Insulin therapy of type I diabetes

Type 1 diabetes is a disease due to hormone deficiency. Therefore treatment with insulin is hormonal substitution and should be done according to physiological data with 4 injections NPH-insulin and 3 preparandial injections of regular insulin before the main meals. Intensified insulin treatment should be separate substitution of basal and prandial insulin need. The basal insulin substitution should be tested by a fasting day over 24 h giving only basal insulin. Insulin treatment has to be supplemented by diabetes education, blood glucose self control and regulation of diet and exercise. Target values are blood glucose concentrations of 80 to 120 mg/dl fasting and before the main meals, 110 to 160 mg/dl at bedtime and above 65 mg/dl after midnight. A written plan with the algorithms of insulin substitution is helpful for the care of the diabetic patient. A successful insulin treatment is assessed by a HbA1c of 7.x without hypoglycemias.