Introduction

Insulin treatment is required from the time of diagnosis of type 1 diabetes. Various insulin regimens are used, including:

• multiple daily injections (basal–bolus)—usually four injections daily
• continuous subcutaneous insulin infusion (CSII)—given by a pump
• mixed insulin—free-mixed insulin or fixed-dose combination (biphasic premixed) insulin, usually two injections daily.

The insulin regimen used depends on local circumstances and expertise; however, whatever regimen is chosen, it should be applied with a target-orientated approach. Typical targets are a blood glucose concentration between 4 and 8 mmol/L and glycated haemoglobin (HbA1c) less than 53 mmol/mol (7%). Intensive regimens require input from a multidisciplinary diabetes team and frequent blood glucose concentration monitoring.

If a multiple daily injection (basal–bolus) regimen is not feasible, a regimen requiring less frequent insulin injections (such as a mixed insulin regimen) can be considered for younger children.

After glycaemic targets are initially achieved following the diagnosis of type 1 diabetes, the patient's required insulin dosage may decline, sometimes to minimal amounts. This is often referred to as the remission phase ('honeymoon phase') and can persist for 6 to 12 months, or occasionally longer. Regular blood glucose concentration checking and clinical review are critical to detect increasing insulin requirements that indicate the end of the remission phase.