Therapeutische Umschau. Revue thérapeutique
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Since the controlled long-term study DCCT has clearly demonstrated that the progression of diabetic late complication is highly dependant on metabolic control an adaptation of insulin therapy became mandatory. In the eighties first successful attempts were made with the so-called Basis-Bolus-Principle (regular insulin before meals and depot-insulin at bedtime), the dosis being adapted depending on blood sugar tests. Near normoglycemia could only be achieved by a very strict time-schedule concerning meal-times and quantity of meals and still was accompanied by an increase of severe hypoglycemia. ⋯ In case of increased risk of hypoglycemia the target of blood sugar must be elevated. The goal of a good metabolic control while minimizing the risk of hypoglycemia and of increased flexibility in daily life can only be reached by special efforts of the teamwork between physician, diabetes nurse and dieticians with the diabetic patient. Different sorts of problems and recommendations of insulin treatment are discussed in a supplement.