[Standardized ambulatory insulin therapy of initial moderate ketoacidosis in type 1 diabetes. A pilot project]

Most textbooks advise that newly diagnosed insulin dependent mellitus be admitted to the hospital for starting carefully insulin treatment. We report a pilot study for starting an outpatient insulin using continuous subcutaneous insulin infusion. In 40 newly IDDM (glycaemia over 16.5 mM/l, CO2 over 15 mM/l), intensive therapy was done by CSII = basal rate 1 unit/hour, bolus 5 units per meal. After a long explanatory talk (4 hours) with the physician and the nurse on hypo, hyperglycaemia, on blood glucose sensor and pump, 21 patients agreed to start insulin at home and 19 remained in hospital for 2 or 7 days. At days 3, 30 and 365, clinical and biological evaluation was done and at D30 patient education program for 5 days was undergone. Never emergency even was reported in any patient, and no difference appeared between the in and out patient in D1, D3 and D365 normalisation of blood glucose (3 days) or level cetone body (2 days) and total insulin dose. Our results suggest that outpatient is a safe and cost effective IDDM onset therapy.