Insulin therapy regimens in paediatric age.

Paediatric Diabetologists aim to personalize insulin therapy in order to attain good metabolic control and good quality of life. Nowadays this goal may be obtained through many devices: syringes, pens or injectors and by several insulin preparations. In fact besides human "traditional" (regular, NPH, Lente zinc and Ultralente zinc insulins) recently, insulin analogues have been synthesized with different pharmacokinetics: short acting (Lispro and Aspart) and long acting (Glargine, Detemir). Since children with diabetes are, often, totally c-peptide negative, insulin therapy must substitute the absence of insulin production and the successful use of short acting insulin analogues requires optimal association with basal insulin. Insulin therapy regimens are adapted to the life style of children and factors affecting the diabetologist's decision to change the regimen are not only glycaemic profiles, HbAlc and metabolic control but, also, age, school needs, prevention of hypoglycaemia, meals timing etc. and, also, culture of patients and their families, compliance to the therapy, possibility to contact frequently the diabetology team, etc. In conclusion insulin regimens must reflect the life style of the diabetic patient who is educated in the strategy of intensive insulin therapy. Italy is a "long" country and the life styles are different region by region; Italian Paediatric Diabetologists are fanciful and the personalization of insulin therapy is a recent conquest thanks to the new and old insulin preparations.