*The African Face of Childhood Diabetes DOI: http://dx.doi.org/10.5772/intechopen.108723*

Africa that one should have experienced the use of insulin syringes and a basal bolus or premixed regimen prior to using a pump so as to adapt to the whole concept and learn how to use a syringe in case of any pump breakdown. The cost is still high, although it is subsidized and supported by the Governments of some sub-Saharan countries like Sudan. In spite of that, it still needs a high-class category of people who are dedicated and educated and can afford the pump expenses.

In a mini-survey done at the last African Society of Pediatric and Adolescent Endocrinology's (ASPAE) virtual conference in February 2022, 74% of the endocrinologists from sub-Saharan Africa have never used a pump for their patients. More than 50% of the endocrinologists have never educated their patients about carbcounting because they either do not know how to do it, or they think patients would not understand it, or because of the lack of local food exchange tables. From that survey, 44% of the patients could check their blood glucose twice daily, while about 20% would do it about 4–5 times a day, and these are the patients on the basal-bolus regime. In that survey, it was clear that training should be intensified among doctors about the benefits of basal bolus regimen and insulin pumps whenever feasible. Even for basal bolus regimen, NPH insulin can be used with short-acting insulin since these are much cheaper than insulin analogues.

Premixed insulin regimen, which has been widely used in sub-Saharan Africa, is associated with early diabetes complications like nephropathy and neuropathy in addition to Mauriac syndrome, which is rarely seen nowadays in Western countries. In a recent study from Sudan by Hana Ahmed et al., frequency of nephropathy and retinopathy has been found in 36% and 33% of the patients in the age category 10–18 years, respectively [26]. In another study from Sudan, 88% of the studied population had evidence of peripheral neuropathy [27]. All patients from the two studies were on premixed or modified premixed insulin regimen. Although the sample size was small in the two studies, it still rings a bell that early complications are common among premixed insulin users.

**Figure 6.** *Readily available foods (Mostly starch).*
