Individualized insulin therapy in children and adolescents with type 1 diabetes.

The most important point about individualized therapy is to make it flexible to fit the needs of the patient. These needs are determined by age, pubertal status, treatment schedule, exercise, intelligence, education and socioeconomic status. In addition, major emphasis should be placed on the dietary needs, attitude and ability of the patient. Aspects of insulin regimens that can be adjusted include number of injections per day, timing of injections and the type of insulin used. Several factors that affect insulin action should also be considered, including the presence of insulin antibodies, the amount of subcutaneous fat, injection technique and muscular activity. Insulin pump therapy in childhood and adolescence may also be considered in certain cases. Controversial areas in childhood diabetes therapy include the number of daily injections, whether porcine insulin has any advantages, use of multiple doses of intermediate- and long-acting insulin, mixing regular insulin and short-acting insulin analogues, strategies to prevent hypoglycaemia and the importance of choice of injection sites in childhood.