THERAPEUTIC CHOICES :-

If the child presents to the doctor with extreme hyperglycemia or diabetic ketoacidosis, the initial treatment is with human regular insulin infused intravenously. Once the blood glucose levels and electrolyte levels are stabilized and ketones are cleared from the circulation, they can be switched to a daily regime of subcutaneous insulin injections. Patients, who present with lesser degree of hyperglycemia not associated with significant ketosis, can initially be treated with insulin directly as out patients. Care must be taken at this time to ensure that patients receive a thorough education of how to use insulin, understand the rules for adjustment of insulin doses, learn to recognize and treat hypoglycemia, understand the relation of insulin to diet and exercise, are instructed on sick day guidelines and are familiarized with other aspects of diabetes such as foot care, dietary guidelines and hygiene (Table 3). Children, adolescents, those with acute illness or learning problems are better hospitalized initially. This can help in familiarizing the child and the parents with insulin injection techniques and intensive education can be given over several days as well as insulin dosage adjustments can be made under the supervision of a physician. 

Table 3: Patient Education at First Visit/Initial Hospitalization

A

B

C

D

FIGURE 1: A- Single Dosage Regime, B- Twice Daily Regime, C- Multiple Daily Regime, D- Normal Physiological Insulin Secretion in Non Diabetic Individual.