The second type of diabetes develops in 90% of all failures in metabolic metabolism. The cause of the disease is insulin resistance, when the cells of the body lose their insulin sensitivity. But in advanced cases, the pancreas can stop producing hormone altogether.
Also, the development of diabetes mellitus type 2 contributes to an inactive lifestyle, which leads to obesity and subsequent disruption in carbohydrate metabolism. Then the concentration of glucose is constantly increasing, which has a toxic effect on the pancreas and its beta cells die.
For certain reasons, the second type of diabetes can become insulin-dependent. But when do you need a hormone?
When are type 2 diabetes treated with insulin?
Often this type of disease develops after 40 years. And in the process of developing the disease the patient is rapidly gaining weight. At this time, insulin deficiency develops, but the characteristic symptoms of diabetes may not manifest.
Gradually, the beta cells responsible for insulin production are depleted. Therefore, treatment involves the introduction of artificial hormone.
But in most cases, the disease is controlled without injections using glucose-lowering drugs, diet therapy and physical activity. But when a person does not follow all these rules, over time his pancreas can no longer independently produce a hormone in the necessary quantity. And if you do not make injections for diabetes, the blood sugar will be greatly increased, which will lead to the development of complications.
Most often, insulin is administered to patients who lead a passive lifestyle. That is, they have the choice of either sport or insulin therapy.
However, physical activity is a more effective method of dealing with the disease, because it improves the susceptibility of cells to insulin. Therefore, if a diabetic begins to lead a correct lifestyle, then over time, the insulin dose will decrease or he will not need any injections.
In addition, the injection is necessary for people who are not on a diet. Such a diet implies a minimum amount of carbohydrate intake, which will allow you to refuse injections or keep the dosage to a minimum. However, those who want to lose weight will also have to reduce protein intake.
But some diabetics need insulin intake, for otherwise the patient may die from the complications of the disease. Fatalities are renal failure, gangrene or heart attack.
Insulins administered to the human body may vary in duration of action. The drug is always selected individually for each patient.
In addition, drugs are distinguished by origin:
- Cattle derived from pancreatic cattle. Disadvantage - often causes allergies. Such remedies include Ultralente MC, Insulp GPP, Ultralent.
- Pork insulin is similar to human, it can also provoke allergies, but much less. The most commonly used insulp SPP, Monosuinsulin, Monodar Long.
- Insulin is genetically engineered and analogs of the Iranian person. These species are harvested from E. coli or pancreatic pigs. Popular representatives from the group are Insulin Aktrapid, Novomiks and Humulin, Protafan.
The classification according to the time and duration of the effect can also be different. So, there is a simple insulin, which acts after 5 minutes, and the duration of the effect - up to 5 hours.
Short insulin takes effect after administration after 30 minutes. The greatest concentration is reached after 2.5 hours, and the duration of the effect lasts 5-6 hours.
Medications of medium action stabilize the patient's condition for 15 hours. Their concentration is reached within a couple of hours after administration. Per day you need to do 2-3 injections from diabetes.
Long-acting insulin is used as a base hormone. Such drugs collect and accumulate hormone. For 24 hours you need to do up to 2 injections. The highest concentration is reached after 24-36 hours.
Among the category of drugs that have a long-lasting effect, it is worth noting off-peak insulins, since they act quickly and do not cause severe inconvenience in use. Popular drugs in this group include Lantus and Levemir.
Combined means act half an hour after the injection. On average, the effect lasts 15 hours. A peak concentration is determined by the percentage of the hormone in the preparation.
The dosage and number of injections prescribed by the attending physician. In case of diabetes of the second type, injections can be made in the hospital or on an outpatient basis, which is determined by the patient's condition.
The use of insulin for the treatment of type 2 diabetes
For many years, unsuccessfully struggling with diabetes?
The head of the Institute: “You will be amazed how easy it is to cure diabetes by taking it every day.
Type 2 diabetes is called insulin-independent. But today it is established that almost all patients suffering from this type of diabetes, at a certain stage of the disease require the use of insulin. In the treatment of type 2 diabetes, it is important not to miss the moment and prescribe insulin in a timely manner.
Worldwide, the leading treatment for diabetes is insulin therapy. It helps to significantly improve the well-being of diabetics, delay the onset of complications and prolong life.
Insulin in type 2 diabetes is recommended for such purposes:
- temporarily - to prepare the patient for surgery or in the event of serious infectious diseases,
- constantly - with the ineffectiveness of glucose-lowering drugs in pills.
The duration of the period from the first symptoms of type 2 diabetes to the need for constant insulin administration directly depends on 2 factors. Namely, from a decrease in the efficiency of beta cells and increased insulin resistance. Significantly reduces the duration of this period, the state of constant hyperglycemia.
In other words, the worse a person controls diabetes mellitus type 2 (sticks to a diet and takes hypoglycemic agents), the faster insulin will be prescribed.
For diabetics, there are a number of factors that increase insulin resistance: comorbidities, the use of drugs with negative metabolic effects, weight gain, low physical activity, frequent agitations and experiences. Together with lipo - and glucose toxicity, they accelerate the decline in the performance of beta cells in patients with type 2 diabetes.
Indications for prescribing insulin therapy
With an increasing decrease in beta cell secretion and the ineffectiveness of tableted hypoglycemic drugs, insulin is recommended in monotherapy or in combination with tableted hypoglycemic agents.
Absolute indications for insulin administration:
- signs of insulin deficiency (for example, weight loss, the presence of symptoms of decompensation of type 2 diabetes),
- the presence of ketoacidosis and (or) ketosis,
- any acute complications of type 2 diabetes,
- exacerbations of chronic diseases, acute macrovascular pathologies (stroke, gangrene, heart attack), the need for surgical treatment, severe infections,
- newly diagnosed type 2 diabetes, which is accompanied by high sugar during the day and on an empty stomach, without taking into account body weight, age, estimated duration of the disease,
- newly diagnosed type 2 diabetes in the presence of allergies and other contraindications to the use of drugs from sugar tablets. Contraindications: hemorrhagic diseases, pathology of the kidneys and liver,
- pregnancy and lactation,
- severe disorders of the kidneys and liver,
- the lack of favorable sugar control in the treatment of maximum doses of tableted glucose-lowering drugs in acceptable combinations and doses, along with adequate physical exertion,
- precoma, coma.
Insulin therapy is attributed to patients with type 2 diabetes with the following laboratory parameters:
- fasting blood sugar levels above 15 mmol / l in patients with suspected diabetes,
- plasma C-peptide concentration below 0.2 nmol / l after intravenous test with 1.0 mg of glucagon,
- despite the use of maximum daily doses of tableted drugs for sugar, fasting glucose levels in the blood are above 8.0 mmol / l, after eating above 10.0 mmol / l,
- glycated hemoglobin level is constantly above 7%.
The main advantage of insulin in the treatment of type 2 diabetes is its effect on all parts of the pathogenesis of this disease. First of all, it helps to compensate for the lack of endogenous hormone insulin, which is observed with a progressive decrease in the functioning of beta cells.
Mechanisms of action and effects of insulin
Insulin therapy is performed to eliminate glucose toxicity and correct the production function of beta cells with average hyperglycemia. At first, the dysfunction of beta cells in the pancreas and producing insulin is reversible. Endogenous insulin production is restored when the sugar level drops to normal levels.
