postprandial blood sugar of less than 200 mg/dl (140-200 mg/dl) and a HbAlc-concentration below 8% (= less than + 3 SD).