Insulinothérapie et autosurveillance glycémique : schéma thérapeutique et recommandations

Abstract

Self-monitoring of blood glucose (SMBG) has been widely spread during the last twenty years, and is at present considered as mandatory for the management of insulin therapy. The ALFEDIAM and the ADA recommend type 1 diabetic patients to perform more than 4 capillary glucose determinations per day, ideally 4 to 6. To be efficient in using these results, several parameters are required: glycemic targets have to be clearly defined, an intensified insulin regimen (3 or 4 injections per day or insulin pump therapy) should be proposed, and the patient should be teached how to modify his insulin doses. Short acting insulin analogs are available, and long acting insulin analog will be soon. This is a real progress in the choice of flexible insulin regimen. The practice of SMBG and its use for insulin adjustment requires continuing education, in order to translate SMBG in real diabetes self-management. This prerequisite is mandatory to obtain a sustained improvement in metabolic control.