[Social and economic aspects in diabetes mellitus]. / Soziale und ökonomische Aspekte beim Diabetes mellitus.

The possibility of obtaining health and accident insurance as well as participation in a pension scheme does not pose any problems for diabetics in Switzerland. However, for a life insurance contract, the diabetic must often pay a surplus. The socio-medical evaluation for invalidity insurance for diabetics is based upon an eventual decrease in efficiency associated with functional alteration of certain organs. Diabetics treated only by dietary means can exercise any profession. When treated with oral antidiabetic agents or insulin, certain professions are discouraged, particularly when a metabolic crisis might be hazardous to the diabetic or a third party. Treatment of active diabetics most often aims at obtaining normoglycemia. This should enable patients to follow a physically active, even irregular life in their profession, studies and leisure without excessive risk.

[Insulin injection/insulin pharmacokinetics]. / Insulininjektion/Insulinpharmakokinetik.

Whereas the importance of changing dietary composition and physical activity for metabolic control in diabetic patients is well respected, pharmacokinetic variables of insulin are often neglected in therapeutic decisions. The ambitious goal of euglycemia can rearly be achieved, however, without a profound knowledge of factors influencing the pharmacokinetics of insulin, such as site of injection, injection technique, miscibility of insulins, dose of insulin, injection volume, local blood flow, etc. Available data indicate that it is of major importance to implement pharmacokinetic aspects in the daily care of the insulin-treated patient.

[Metabolic self care in diabetics: when blood sugar analysis, when urine analysis?]. / Stoffwechsel-Selbstkontrolle bei Diabetikern: wann Blutzucker-, wann Urinkontrollen?

Techniques, costs and clinical use of home urine glucose monitoring (HUGM) and of home blood glucose monitoring (HBGM) are discussed. HUGM is recommended for type II diabetics with a near-normal renal glucose threshold and for stable type I diabetics. HBGM ist indicated in the following cases: during normoglycemic insulin therapy, at the beginning of insulin therapy, to distinguish between a rapid fall in blood glucose and true hypoglycemia, to assess the risk of nocturnal hypoglycemia, to manage hyperglycemic episodes, when HUGM ist misleading, e.g. in the presence of residual bladder urine and with a high or low renal glucose threshold. In conclusion, the disadvantages of HBGM are discussed.