Early administration of insulin to type 2 diabetics is one of the treatment options with insufficient glycemic control at the stage of application of diet and exercise therapy, bypassing the stage of tableted drugs.
This option is preferable for diabetics who prefer insulin therapy, rather than the use of glucose-lowering drugs. As well as in patients with a lack of weight and with suspected latent autoimmune diabetes in adults.
A successful decrease in glucose production by the liver in type 2 diabetes requires the suppression of 2 mechanisms: glycogenolysis and gluconeogenesis. The introduction of insulin can reduce hepatic glycogenolysis and gluconeogenesis, as well as enhance the sensitivity of peripheral tissues to insulin. As a result, it becomes possible to effectively “repair” all the main mechanisms of the pathogenesis of type 2 diabetes.
Positive results of insulin therapy in diabetes mellitus
There are positive aspects of taking insulin, namely:
- reducing sugar levels on an empty stomach and after meals,
- increased pancreatic insulin production in response to glucose stimulation or food intake,
- reduction of gluconeogenesis,
- the production of glucose by the liver,
- inhibition of glucagon secretion after eating,
- changes in lipoprotein and lipid profile,
- suppression of lipolysis after eating,
- improving anaerobic and aerobic glycolysis,
- reduced glycation of lipoproteins and proteins.
The first treatment of diabetics is aimed at achieving and maintaining the target concentrations of glycated hemoglobin, fasting blood sugar and after meals. The result will be a reduction in the possibility of the development and progression of complications.
The introduction of insulin from the outside has a positive effect on carbohydrate, protein and fat metabolism. This hormone activates deposition and suppresses the breakdown of glucose, fat and amino acids. It reduces the level of sugar by increasing its transport in the middle of the cell through the cell wall of adipocytes and myocytes, as well as inhibiting the production of glucose by the liver (glycogenolysis and gluconeogenesis).
In addition, insulin activates lipogenesis and inhibits the use of free fatty acids in energy metabolism. It inhibits muscle proteolysis and stimulates the production of proteins.
Insulin dose calculation
Selection of the dose of the drug is made individually. It is based on the weight of the diabetic, the clinical picture and the daily glucose profile. The need for this hormone depends on the degree of insulin resistance and the secretory ability of beta cells, reduced due to glucose toxicity.
Patients with type 2 diabetes with concomitant obesity need more insulin than others to achieve control. The number of injections and the insulin dose per day depend on the level of sugar in the blood, the general condition of the diabetic and the dietary regimen.
Most commonly recommended bolus insulin therapy. This is when an analogue of human insulin (or short-acting insulin) is administered several times a day. Perhaps a combination of insulin short and intermediate action (2 times a day or at bedtime) or an analogue of prolonged insulin (used before bedtime).
The most commonly prescribed bolus insulin therapy is when short-acting insulin (or human insulin analogue) is used several times a day. A complex of insulin with short and intermediate action (at bedtime or 2 times a day) or an analogue of prolonged insulin (at bedtime) is possible.
The insulin solution is injected subcutaneously. The injection site must be pre-massage well. Places for injections should be alternated every day.
The patient himself pushes the injection; for this purpose, a special spitz-dog with a thin needle or a syringe handle is used. If possible, preference should be given to the pen.
Advantages of using a pen:
- it has a very fine needle, the use of which makes the insulin injection almost painless,
- compactness - the device is convenient and easy to carry,
- insulin in the pen does not collapse, it is protected from the effects of temperature and other environmental factors,
- the device allows you to individually prepare and apply mixtures of insulin preparations.
Between the administration of insulin and food intake should take no more than 30 minutes. At a time it is allowed to enter no more than 30 U.
Types of treatment: monotherapy and combination therapy
For the treatment of type 2 diabetes, there are 2 types of therapy: insulin monotherapy and combined with hypoglycemic drugs in tablets. The choice can only be made by the doctor, based on his knowledge and experience, as well as on the characteristics of the patient’s general condition, the presence of concomitant diseases, and from medical treatment.
When monotherapy with hypoglycemic pills does not lead to adequate control of blood sugar levels, combination therapy with insulin and tablet preparations is prescribed. Combined, as a rule, like this: insulin with sulfonylurea, insulin with meglitinides, insulin with biguanides, insulin with thiazolidinedione.
The advantages of the combined schemes include increasing the sensitivity of peripheral tissues to insulin, the rapid elimination of glucose toxicity, and the increase in endogenous insulin production.
Monotherapy insulin diabetics with type 2 according to the traditional or intensified scheme. Significant progress in endocrinology is associated with a huge selection of insulin, which makes it possible to satisfy all the needs of the patient. For the treatment of type 2 diabetes, any insulin regimens that can successfully control blood sugar levels and protect against unwanted hypoglycemia are acceptable.
The choice of insulin administration depends on the age of the patient, concomitant diseases, the mood for treatment, social status and material resources.
The traditional scheme implies a strict diet for a diabetic, as well as every day the same food according to the time of admission and the amount of carbohydrates. The introduction of insulin injections is fixed in time and dose.
In this mode, the patient may not often measure blood sugar in himself. The disadvantage of this scheme is that there is no flexible adaptation of the amount of insulin to changing blood sugar levels.The patient is tied to the diet and schedule of injections, which prevents him from leading a full life.
The traditional scheme of insulin therapy is used in the following categories:
- elderly diabetics
- patients who cannot use the meter themselves and control their sugar,
- diabetics suffering from mental illness
- patients requiring constant external care.
Intensified regimen - directed, with the help of injections, to simulate normal natural insulin production. The advantages of using this scheme for a diabetic are many, but it is somewhat more difficult to apply.
Principles of Intensified Insulin Administration:
- baseline bolus insulin therapy
- lax diet, adaptation of each insulin dose to a specific food and amount of carbohydrates eaten,
- the need to determine blood sugar levels several times a day.
Complications of insulin therapy
Sometimes in the treatment of type 2 diabetes there are complications:
- allergic reactions
- hypoglycemic states
- postinsulin lipodystrophy.
Complications develop, as a rule, due to non-compliance with the rules of insulin administration.
The main goal of treatment for type 2 diabetes is to maintain a normal level of glucose in the blood, delaying complications, and increasing life expectancy.
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All this can be achieved on condition of timely prescribed insulin therapy. Modern drugs have proven their effectiveness and safety in the appointment of them, even in severe forms of diabetes.
Insulin in diabetes
Insulin is a hormone produced by the pancreas. It is responsible for the regulation of blood sugar levels. When insulin enters the body, oxidative processes are triggered: glucose is broken down into glycogen, proteins and fats. If an insufficient amount of this hormone enters the blood, a disease called diabetes mellitus is formed.
In the second type of diabetes, the patient must compensate for the constant lack of hormone injections. With proper use of insulin brings only benefit, but you need to carefully choose the dose and frequency of applications.
Why does insulin need diabetics?
Insulin is a hormone designed to regulate blood glucose levels. If for some reason it becomes low, diabetes is formed. In the second form of this disease, it is not possible to compensate for the lack of pills alone or proper nutrition. In this case, insulin injections are prescribed.
