Modern strategies for management of glycaemia in type 1 diabetes

The last decade has seen significant advances in the management of type 1 diabetes. The usual management of type 1 diabetes involves 'physiological' basal bolus regimens with multiple daily insulin injections, but use of insulin pumps (continuous subcutaneous insulin infusion) is growing. Structured education programmes are of great importance in realizing the potential of the flexible insulin regimens that are now technically possible; these now offer patients with type 1 diabetes standardized support and education in counting carbohydrates (and perhaps fat and protein) and in adjusting doses for other behavioural factors. Evolution of continuous glucose monitors from being tools for 'forensic' retrospective monitoring to 'real-time' devices for continuous use has led to major interest in strategies for glycaemic control that involve insulin pumps linked to continuous glucose monitoring, with the hope that this will provide increasing automation of insulin delivery. Data from many devices - meters, pumps and continuous glucose monitors - are downloadable and can be analysed and/or shared with healthcare providers. In this chapter, we describe how modern glucose monitoring and insulin replacement can be used strategically together with education to manage glycaemia in type 1 diabetes.