Immune Intervention in Type I Diabetes Mellitus

In many countries Type 1 diabetes [T1D] is the most common life-threatening disease in chil‐ dren, and nobody can be cured. For long time the incidence has increased all over the world [1]. The disease causes serious morbidity and increased mortality [2,3] in spite of an intensive treatment with multiple daily injections of insulin, adapted to regular meals with suitable content based on self-monitoring of blood glucose. Many patients do never succed to get good metabolic control because of the complicated treatment and another problem preventing good metabolic control is hypoglycaemia [4]. Modern insulin pumps and glucose sensors have made it possible to improve insulin treatment [5]. The simplest approach to reduce severity of hy‐ poglycemia when treatment is intensified is to interrupt insulin delivery. There are insulin pumps with an integrated continuous glucose monitoring, which automatically suspends in‐ sulin delivery for up to 2 hours when hypoglycemia is detected even when the hypoglycemia alarm is not acknowledged by the patient [6,7]. Closed-loop insulin delivery [artificial pan‐ creas] is aiming to achieve near normal blood glucose without increasing the risk of hypogly‐ cemia [8]. Thus a disposable sensor measures interstitial glucose levels, which are fed into an algorithm controlling delivery of a rapid-acting insulin analog into the subcutaneous tissue by an insulin pump. So far research has focused on closed loop insulin delivery during night, and this technique is improving [9]. However, also in the future there will be need for the patient to learn how to handle also these devices, not least during infections, longer exercise, and several other situations and changes of life.