MMPAD Milan Meeting Report

17 European Roadshow - Milan, 29 June 2018 MEETING REPORT PRACTICAL INSULIN TREATMENT Presented by Professor Claudio Maffeis - University of Verona The basic goal of insulin therapy is to try to mimic the physiology of the body, mimicking insulin secretion during meals and the basal insulinaemia of non-diabetic subjects. The mean values of HbA1c can be high during developmental years and subject to great variability in blood glucose. The first objective is therefore to reduce glycaemic variability. The main available insulins are fast-acting analogues such as lispro, aspart and glulisine, and basal insulin analogues, such as glargine, detemir and degludec. NPH insulin is now little used. There is also a biosimilar to glargine insulin, abasaglar. Reflection: Practical arrangements for the administration of insulin therapy Since insulin administration schemes should mimic insulin levels in non-diabetics, in children, more than in adults, it is still preferable to administer regular insulin in the morning. The characteristics of the needle and injection procedures are particularly important in children, which, after the first 2 years of age, have a lower subcutaneous fold than adults. Pen injectors are now also available for children. It is very important to reduce the risk of hypoglycaemia by ensuring that the injection is subcutaneous and not intramuscular: for this reason, 4 mm needles are used in paediatrics. If the subcutaneous tissue is thin, a small puncture has to be carried out or the needle must be tilted at 45°. The injection site should also be changed to avoid the risk of developing lipohypertrophy. For very small patients or those with fear of needles, catheters in place for a few days are also available. The 2014 and 2018 ISPAD guidelines provide a set of recommendations for the evaluation of the correct dose of insulin, which must take into account a number of factors related to the characteristics of the patient, their lifestyle and length and stage of diabetes . 24 In prepubescent children, generally, 0.7–1.0 IU/kg/day are required, while during puberty the dose may significantly increase to between 1.2 and 2 IU/kg/day. In the partial remission phase, however, the total daily dose of insulin is generally <0.5 IU/kg. Then there are situations of insulin resistance due to various factors, especially hormones, which require high doses of insulin. An extract from Professor Maffeis‘ presentation is available here