It is designed to restore the normal functioning of the regulatory system, which the damaged pancreas can no longer provide. Under the influence of negative factors, this organ begins to thin and can no longer produce enough hormones. In this case, the patient is diagnosed with type 2 diabetes. To provoke such a deviation can:
- Non-standard course of diabetes,
- Extremely high glucose level - above 9 mmol / l,
- Sulfonylurea-based drugs in large quantities.
Indications for taking insulin
Disruption of the pancreas is the main reason why people are forced to inject insulin. This endocrine organ is very important for ensuring normal metabolic processes in the body. If it stops functioning or does it partially, failures in other organs and systems occur.
The beta cells that line the pancreas are designed to produce natural insulin. Under the influence of age or other diseases, they are destroyed and die - they can no longer produce insulin. Experts note that in people with the first type of diabetes after 7-10 years, there is also a need for such therapy.
The main reasons for prescribing insulin are as follows:
- Hyperglycemia, in which the blood sugar level rises above the mark of 9 mmol / l,
- Pancreatic exhaustion or disease,
- Pregnancy in a diabetic woman,
- Forced drug therapy with drugs that contain sulfonylurea,
- Exacerbation of chronic diseases affecting the pancreas.
Also, this hormone helps to more easily transfer inflammatory processes in the body of any nature. Insulin injections are given to people with neuropathy, which is accompanied by strong painful sensations, as well as with atherosclerosis. To maintain the normal functioning of the body, insulin therapy is indicated for pregnant and lactating women.
Due to their own ignorance, many patients try not to start insulin therapy for as long as possible. They believe that this is the point of no return, which speaks of a serious pathology. In fact, there is nothing scary about such injections. Insulin is the substance that will help your body work, and you will forget about your chronic illness. With the help of regular injections you can forget about the negative manifestations of type 2 diabetes.
Types of insulin
Modern manufacturers of drugs to market a huge number of drugs, which are based on insulin. This hormone is intended solely for maintenance treatment of diabetes. Once in the blood, it binds glucose and removes it from the body.
To date, insulin are of the following types:
- Ultrashort action - acts almost instantly
- Short-acting - have a slower and smoother effect,
- The average duration - begin to act 1-2 hours after the introduction,
- Long-acting - the most common form, which ensures the normal functioning of the body for 6-8 hours.
The first insulin was withdrawn by man in 1978. It was then that British scientists forced E. coli to produce this hormone. Mass production of ampoules with the drug began only in 1982 with the United States. Until that time, people with type 2 diabetes were forced to inject pork insulin. Such therapy has constantly caused side effects in the form of serious allergic reactions. Today, all insulin is of synthetic origin, so that the drug does not cause any side effects.
Mapping insulin therapy
Before you go to the doctor for the purpose of drawing up the scheme of insulin therapy, it is necessary to conduct a dynamic study of blood sugar levels.
To do this, every day during the week you need to donate blood for glucose.
After you receive the results of the study, you can go to a specialist. To get the most accurate results, before taking blood for a few weeks, begin to lead a normal and correct lifestyle.
If, on diet, the pancreas will still require an extra dose of insulin, it will not be possible to avoid therapy. Doctors, in order to create correct and effective insulin therapy, answer the following questions:
- Do I need insulin shots for the night?
- If needed, the dosage is calculated, after which the daily dose is adjusted.
- Do I need long-acting insulin shots in the morning?
To do this, the patient is placed in a hospital and is being examined. He does not give breakfast and lunch, learn the reaction of the body. After that, long-acting insulin is administered for several days in the morning, if necessary, the dose is adjusted.
- Do I need insulin shots before meals? If so, then before what are needed, and before what - no.
- Calculate the starting dosage of short-acting insulin before meals.
- An experiment is being conducted that allows you to determine how much insulin you need to prick before meals.
- The patient is taught to inject insulin himself.
It is very important that the development of insulin therapy was carried out by a qualified attending physician. The exact dosage and time of administration are calculated for each patient individually. Some of them need injections only at night or in the morning, while others require constant maintenance therapy.
Permanent insulin therapy
Type 2 diabetes mellitus is a chronic progressive disease in which the ability of the beta cells of the pancreas to produce insulin gradually decreases. It requires continuous administration of a synthetic drug in order to maintain normal blood glucose levels. Consider. That the dose of the active substance must be constantly adjusted - usually to increase. Over time, you will reach the maximum dose of pills. Many doctors do not like this dosage form, as it constantly causes serious complications in the body.
When the insulin dose is higher than that of the pills, the doctor will finally transfer you to the injections. Consider that this is a permanent therapy that you will receive for the rest of your life. The dosage of the drug will also change as the body quickly becomes accustomed to the changes.
The only exception is when a person constantly adheres to a special diet.
In this case, the same insulin dose will be effective for him for several years.
Typically, this phenomenon occurs in those people who have diabetes was diagnosed early enough. They also need to maintain normal pancreatic activity, especially the production of beta cells. If a diabetic could bring his weight back to normal, he eats properly, plays sports, does his best to restore the body - he can do with minimal doses of insulin. Eat right and lead a healthy lifestyle, then you will not have to constantly increase your insulin dose.
High doses of sulfonylurea
To restore the activity of the pancreas and islets with beta cells, sulfonylurea preparations are prescribed. Such a compound provokes this endocrine organ to produce insulin, so that the level of glucose in the blood is kept at an optimal level. It helps to maintain in a normal state all the processes in the body. Usually the following drugs are prescribed for this purpose:
All these drugs have a powerful stimulating effect on the pancreas. It is very important to observe the dosage chosen by the doctor, since the use of too much sulfonylurea can lead to the destruction of the pancreas. If insulin therapy is carried out without this medication, the pancreas function will be completely suppressed in just a few years. It will retain its functionality for as long as possible, so you do not have to increase your insulin dose.
Medicines designed to maintain the body in diabetes of the second type, help to restore the pancreas, as well as protect it from the pathogenic effects of external and internal factors. Also, to achieve the best effect, you must follow a special diet. With its help, it will be possible to reduce the amount of sugar in the blood, as well as to achieve an optimal balance of proteins, fats and carbohydrates in the body.
Therapeutic effect of insulin
Insulin is an important part of life for people with type 2 diabetes. Without this hormone, they will begin to experience serious discomfort, leading to hyperglycemia and more serious consequences. Doctors have long established that proper insulin therapy helps to relieve the patient from the negative manifestations of diabetes, as well as significantly prolong his life. With this hormone, it is possible to bring to the proper level the concentration of glucose hemoglobin, and sugar: on an empty stomach and after eating.
Insulin for diabetics is the only remedy that will help them feel good and forget about their illness. Properly chosen therapy allows you to stop the development of the disease, as well as to prevent the development of serious complications. Insulin in the right doses is not capable of harming the body, however, overdose can cause hypoglycemia and hypoglycemic coma, which requires urgent medical attention. Therapy with this hormone causes the following therapeutic effect:
- Reducing blood sugar after a meal and on an empty stomach, getting rid of hyperglycemia.
- Increased hormone production in the pancreas in response to food intake.
- Reduction of the metabolic pathway, or gluconeogenesis. Due to this, sugar is more quickly eliminated from non-carbohydrate constituents.
- Decreased lipolysis after a meal.
- The decrease in glycated proteins in the body.
