Management of type 1 diabetes mellitus 

Almost 90 years after the discovery of insulin, people with type 1 diabetes still use subcutaneous insulin to manage their condition. Such treatment is life saving, preventing early death from ketoacidosis, relieving symptoms, and reversing most of the pathophysiological features within a few weeks of diagnosis. Yet people with diabetes still die prematurely from long-term complications, and the quality of the lives of others is blighted by impaired vision, amputation, renal replacement therapy, or recurrent hypoglycaemia. Despite the clear demonstration that tight glycaemic control can delay, and perhaps prevent, both micro- and macro-vascular disease, the limitations of current therapy prevent most from achieving these levels of blood glucose control. There is now a realistic, albeit distant, prospect of a revolution in treatment, involving either cell therapy (see Chapters 13.10 and 13.11) or closed-loop technology combining continuous glucose sensing and insulin-infusion pumps (see Chapter 13.4.9.2). However, for the foreseeable future, the responsibility of the diabetes professional is to assist individuals with type 1 diabetes to achieve both an optimum level of blood glucose and quality of life with best use of available methods.