The advantages and disadvantages of intensive insulin are shown in Table 2.

Table 2: Intensive Insulin Therapy

ADVANTAGES :-

DISADVANTAGES :-

The major disadvantage of intensive insulin therapy is that there is distinct increase in the incidence of clinically significant hypoglycemia. Furthermore, it may be associated with hypoglycemia unawareness. These effects may be attributable to increased threshold of secretory response of adrenaline to hypoglycemia and enhanced suppression of neoglucogenesis in the liver by insulin (5,6). Intensive insulin regimes are associated with a significantly greater weight gain than standard therapy (7) and these children may be at a significant risk of developing obesity. Careful attention has thus to be given to diet and caloric restriction in these patients. Transient exacerbation of retinopathy has been reported with intensive insulin therapy but this is rarely, if ever, encountered in the pediatric age group. Those small subset of patients who are on insulin pump therapy(continuous subcutaneous insulin infusion-CSII) may face the likelihood of increased risk of diabetic ketoacidosis due to pump failure and an increased incidence of infection at the pump infusion site (8). As great vigilance and frequent adjustment of doses is required for this type of regime, it is not generally recommended for very small children. Furthermore, intensive insulin regimes require a great deal of time, motivation and effort on the part of the patient. They have additionally to be supported by a dedicated diabetes team especially to prevent frequent episodes of hypoglycemia. Notwithstanding the above, intensive insulin regimes have come to stay and are perhaps the ideal mode of therapy for juvenile diabetics as they are the ones who will inevitably face both microvascular and macrovascular complications in their adult life.