Full insulin therapy has a positive effect on metabolic processes in the body: lipid, carbohydrate, protein. Also, taking insulin helps activate the suppression and deposition of sugars, amino acids and lipids. Thanks to insulin it is possible to achieve active fat metabolism. This ensures the normal output of free lipids from the body, as well as accelerated production of proteins in the muscles.
Traditionally, type 2 diabetes is considered an insulin-independent form of the disease. In reality, this is not the case. For many patients with a similar diagnosis, it is not only preferable, but also essential, that the human hormone analogues be used to achieve consistent compensation and minimize the risk of serious complications.
When you need insulin for type 2 diabetes
Currently, many patients and doctors are strenuously delaying the beginning of the introduction of external insulin. And there are certain reasons for this. However, at the moment, scientists are seriously thinking about the feasibility of an early transition to hormone therapy for patients. After all, the results of practical treatment show that the timely prescription of precisely insulin therapy can significantly improve the quality of life of diabetics, allowing you to maintain your own secretion of an important hormone for many years.
Typically, this treatment is used in sufficiently young diabetics who do not have problems with being overweight, but who are at risk for the occurrence of severe pathologies associated with an unfavorable course of chronic illness. Another reason for giving injections is the ineffectiveness of glucose-lowering drugs, when regular use of drugs does not lead to good compensation. And this situation occurs more and more often.
Replacement therapy is required by many people who have a solid record of terrible illness. American researchers claim that already after 10 years, many people with type 2 diabetes ask the doctor: “how to treat diabetes?”, They are advised to start regularly injecting insulin. It is estimated that approximately 30% of people with type 2 diabetes for more than 10 years are actually insulin-dependent.
Sometimes the main reason for the appointment of hormones is a tendency to ketoacidosis, usually not characteristic of this category of patients. Also an important indicator to the beginning of active treatment is a sharp change in the state, the appearance of pronounced symptoms of diabetes (thirst, copious diuresis, dry mouth, weight loss with increased appetite).
Absolute indications: surgical operations, serious infectious lesions, impaired circulatory system, renal and hepatic failure. Pregnant women with an early diagnosed diagnosis cannot use tableted drugs during pregnancy (they are contraindicated), therefore they are also temporarily transferred to injections.
Why do patients refuse insulin therapy
The main reason for refusing adequate treatment is personal fear.Stereotypes in society promote a negative attitude towards insulin, forcing one to think that it will never be possible to refuse injections. In reality, this statement is true only for type 1 diabetes. Type 2 diabetes is of a different nature, therefore it reacts differently to the administration of external insulin. Often, such treatment is a temporary measure (for example, 3 months), which allows you to bring back to normal rates and significantly slow down the progression of the disease.
Another cause of fear is the danger of hypoglycemia, which haunt people using insulin. Of course, with insufficient self-control, risks are present, but they are quite manageable and, with the right approach, are a rare minor side effect.
Often, older patients who are unable to adequately change the dosage of the drug, forgetting to make regular injections or who have difficulty seeing are having problems with insulin therapy refuse to use insulin therapy (there are problems with a set of doses in the syringe pens). Also, this category of patients often does not show special complaints, writing off many of the manifestations of diabetes mellitus to "age."
The lack of desire to conduct regular self-control is a problem that is widespread among virtually all patients with type 2 diabetes, because the health of these people often doesn’t suffer from the disease, and therefore it is especially difficult to believe in the need for such thorough treatment and control.
How is insulin in diabetes 2
In the treatment of diabetes mellitus 2, the same insulin is used as in the treatment of type 1 diabetes mellitus. Usually they recommend short and ultrashort (lispro, aspart) for jokes for food, of which lantus and detemir are preferred, because they allow normalizing carbohydrate metabolism rather quickly and are distinguished by a mild action.
Currently, several schemes have been successfully applied for the introduction of an external analogue of pancreatic hormone etiology in sugar disease.
• Full transition to insulin replacement therapy, when the diet, hypoglycemic pills, alternative methods of treating diabetes turned out to be untenable. The scheme can vary greatly from a single injection 1 time per day to intensive replacement therapy as in type 1 diabetes.
• Combined scheme: injections and hypoglycemic drugs are applied simultaneously. Combination options here are strictly individual, selected together with your doctor. This approach is considered the most effective. Usually combined extended insulin (1-2 times a day) and daily intake of oral medications to reduce blood sugar. Sometimes, before breakfast, the introduction of mixed insulin is chosen, because the pills do not cover the morning need for hormone.
• Temporary transition to injections. As already noted, this approach is mainly justified when conducting serious therapeutic operations, severe body conditions (heart attacks, strokes, injuries), pregnancy, a strong decrease in insulin sensitivity, a sharp increase in glycated hemoglobin.
Early insulin therapy: danger or the only right decision
Since the good results of the compensation of type 2 diabetes on insulin make it necessary for physicians to actively recommend just such an approach to treating the disease, many patients, and even the doctors themselves, find themselves in a situation of difficult choice: “when is it time to prescribe insulin?”. On the one hand, the patient's understandable fear makes the doctors postpone the moment, on the other hand, progressive health problems do not allow insulin therapy to be postponed for a long time. In each case, the decision is made individually.
Remember, any methods of treatment for endocrine pathologies can be applied only after consultation with your doctor! Self-medication can be dangerous.
On the selection of insulin, conducting insulin therapy and its comparison with hypoglycemic pills
Insulin is often used to treat diabetes of the first and second types. This hormone compensates for the violation of carbohydrate metabolism, reduces the likelihood of complications.
Patients are prescribed different drugs according to individually prepared schemes. What features have insulin and insulin therapy, will tell the article.
Why is insulin therapy necessary for treating diabetics?
If a person has insulin resistance, the cells of the organs lose their ability to absorb glucose and begin to experience hunger. This negatively affects the work of all systems: the liver, the thyroid gland, the kidneys, the brain begin to suffer.
Diabetes affects the work of all organs
Diabetes without treatment leads to disability, coma and death. In the first type of disease, when the pancreas cannot produce insulin, it is impossible to do without additional hormone administration.
Use medications for long and short action. The more injections, the better able to recreate the process of carbohydrate metabolism, which is similar to the physiological.
Absolute indications and recommendations
Today, more than 30% of patients with diabetes are given insulin shots. The absolute indications for therapy are:
Many diabetics reluctantly agree on insulin therapy. But with the first type of disease, there is no choice: for normal well-being, life-long treatment is necessary.
Rules and principles of insulin therapy in diabetes mellitus
Any medication has side effects.
The risk of developing unpleasant symptoms on the background of insulin injections increases with improperly selected dosage, violation of the conditions of storage funds.
The patient may experience hypoglycemia, lipodystrophy, allergies, vision loss. To reduce the negative effects of insulin therapy, you need to know the principles and follow the rules of treatment.
With type 1 diabetes
To bring the blood sugar level to the physiologically normal level as close as possible by following these rules and principles:
- the average daily dose should be consistent with the natural production of insulin by the pancreas,
- to distribute the dose according to the following scheme: 2/3 for morning, lunch and evening, 1/3 for night,
- combine short insulin with prolonged,
- Injections are recommended before meals.
- Do not administer more than 16 units of a short-acting drug.
