ABSTRACT
Type 1 diabetes mellitus in childhood and adolescence presents special challenges to pediatric health-care providers. The combination of severe insulin deficiency and the physical and psychoemotional changes that accompany normal growth and development make day-to-day management of pediatric patients especially difficult. Moreover, the results of the Diabetes Control and Complications Trial (DCCT) have raised the bar considerably higher with respect to goals of treatment, since intensive treatment was shown to significantly reduce the risk of progression of retinopathy and the development of microalbuminuria (1-3). Current recommendations mandate that youths with type 1 diabetes should aim to achieve metabolic control as close to normal as possible and as early in the course of the disease as possible. Remarkably, a much greater proportion of young patients are meeting strict standards of care than ever imagined possible only a few years ago. Our approach to insulin replacement in children and adolescents with type 1 diabetes is discussed below.
