Rational use of insulin analogues in the treatment of type I diabetic children and adolescents: personal experience

In the last decade, four fast- and long-acting insulin analogues have been created. Due to the pharmacokinetic characteristics of insulin analogues, they provide an insulin profile closer to normal physiology than can be achieved with human insulins. However, they do not necessarily improve glycated haemoglobin, but they allow better quality of life. In the two daily insulin injection regime, fast-acting analogues are very useful to rapidly correct hyperglycaemia, to allow sleeping in and eating something sweet. In the basal-bolus regime ( >= 4 insulin injections), long-acting analogues reduce nocturnal hypoglycaemias and improve fasting blood glucose. In the two insulin regime (2 or 4 injections), rapid-acting human insulin must not be systematically replaced by a fast-acting analogue. On the other hand, insulin dose alteration must be triple: (.) retrospective, according to numerous previous experiments, in order to enjoy more freedom for meals, sports, etc.; (.) prospective according to programmed changes in meals and sports; (.) with only a "touch" of compensatory adaptation according to actual glycaemia. (c) 2006 Elsevier SAS. Tous droits reserves.