With diabetes in children
To maximize the life of the child, reduce the negative effects of the disease, it is worth:
- combine short insulin with a prolonged-release medication
- give an injection of an average hormone two or three times a day,
- children over 12 years old to conduct intensified therapy,
- adjust the dose in stages,
- with high sensitivity, stab divorced counterparts.
It is difficult for a diabetic child to carry out a school plan: you need to inject medication at a certain time. To simplify treatment, to hide the disease from other children, choose pump therapy. The pump automatically supplies the hormone to the body when the sugar level rises.
Gestational diabetes may occur during pregnancy. The need for insulin in a woman during the period of carrying a baby increases.
To maintain normal well-being, you should follow these rules:
- often adjust therapy (in this position, the metabolism is characterized by instability),
- switch to human insulin (allergic reactions occur less frequently on it than on swine or bovine),
- to prevent hyperglycemia do two shots per day,
- use medium, short, combination medications,
- so that sugar does not rise at night, you need to prick a long-acting drug before going to bed,
- You can not further regulate the sugar tablets.
Correct selection of the dose and the scheme of insulin is the key to diabetic well-being.
Features of stimulated, basal-bolus and pump insulin therapy
Doctors use intensified base-bolus and pump techniques for the introduction of pancreatic hormone to treat patients. The first method is based on the imitation of the physiological secretion of the hormone during the day.
For the intensified method, the following features are characteristic:
- a few shots a day
- mainly use the drug short-acting,
- prolonged agent inject in small doses in the form of a basal injection,
- the time of injection is chosen based on when the person is planning to eat.
The peculiarity of the basis-bolus therapy is that in the morning or in the evening they push prolonged or short insulin. Thus, imitation of the natural functioning of the pancreas is achieved. One of the parts of the hormone maintains an optimal level of insulin, the second - prevents sugar jumps.
Features of pump insulin therapy are:
- combining all types of hormone in one injection,
- minimizing the number of injections,
- automatic drug administration,
- inability to imitate the natural work of the pancreas.
Which type of treatment is more suitable for the patient, the doctor decides on the basis of the examination.
Do I need to prick insulin if sugar is normal?
In diabetes of the second type, the pancreas is capable of producing a vital hormone in a certain amount. Therefore, sometimes a person has a normal level of sugar.
If fasting blood glucose is 5.9, and after a meal does not exceed 7 mmol / l, then it is temporarily possible not to inject insulin.
But at the same time, it is necessary to monitor the condition and control the concentration of glucose in the blood with test strips.
What to do if you missed a shot?
It happens that a person forgot to introduce insulin. The algorithm of further actions depends on how many times a day the patient makes injections:
- if one dose is missed with injections of a prolonged hormone twice a day, it is worth adjusting the glycemia level in the next 12 hours with a short-acting drug. Either increase physical activity for natural glucose utilization to occur,
- if the medication is administered once a day, then after 12 hours from the missed injection it is necessary to give an injection in half the dose,
- when skipping bolus insulin, the drug must be administered immediately after a meal. You can increase physical activity and monitor the level of sugar. If the meter shows glycemia 13 mmol / l, then it is necessary to introduce 1-2 units of a short hormone.
Adrenaline and insulin are two opposing substances.
According to the data of the Endocrinological Scientific Center of Russia, a unit of insulin reduces the concentration of glucose by 2 mmol / l, and 1 ml of adrenaline completely stops a hypoglycemic attack.
It is important to bear in mind that insulin (adrenaline) acts differently on diabetics: dependence on the age, weight, and physical activity of a person is traced. So, young and thin people, children are affected by drugs.
To understand how many units insulin reduces sugar, and how much increases its adrenaline, it is possible by testing.
What should you know about diabetes shots?
Injections for type 2 diabetes should be done using special disposable syringes. On their surface there are marks that determine the amount of the drug.
However, in the absence of insulin syringes, regular 2 ml disposable syringes can be used. But in this case, the injection is better to do under the guidance of a doctor.
Unpacked vials should be stored in a refrigerator, and open - at room temperature, as cold weakens the action of the hormone. Diabetics can be given shots in:
However, the best absorption occurs when an injection is made into the abdomen, in which the circulatory system is most developed. But the places should be changed, retreating from the area of the last injection by 2 cm. Otherwise, seals will form on the skin.
Wash hands with soap before starting the procedure. The introduction area and the lid of the package are wiped with alcohol (70%).
Often in the process of filling the syringe into it a little air enters, which may slightly affect the dosage. Therefore, it is important to read the instructions for proper procedure.
First, the caps are removed from the syringe, then air is drawn into it in an amount equal to the volume of insulin. Next, the needle is inserted into the vial with the drug, and the recruited air is released. This will not allow the formation of a vacuum in the bottle.
The syringe should be held vertically, pressing it slightly with the little finger on the palm. Then, using a piston, it is necessary to dial 10 units more into the syringe than the required dose.
After the piston, the excess means is poured into the vial again, and the needle is removed. In this case, the syringe must be held vertically.
Very often astral oris injections are made in diabetes. The advantage of the technique is the absence of the need to fill the syringe and complex drug administration.
If Protafan is used insulin, the method of filling the syringe is slightly different. This medicine has an average duration of action, it is also available in vials.
NPH-insulin is a transparent substance with a gray precipitate. Before using the bottle with the tool should be trotted to distribute the sediment in the liquid. Otherwise, the effect of the drug will be unstable.
The needle is immersed in a container of medication in the manner described above. But after that it is necessary to smash the vial about 10 times and draw the agent into the syringe with an excess. When excess fluid is poured back into the vial, the syringe is removed vertically.
Nutrition Plan and Blood Glucose Monitoring
It is important for an adult and a child with diabetes to stick to a low-carb diet. Sample meal plan:
- breakfast (4 XE) - a portion of cereal porridge, a glass of milk,
- snack (1 XE) - fruits,
- lunch (2 XE) - meat, vegetables, mashed potatoes,
- afternoon snack (1 XE) - fruits,
- dinner (4 XE) - porridge with salad, baked fish,
- before bed (1 XE) - A slice of whole grain bread with tea.
Products are contraindicated:
The recipe for an insulin drug in Latin
All diabetics must be registered with an endocrinologist. They are entitled to receive insulin for free.
Issued a recipe in Latin, which looks like this:
- Rp: Insulini 6 ml (40 ED - 1 ml).
- Da tales doses # 10.
- Inject 10 ED (0.25 ml) under the skin 3 times a day 20 minutes before meals.
What insulin preparations are considered the best?
Modern and frequently used insulin medicines are:
- Humalog This is the best short-acting drug. It reduces sugar in 15 minutes. Contains human insulin. Maintains optimal glucose for 3 hours
- Gensulin N. Medium-acting drug. Lowers glucose in an hour after administration for 20 hours. According to the instructions has the least adverse reactions,
- Lantus. This is a prolonged type of medication. Valid for 40 hours.
Insulin injections or pills: which is better?
Diabetes of the first type is treated exclusively with insulin. Patients with the second type of pathology can use tablets or injections.
The capsule form is more convenient to use and provides natural glucose control. At the same time, the pills have a negative effect on the work of the liver and kidneys.
With the wrong dose, there is a risk of cardiovascular complications. Injections in this regard are safer and can replace the pancreatic function by 100%.
