A friend of ours has a 22 month son who was recently diagnosed with type 1 diabetes, and there is a strong family history (father from age 16, and two grandparents). There seems to be some dispute over which is the best insulin regimen in the under five year olds. Any advice?

The dispute is entirely legitimate because there is no good scientific evidence on appropriate insulin regimens for the under five year olds. However, the real answer is that the regimen should be flexibly adjusted until it suits the child. The recent appearance of new analog insulins offers opportunities to tailor treatment very precisely but a view has to be taken on how tightly controlled such children should be. There is an increased risk that serious hypoglycaemia may cause long term problems in young children and this, together with evidence that it is justifiable to allow the hemoglobin A1c to be slightly higher in very young children, suggests that striving to achieve as tight control as is recommended for older children and adults is unwise.

KJR