Premeal Insulin Treatment During Basal- Bolus Regimen in Young Children With Type 1 Diabetes

The introduction of insulin analogs inclinical practice suggests updatingtherapeutic schemes in subjects with type 1 diabetes. We read with inter-est the recent article by Alemzadeh et al. (1), which was designed to determine the feasibility of a flexible multiple daily insulin regimen in preschool children. Rapid-acting insulin analogs offer un-questionable advantages due to their pharmacokinetics and pharmacodynamic properties. However, when used in a bas-al-bolus regimen, they also need great ac-curacy in determining the carbohydrate content of the meal. A small mistake could generate a significant problem, in-cluding hyperglycemia or hypoglycemia. The meal carbohydrate count system seems to be effective and safe in control-ling postmeal hyperglycemia in children treated with continuous subcutaneous in-sulin infusion (2), but when rapid-acting analogs are associated with glargine at bedtime, they could leave a “window ” of low plasma insulin levels during the first portion of the night. Indeed, glargine-insulin plasma levels could not yet be consistently stable (3). Moreover, when using rapid-acting insulin analogs, children need an addi-tional insulin shot to control the carbohy-drate intake of their afternoon snack, which is a common practice among chil-dren living in theMediterranean area. The object of the present study was to evaluate fasting and postmeal metabolic effects in prepuberal children treated with glargine and regular or rapid-acting insulin using the carbohydrate counting system