About insulin therapy for diabetes mellitus type 1 and 2 in the video:
Thus, diabetes is treated with sugar-reducing tablets or insulin injections. The first option is only suitable for patients of the second type. Injection therapy is the only way for people with the first type of pathology.
Insulin therapy and type 2 diabetes
Health care is alarming due to the accelerated rate of diabetes worldwide.Moreover, the disease is equally overtaking the developing and economic developed countries.
In addition, not only adults suffer from diabetes. More and more disease appears in children and adolescents.
Do not forget that diabetes mellitus (DM) is becoming a fertile ground for the development of future diseases of the heart and blood vessels.
What is harmful high blood sugar?
It is believed that elevated blood sugar negatively affects the microvascular bed and a decrease in this indicator can be a significant help in the development of diabetic nephropathy and retinopathy. Elevated sugar, or hyperglycemia, is sometimes quite difficult to control and in many cases the achievement of normal numbers is not achieved.
This complexity arises from the uneven functioning of the beta cells of the pancreas. That is why patients with the disease type 2 diabetes no positive effects are observed when taking hypoglycemic drugs.
A large number of cases of hyperglycemia is not adjusted, adequate hypoglycemic therapy is not carried out. In this regard, the risk of complications of the disease increases several times.
What is clinical inertness?
The term “clinical inertness” refers to the absence of prescription and activation of treatment in the presence of clinical indications. This situation is most pronounced in the use of insulin preparations.
That is why, in order to improve the possibilities of therapy and reduce the likelihood of complications, it is necessary to more actively manage the glycemic status.
Early use of insulin, therefore, can be very justified.
What to look for in achieving normoglycemia?
There are three pathophysiological characteristics, based on which you need for adequate control of glycemia:
- Insulin deficiency
- Insulin resistance,
- Violation of insulin action.
Only insulin can adequately act and eliminate all these three points.
Explanation of insulin resistance and simultaneous efficacy of insulin
Target cells, for example, fatty or muscular, are resistant to insulin effects due to the malfunctioning of insulin receptors on their surface or due to the presence of damage in the post-receptor apparatus.
Thus, an increase in blood sugar occurs, and the pancreatic beta cells (RV) respond to hyperglycemia by increasing insulin. However, these actions do not bring any positive result.
Over time, the amount of synthesized insulin decreases - relative insulin deficiency develops. In this case, hyperglycemia will only increase.
This fact suggests that proper and adequate glycemic control will allow you to avoid many troubles during the development of diabetes.
The earlier insulin therapy is started, the easier it is to control the level of glycemia in patients with the disease. second type of diabetes. There are heated discussions and debates about the timing of the start of insulin therapy.
To come to some kind of ideal solution is not yet obtained.
How to inject?
Before you give injections for type 2 diabetes, you need to handle a bottle of the drug with seventy percent alcohol. You should also wipe the area of the body where the injection will be made.
The skin needs to be clamped with fingers to make a fold into which the needle should be inserted. Insulin is administered by pressing on the plunger. But the needle should not be immediately removed, because the drug can leak out. At the same time, the smell of Metacrest will be felt.
However, it is not necessary to reintroduce the drug. It is just necessary to note the loss in the diary of self-control. Although the meter will show that sugar is elevated, compensation should still be carried out only when the effect of insulin is over.
The area of the skin where the injection was made may bleed. To eliminate blood stains from the body and clothing, the use of hydrogen peroxide is recommended.
It is worth noting that, in addition to insulin in diabetes, Actovegin and vitamin B injections (intramuscular or subcutaneous administration) are often prescribed. The latter are used as part of complex therapy for polyneuropathy. Actovegin is necessary in the case of diabetic encephalopathy, which is introduced in / m, in / in or taken orally in tablet form.
It is worth noting that the i / m method of administration is almost the same as subcutaneous. But in the latter case, you do not need to make a skin fold.
The needle is inserted at right angles into the muscle tissue at ¾. Regarding the intravenous method, this process must be carried out by a doctor or an experienced nurse. But in / in injections are rarely done when the patient is in a very serious condition.
In addition, Thioctic acid is often used in type 2 diabetes. It can be introduced into the body in / in the drip or it is taken in the form of tablets.
Insulin was discovered in 1921 in Toronto. This is one of the most important and most important discoveries in medicine for all the time of its existence.
After the discovery, insulin was purified and it became possible to use it in humans. The first patient was Leonard Thompson, who received purified insulin at the Toronto hospital on January 11, 1922.
After that, the production of a drug that had undergone a special cleaning was adjusted.
This insulin was of animal origin, had a short action, and required 3 to 4 injections per day for a normal therapeutic effect.
In 1980, human insulin production was launched. However, this insulin still could not provide humanity with complete independence in the treatment of diabetes, therefore, human insulin analogues were created with different duration of action.
Improved products provided the following features:
- Short-acting insulin was supposed to give a peak of activity that was combined with food intake,
- Long-acting insulin maintained the basal level constant.
Under physiological conditions of the body, almost half of the isolated insulin falls on the basal long-acting. The remaining amount is provided by a short insulin, which is produced in response to a meal.
Indications for insulin therapy for type 2 diabetes
According to European diabetologists, insulin therapy should not begin very early or too late.
Not a wound, because secretory insufficiency may be secondary to insulin insensitivity, but also because of the risk of hypoglycemia.
It is not late, because it is necessary to achieve the necessary adequate glycemic control.
How to introduce insulin therapy in the treatment process?
Type 2 diabetes the disease in every sense of the progressive appointment of insulin is just a matter of time.
At the moment, the appointment of two anti-hypoglycemic drugs is considered traditional. After 10-15 years of taking the pills go to the final stage - insulin therapy.
Delaying this treatment method is also explained by the fact that you need to make injections, hypoglycemia can develop, and the patient can also gain weight significantly. However, many patients believe that the result is unstable, the efficiency is low.
Unsuccessful personal experience hinders treatment very much when the wrong treatment was the cause of frequent hypoglycemic conditions.
It should be noted that the appointment of a short course of insulin therapy at the very beginning of the disease can lead to long-term remission and leveling of blood glucose without the need for subsequent use of anti-lowering drugs.
However, many practicing endocrinologists do not approve of this technique and advocate step therapy. Of course, there are situations where the early onset of insulin is most appropriate.
For example, with the ineffectiveness of the use of glucose-lowering drugs in the early stages, insulin is prescribed. From this drug, the quality of life and patient satisfaction with treatment increases several times.
Numerous studies have found that hyperinsulinemia is a trigger in the development of atherosclerosis. In addition, the early use of insulin as a drug can lead to the formation of coronary heart disease (CHD). But today there is no accurate and reliable information about this connection.
Before starting insulin therapy, it is necessary to determine and consider several factors and characteristics that may affect this technique. From them we select:
- body weight,
- life prognosis
- presence, severity of microvascular changes,
- failure of previous treatment.
In order to be convinced of the need for insulin therapy, it is worthwhile to determine the level of activity of the beta cells of the pancreas by determining the amount of synthesized C-peptide.
To start insulin therapy in type 2 diabetes mellitus:
- with severe hyperglicemia at high and maximum doses of hypoglycemic drugs,
- severe weight loss
- low levels of C-peptide.
