Optimal glucose control can be achieved in the young diabetic

Recent studies indicate that glucose control may be improved in adult diabetics with intensive insulin (II) Rx (using either infusion pumps or multiple injections) and home blood glucose monitoring. To examine the efficacy of these Rx strategies in children, we examined whether near normal glucose levels could be achieved in 8 young (age 10-15 yrs) diabetics given II Rx (6 pump, 2 multiple injections) for 2-6 mos. Control was assessed by HbA1 (nl 5-8%) and glucose measurements of blood samples mailed from home (HG). Glycemic excursions (MAGE) were determined from inpatient glucose profiles (IG). Effect of II Rx on glucose levels (mg/dl) is shown below (¶ p < 0.01). HbA1 levels fell significantly after 2 wks (12.7±1.0 to 9.3±0.7%) and was further reduced by 4-8 wks.(7.6±0.1%, p<0.005). Glycosuria was virtually eliminated (81±20 vs 3±1 gm/day). Insulin dose increased by 50% with II Rx (to 1.4 U/kg/day). However, hypoglycemia symptoms were mild and none required IV glucose. Conclusions: Near normal glucose control can be achieved in the outpatient management of children and adolescents with diabetes. The comparative efficacy of insulin pump vs multiple injections needs to be determined.