MMPAD Munich Meeting Report

MEETING REPORT 15 European Roadshow - Friday 25 th May, 2018 Munich, Germany In cases of persistent deviations from target glucose levels, Karges outlined practical advice from the ISPAD guidelines . 16 For example, in cases of the dawn phenomenon, with elevated glucose levels before breakfast triggered by the release of cortisol and growth hormones in adolescents, she recommended checking blood glucose levels at 02:00 and 05:00, and increasing regular insulin in the evening or insulin at dinner, if necessary. Onset and duration of efficacy may be influenced by the choice of insulin. What else to consider? Insulin treatment should be accompanied by intensive training. An important element is the motivation of families, which is difficult to accomplish, Karges conceded. Regular monitoring of injection sites should also take place. In addition, devices must be monitored because standard deviation should not exceed 15%. According to the 2018 ISPAD recommendations, an individualised therapy would be desirable, which aims to reach the lowest achievable HbA1c values without risking severe hypoglycaemia. Insulin pump Continuous subcutaneous insulin infusion via a pump is being increasingly introduced in paediatric patients. According to Karges, of the diabetic children in Germany, 50% have a pump while the other half receive multiple daily injections. "The best way to imitate the physiological profile is with a pump." Furthermore, the pump can be attached to a glucose sensor. Patients with pumps have a low rate of DKA, severe hypoglycaemic episodes and coma, the speaker said. Indications for pump treatment are: recurrent severe hypoglycaemic events, pronounced fluctuations of blood sugar levels, suboptimal metabolic control (exceeding HbA1c upper limits), microvascular complications and the risk thereof, and whether the insulin dosing regimen inhibits the patient’s lifestyle. Moreover, insulin pumps are beneficial in young children, patients with a needle phobia, athletes and for pregnant women. Prior to the initiation of insulin pump treatment, there are some aspects to consider (Figure 4) . Figure 4 : What should be considered prior to initiation of pump treatment in paediatric patients (slide: Karges) . 17 An extract from Professor Karges' presentation is available here