As a temporary treatment, insulin is prescribed when it is necessary to reduce the toxicity of glucose with its elevated level in the blood. Studies have shown that insulin therapy significantly reduces the likelihood of developing microvascular complications.
Benefits of Early Insulin Therapy
In case of type 2 diabetes, insulin therapy has the following positive qualities and advantages:
- eliminates the toxicity of blood glucose,
- the introduction of insulin in the early stages of the disease can trigger the development of remission,
- Glucose analysis by glucose allows you to control its daily level,
- with the progression of diabetes necessarily restore the basal and peak insulin levels in the blood,
- An individual approach to insulin treatment ensures patient safety from the onset of hypoglycemia and diabetic coma.
Type 2 diabetes mellitus: insulin treatment
Diabetes mellitus is a chronic disease that occurs throughout life. In people with type 2 diabetes, the function of insulin-producing beta cells in the pancreas declines by about 5% per year since the disease was detected.
Therefore, over time, the effectiveness of diet therapy, exercise therapy and treatment of hypoglycemic pills decreases and people come to the fact that they have to inject themselves with insulin.
Either start with a combination of insulin and Metformin oral medication, or completely switch to insulin therapy.
In this article we will look specifically at the treatment of patients with type 2 diabetes mellitus with insulin.
What to do to reduce the dose of insulin?
Excessive consumption of carbohydrate foods causes excessive blood sugar, which requires insulin injection. However, a large amount of the hormone injected can lower glucose levels very much, leading to hypoglycemia, which also has its adverse effects.
Therefore, you need to strictly monitor the amount of carbohydrates consumed, thereby minimizing the dose of funds. And it will allow you to accurately control the concentration of sugar in the blood.
Carbohydrates should be replaced with proteins, which is also quite a rich product, and healthy fats of vegetable origin. The category of approved products for type 2 diabetes are:
- lean meats,
- vegetables, better green, but not potatoes, as it is replete with carbohydrates,
- cream and butter in a small amount,
- savory and low-fat yogurt.
Cereals, sweets, starchy foods, including vegetables and fruits, should be removed from the diet. Also it is necessary to refuse cottage cheese and whole milk.
It is worth noting that proteins also increase the concentration of glucose, but by a small amount. Therefore, such jumps can be quickly repaid, which cannot be said about carbohydrate foods.
Also important in the life of a diabetic who does not want to depend on insulin, should have a sport. However, the load should be chosen sparing, for example, a special fitness run. You can also go swimming, cycling, tennis or work out in the gym with low weight. How to enter insulin correctly tells and shows the video in this article.
Basic approaches to insulin therapy
The purpose of insulin treatment is to stabilize the blood glucose level, in order to level the glycemic daily curve.
When calculating the dose of insulin, the daily need of the patient for insulin is initially calculated. In a healthy person, the daily requirement is approximately 30-70U / day, while the basal insulin secretion is 1U / h.
During a meal, a bolus increase in insulin occurs, approximately 1-2 U per 10g of eaten carbohydrates. At the same time, a certain balance is observed between the concentration of insulin in the blood and the need for it of the human body.
In patients with type 2 diabetes mellitus, the calculation of daily need is carried out strictly individually, taking into account the lifestyle of a person.
Below are sample diagrams:
- in the presence of normal or slightly reduced own production of insulin-0.3-0.8 U / kg,
- if there is a minimum of own insulin production in people with long illnesses, the need is 0.7–0.8 U / kg,
- when newly diagnosed diabetes is 0.5 U / kg,
- after compensation, the dose is reduced to 0.3-0.4 U / kg.
But all the same, we repeat that all this is calculated strictly individually.
In the treatment of insulin can be divided into 2 modes of treatment of diabetes:
Traditional insulin therapy includes daily injections 2 times a day of 2 types of insulin (prolonged and short action) before breakfast and before dinner.
Meal times should be adjusted according to the time of insulin injections and should be strictly observed.
In this mode, patients mix insulins of short and long-acting and make injections (2/3 of the daily requirement) 30 minutes before breakfast and 15 minutes before dinner (1/3 of the daily requirement).
If you use short-range insulin analogues, then you can make injections right before eating. Be sure to look at the level of sugar on an empty stomach.
In this case, an amendment to the lifestyle, the presence of physical activity and the amount of food (the amount of carbohydrates in HE).
In the presence of physical activity, the dose of insulin should be reduced before meals in order to avoid the risk of hypoglycemia (lower blood sugar levels).
Often, traditional therapy is not enough to correct the level of glucose in the blood and then resort to intensified therapy. With this type of treatment, patients give themselves short-acting insulin injections 3 times a day before breakfast, lunch and dinner, and 2 times a day they give themselves prolonged-action insulin injections in the morning and before bedtime (usually for 22-23 hours).
The dose of short insulin will be variable depending on the composition of the meal and the level of glucose before the meal. Of these, about 60-50% of the daily dose falls on short-acting insulins (divided in proportion to food intake) and 40-50% falls on long-acting insulins (2/3 in the morning and 1/3 in the evening).
It is believed that intensified therapy better stabilizes blood glucose levels than traditional therapy.
Alternatively, medium duration insulins and short-acting insulins can be mixed together and administered 2 times a day and the meal times are adjusted to the times of injections. A single injection is justified with a stable glucose level and reduced daily insulin requirements (less than 30-40 U / day). Usually administered 2/3 of the dose before breakfast and 1/3 before dinner.
There are a lot of schemes for administering insulin and the doctor selects them individually.
- before breakfast, 7Un short-acting insulin is administered,
- at lunch - 10Understood insulin,
- before dinner again 7Ed short insulin.
At the same time, they prick 10Ed of medium-level insulin in the morning and 6Ed in the evening. At the same time be sure to watch the sugar level on an empty stomach. If in the morning it was raised, then:
- with glucose 11-12 mmol / l-2U, increase the dose of short-acting insulin before meals,
- at 13-15mmol / l-on 4 U of short-acting insulin,
- at 16-18 mmol / l-6 6 U of short-acting insulin,
-when above 18 mmol / l-12Ud short-acting insulin.
It must be remembered that the dose of prolonged insulin in the daytime should be 2 times higher than in the evening to avoid night hypoglycemia. Do not go to bed at the level of evening sugar 5.6 mmol / l and below, in this case, you have a high probability of experiencing hypoglycemia. In this case, the insulin dose should be minimal and something to eat.
People with type 2 diabetes should control their glucose levels as often as with type 1 diabetes — at least 4 times a day (sometimes more often).
Another practical recommendation: after injection of short-acting insulin, after 2-3 hours you should have a snack, and after injection of long-acting insulin, snacks should be done every 4 hours, the last time 1-2 hours before sleep.
The basics of insulin therapy in patients with type 2 diabetes mellitus are in principle similar to those in the treatment of type 1 diabetes, but there are still differences with regard to the insulin secretion that is still preserved.
And remember: only a doctor will help you find the right treatment regimen!
Recommendations for self-control of diabetes mellitus, we consider in one of the following articles.
Carefully monitor your blood glucose and stay healthy!
Drug Therapy for Diabetes
Therapy for diabetes mellitus involves the appointment of drug treatment, the use of medicinal herbs, exercise and diet №9. Meals should be reusable and balanced. On the day you need to eat at least 4 times.
