DIABETIS MELLITUS2

management of patient with classical symptoms of DM:
Without biochemical decompensation (post acidotic phase):
Immediate aim of this therapy is to:
1-Provide adequate nutrition, and exogenous insulin in way that prevent polydypsia, and polyurea include nocturia.
2-Prevent DKA.
3-Avoid severe hypoglycemia.
4-Permit normal growth and development within an active life style.

? The patient should admitted for initial therapy, and educate parents, and the patient about nature of disease and insulin therapy, at onset of DM or after recovery from DKA, and the total daily dose of insulin is 0.7 U/kg/day in pre pubertal age group ,1 U/kg / day in puberty and 1.2 U /kg /day in late puberty. The insulin, glargine type is used in 25-30 % of the total dose in toddler age and 40-50 % in older age at bed time and the rest of the dose given in 3 divided doses with in the 3 meals in form of lispro or aspart insulin .
? We can use lenti insulin in staid of glargine , if we have poor control of glucose level .
? But the previous regime of insulin as the fallowing :The total amount give in 2 doses of insulin: 2/3 morning (contain 1/3 soluble, and 2/3 lenti), and 1/3 at evening also the same composition of morning dose. We monitor the blood sugar, and increase or decrease the dose by 10-15% if there is hyper- or hypoglycemia.
? Lesipro insulin: duration 3 hours, peak action 1.5 hours, start action at 15 minute