Blatniczky L.,Pediatric Diabetes Care Unit
Lege Artis Medicinae | Year: 2012
INTRODUCTION - Since the end of the past century, the basis/bolus method has been a determinate factor of adjusting insulin therapy. Experiences with insulin pump treatment prove that well-quantified and adequately timed basal insulin treatment can fully compensate for the diurnal glucose-producing activities of the liver and the diurnal changes in the activity of insulin receptors. Suitably selected basal insulin treatment can, therefore, keep the changes in blood sugar level that are dependent of the diet's carbohydrate content well under control. CASE REPORT - By presenting the approximately five-year treatment of an adolescent boy, the author presents the current options (and failures) of insulin therapy that might be used with more or less success. Each treatment approach had its place in the various stages of the patient's diabetes. Nevertheless, insulin pump therapy, admittedly the most state-of-the-art method today was unsuccessful due to patient's lack of compliance, thus this treatment had to be stopped. Still, on the basis of the experiences with insulin pump therapy, the restored intensive-conservative treatment was set up on glargine basal insulin, defining doses of bolus in correlation with 10 grams of carbohydrate, which made the diet less strict. This approach resulted in a considerable improvement of the patient's metabolic profile. CONCLUSION - The right choice of the doses and efficacy curve of basal insulin is essential for achieving a good metabolic balance during intensive-conservative therapy. In case of deteriorating metabolic balance, suspending the inefficient insulin pump therapy is justified and means no disadvantage for the patient, as long as the subsequent adjustment is prudent. By defining doses of a short-acting bolus insulin analogue in correlation with carbohydrate intake along with glargine therapy permits adaptation to the metabolism of patients with poor compliance and unsatisfactory lifestyle - in expectation of better results.