Lege Artis Medicinae

[Possibilities of applying basis/bolus method in treatment of adolescent with type 1 diabetes mellitus]

BLATNICZKY László

MARCH 22, 2012

Lege Artis Medicinae - 2012;22(03)

[INTRODUCTION - Since the end of the pastcentury, the basis/bolus method has been adeterminate factor of adjusting insulin thera-py. Experiences with insulin pump treatmentprove that well-quantified and adequatelytimed basal insulin treatment can fully com-pensate for the diurnal glucose-producingactivities of the liver and the diurnal changesin the activity of insulin receptors. Suitablyselected basal insulin treatment can, there-fore, keep the changes in blood sugar levelthat are dependent of the diet’s carbohydratecontent well under control. CASE REPORT - By presenting the approxi-mately five-year treatment of an adolescentboy, the author presents the current options(and failures) of insulin therapy that might beused with more or less success. Each treat-ment approach had its place in the variousstages of the patient’s diabetes. Nevertheless,insulin pump therapy, admittedly the moststate-of-the-art method today was unsuccess-ful due to patient’s lack of compliance, thusthis treatment had to be stopped. Still, on thebasis of the experiences with insulin pumptherapy, the restored intensive-conservativetreatment was set up on glargine basalinsulin, defining doses of bolus in correlationwith 10 grams of carbohydrate, which madethe diet less strict. This approach resulted ina considerable improvement of the patient’smetabolic profile. CONCLUSION - The right choice of thedoses and efficacy curve of basal insulin isessential for achieving a good metabolic bal-ance during intensive-conservative therapy.In case of deteriorating metabolic balance,suspending the inefficient insulin pump ther-apy is justified and means no disadvantagefor the patient, as long as the subsequentadjustment is prudent. By defining doses of ashort-acting bolus insulin analogue in corre-lation with carbohydrate intake along withglargine therapy permits adaptation to themetabolism of patients with poor compli-ance and unsatisfactory lifestyle - in expec-tation of better results. ]

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