Drug treatment of diabetes
In case of diabetes mellitus, the mode of repeated insulin injections is always prescribed. This especially applies to type 1 diabetes, as it is considered insulin-dependent. In type 2 diabetes, insulin therapy is not used in all cases. Purpose of insulin deals only with the treating endocrinologist, on the basis of glucose level, features of the pathology and other important factors.
Basic insulin regimen
|Injection time||Type of insulin|
|In the morning before eating||Short acting and prolonged|
|In the afternoon, before lunch||Short action|
|In the evening, before dinner||Short action|
|Before bedtime||Prolonged action|
To learn how to correctly calculate the insulin dosage in each case, you can learn from the video:
Insulin therapy for type 1 diabetes
Insulin therapy in type 1 diabetes fully replaces the physiological secretion of hormones that are produced in the pancreas. Basal insulin is usually administered twice a day and a bolus insulin before meals. There are insulin preparations of various actions:
|Type of insulin||Name of drugs||Features|
|Ultrashort action||"Humalog", "Apidra", "Novorapid"||Begins to act immediately, a maximum of 20 minutes. Maximum efficiency in one hour. The result lasts an average of 3-5 hours.|
|Short action||"Humulin regulator", "Antrapid", "Rapid"||It starts to work in half an hour. Maximum efficiency - 2-4 hours. The result lasts from 6 to 8 hours.|
|Medium lasting action||"Insuman", "Insulatard", "Humulin NPH"||Begins to act after 60 minutes. Maximum efficiency in 4-12 hours. The result is kept on average from 16 hours to days.|
|Prolonged action||Levemir, Lantus||The impact is distributed evenly over the course of 24 hours. Enter need 1-2 times a day.|
|Combined drug||Mixted, Humulin M3, Humalog-mix 50, 25, Insuman-Combi 25||The onset of exposure occurs after 30 minutes. Maximum efficiency in 1-2 hours. The result lasts on average from 6 to 18 hours.|
Most often, insulin therapy involves the use at the same time during the day 2 drugs of different actions. This provides the body with the necessary enzyme, thereby improving the work of all systems. The scheme of treatment is selected at the individual level. Injections are carried out using a thin needle or a special pump.
In type 2 diabetes mellitus, insulin therapy is not always prescribed. First of all, the patient takes sugar reducing agents. If there is a need for insulin, then it is administered gradually, in small dosages.
Be sure to use the basal type of drug. Insulin in type 2 diabetes can be prescribed temporarily - during infection and before surgery.
Constantly appointed only if there is no effect of glucose-lowering therapy with pills.
The dosage and duration of insulin therapy is determined by the endocrinologist. The indications are the following:
- symptoms of insulin deficiency (a sharp decrease in body weight, etc.),
- presence of concomitant pathologies,
- diabetes complication
- exacerbation of chronic diseases,
- allergic reaction to pills,
- pregnancy and breastfeeding,
- an excessively high degree of glucose in the blood fluid.
You can learn more about the features of insulin therapy for type 1 and 2 diabetes from the video:
Preparations in tablets for the treatment of type 1 diabetes
For diabetics of the first type, insulin therapy is the basis of treatment. But in the presence of concomitant diseases, the following drugs may be prescribed:
- In order to normalize blood pressure and prevent negative effects from taking other medications, ACE inhibitors are prescribed.
- Preparations for the restoration of the digestive tract. This may be "Tsurekal", "Erythromycin", etc.
- "Levastatin" and similar agents are used to lower cholesterol and prevent the development of atherosclerosis.
- Tablets that strengthen the cardiovascular system. For example, "Cardio Magnetic".
- "Dialek" - to normalize the functionality of the pancreas.
Preparations in tablets for the treatment of type 2 diabetes
At the initial stages of development of diabetes mellitus of the second type, the healing process is carried out through dieting. However, there comes a time when it becomes necessary to take sugar-lowering drugs, which are divided into several groups:
- Sulfonylurea based. This group has been practicing in the treatment of diabetes for 50 years. Tablets quickly lower glucose levels at the cellular level. Namely, they act on insulin-producing beta cells. Due to this, the latter is released and thrown into the blood stream. Sulfonylureas also actively protect the renal system and blood vessels. There are disadvantages to the group: they increase weight, they deplete cells. An allergic reaction may occur and hypoglycemia develops. The most popular means include “Maninil”, “Glikvidon”, “Amaril”, “Diabeton”.
- Meglitinid group refers to the means of the new generation. Stimulates the production of natural insulin. The remedies can cause an adverse reaction in the form of abdominal pain, allergies and diarrhea. The most popular pills: Starlix and Novonorm. The dosage is selected only at the individual level.
- Biguanide group prevents the release of glucose from the liver. Helps sugar to spread through cells and tissues, and not in the blood. Due to this, the level of glucose in the blood fluid is reduced. Contraindications - renal and heart failure. The most effective drugs: Metformin and Siofor. Additionally, reduce body weight, absorb sugar in the intestine.
- Thiazolidinediones act like the previous group, but are not used for obesity, as they contribute to an increase in body weight. There are a number of contraindications and adverse reactions. The most popular pills are Avandia and Aktos. Additionally, they speed up the metabolism, increase the susceptibility of tissues and cells to insulin, slow down the synthesis of sugar in the liver. Have a very high cost.
- Alpha Glucosidase Inhibitors Group. The main action is blocking the production of intestinal enzymes, which dissolve the most complex carbohydrates. This leads to a slower process of digestibility of polysaccharides. Quickly reduce blood sugar levels, have a minimum of adverse reactions and contraindications. The group belongs to the new generation of drugs. The most popular pills: "Miglitol" and "Glukobay."
- Another group of new generation Incretins aims to accelerate the production of natural insulin in the pancreas. Differently, this group is called dipeptidyl peptidase inhibitors. Tablets contribute to the release of glucose from the liver. The most well-known drugs: "Januvia", "Saksagliptin" and "Galvus". Tablets are so potent that it is enough to take them once a day. Virtually no contraindications and side effects.
A complete list of tablets is available here.
Combination therapy can be used for diabetes mellitus (type 1 and type 2). The main focus is to prevent the development of complications and improve the health status of the diabetic as a whole.
With type 2 diabetes, it is necessary if monotherapy has not brought the expected result.
Basically, a special combination of medicines is used, which simultaneously affect the processes of insulin production, sugar reduction and the level of sensitivity of peripheral tissue to insulin. The most successful combination of drugs in combination therapy:
- Sulfonylurea preparations and agents from the biguanide group.
- Sulfonylurea derivatives and thiazolidinedione group.
- Clays and thiazolidinediones group.
- Clay and biguanides.
- Biguanide group of tablets and thiazolidinediones.
- "Acarbose" and any drug from the sugar reduction series.
Before prescribing a combination therapy, the endocrinologist increases the dosage of drugs during monotherapy. If the effect is zero, the agent from the other group is gradually introduced, but in the average dosage. If in this case the result is negative, the dose is increased. Sometimes the combination consists of 3 drugs.
It is impossible to completely cure diabetes mellitus, therefore it is extremely necessary to turn to an endocrinologist when the first signs appear. This will allow you to properly prescribe medication, suspend the pathological process and prevent the development of complications.