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From Brazil:

I'm a pediatric endocrinologist and I work with diabetic children in my city. My methodology of control is done with urine examination, four times a day, checking for ketonuria and glycosuria, and one time a week, the patient does a blood sugar determination with a glucose meter at home. I do the clinic control of the patients monthly. I use NPH insulin twice generally. Would you suggest anything different or better to control these patients?


In Italy, for a long time, we have generally treated children and young adult Type 1 patients with an intensified insulin regimen (at least 3 shots a day, using Regular insulin before breakfast and lunch, and Regular and NPH before supper, more and more often switching them to Regular before each meals and NPH at bedtime). We don't use urine testing anymore (except for ketones). We can give patients, free from our National Health Service, strips and meters for self monitoring (generally 4 tests a day). We assess metabolic control during a visit with a HbA1c determination at least 4 times a year.


Original posting 2 Aug 97


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