The dose of prandial insulin may be static, or may be calculated by the patient using either their current blood sugar, planned carbohydrate intake, or both. This calculation may also be performed by an insulin pump in patients using a pump. Insulin regiments that consist of doses calculated in this manner are considered intensive insulin regimens. Prandial insulin is usually administered no more than 15–30 minutes prior to a meal using a rapid-acting insulin or a regular insulin. In some patients, a combination insulin may be used that contains both NPH (long acting) insulin and a rapid/regular insulin to provide both a basal insulin and prandial insulin. Challenges in treatment
There are several challenges involved in the use of insulin as a clinical treatment for diabetes:
Mode of administration. Selecting the right dose and timing. The amount of carbohydrates one unit of insulin handles varies widely between persons and over the day but values between 7 and 20 grams per 1 IE is typical. Selecting an appropriate insulin preparation (typically on speed of onset and duration of action grounds). Adjusting dosage and timing to fit food intake timing, amounts, and types. Adjusting dosage and timing to fit exercise undertaken. Adjusting dosage, type, and timing to fit other conditions, for instance the increased stress of illness. Variability in absorption into the bloodstream via subcutaneous delivery
The dosage is non-physiological in that a subcutaneous bolus dose of insulin alone is administered instead of combination of insulin and C-peptide being released gradually and directly into the portal vein.
1997 – Nelson J reported diffuse MRI abnormality in Cerebral and cerebellar atrophy with white matter changes suggested more diffuse disease. 1998 – Dollfus H reported a patient with a phenotype suggestive of a chromosomal abnormality. 2008 – Mariën P found limited cognitive deficit that closely resembles the "cerebellar cognitive and affective syndrome" (CeCAS). References
External links

Gillespie syndrome at MedlinePlus