[Do young diabetic patients benefit from functional insulin therapy in the long run?].

NIS therapy (normoglycemic insulin substitution) is accepted by many juvenile diabetics with big expectations concerning a less restrictive diet and way of life. Based on our experience for many years the following problems with this type of therapy have evolved: a) In patients having dietary and weight problems, this type of therapy activates subclinical eating disorders. b) Patients with limited capacity for structured thinking, feel overloaded with the decision making they have to do on their own. c) Patients with severe compulsive ideas develop fears to do something wrong, leading to regulopathy (Thorsten Deckert). d) Furthermore many adolescent patients expect a lot of attention from their physician and therefore may experience a feeling of love deprivation when made selfresponsible for their own therapy. We conclude that introduction of this type of selfresponsible therapy needs deliberate planning both by patient and physician. In our hands a very cautious and stepwise approach, with increasing frequency of blood glucose selftesting and insulin injections combined with simultaneous easing of dietary restrictions as well as the option to return to more conventional therapy whenever necessary, has proven to be most successful.