Starting Insulin Therapy in Children With Newly Diagnosed Diabetes: An Outpatient Approach

Sir.—I was delighted to see the clinical commentary by Dr Schneider regarding his experience with eight years of outpatient treatment of children with newly diagnosed diabetes who are not in need of hospital care.1This approach was taught to me 20 years ago by the late David W. Smith, who early recognized that he could no better estimate a dose of intermediate-acting insulin after a week of chasing glucose with regular insulin in the hospital than if he had simply used a rule of thumb at the time of diagnosis. I remain convinced of the tremendous advantage of complete outpatient management as proposed by Dr Schneider.2,3However, some youngsters do not have the family resources to respond appropriately to this approach; in such cases, hospitalization may be necessary to sort out the psychosocial situation and assure responsibility for the child. I have also found it necessary to