Insulin therapy for diabetes mellitus

Insulin therapy is indicated to compensate for carbohydrate metabolism disorders in the body. Let's consider the features of this method, the rules and principles of implementation, and the drugs.

If it is impossible to restore normal blood sugar levels with the help of pills, a healthy lifestyle or proper nutrition, insulin intake is necessary. Its use is directly related to the depletion of the pancreas. The organ contains beta cells that produce the hormone. Under the influence of certain factors, the gland is depleted, these include:

1. Glucose level is more than 9 mmol/l. High sugar has a destructive effect on the pancreas, which stops producing hormones and leads to such a pathology as glucose toxicity.
2. Long-term use of high doses of sulfonylurea. Changes in sugar levels occur on an empty stomach, but the gland retains the ability to produce insulin in response to taking sulfonylurea drugs (Maninil, Diabeton, Amaral), which stimulate its work
3. Failure to follow medical recommendations for the treatment of endocrine disease. If the glucose level remains elevated for a long time, and a person does not adhere to a diet, but takes medications to normalize blood sugar, then the beta cells of the pancreas fail. The organ is depleted, and glucose is elevated regardless of food intake.

According to the conducted research, the pancreas fails 6-8 years after the diagnosis of diabetes mellitus type 2. The introduction of insulin into the body is aimed at eliminating the syndrome of glucose toxicity. The drug unloads the affected organ and promotes its recovery.

In clinical practice, insulin therapy is used not only to treat diabetes, but also for some mental illnesses. This method is indicated for type 2 diabetes before a planned operation, as well as for the treatment of type 1 diabetes.

Advantages of using insulin preparations:

• The glucose level does not change over a long period of time and remains within normal limits.
• The patient independently determines the amount of drug to be administered.
• There are no clear recommendations regarding the regimen for taking the drug.
• The progression of diabetes and the development of its complications slows down.

As for the disadvantages, this method of treatment requires regular monitoring of blood sugar levels using a glucometer. In mild diabetes, there is a risk of its progression.

Today, there are many insulin preparations on the pharmaceutical market, which differ in their pharmacological properties, degree of purification and duration of action. Based on this, all medications and recommendations for their use should be given only by the attending endocrinologist.

Principles of insulin therapy

Like many treatment methods, insulin therapy has certain principles, let's consider them:

1. The daily dose of the drug should correspond to the physiological one as much as possible. During the day, up to 70% of the dosage should be administered, the remaining 30% - before bedtime. This principle allows simulating the real picture of hormone production by the pancreas.
2. The choice of the optimal dosage is influenced by the daily requirements for the drug. They depend on the physiological characteristics of the body. Thus, one person needs ½ a unit of insulin to assimilate one bread unit, while another needs 4.
3. To determine the dose, it is necessary to measure the blood glucose level after eating, taking into account the number of calories consumed. If glucose is higher than normal, the dose of the drug is increased by several units until this indicator returns to normal.
4. The dosage of the medicine can be adjusted according to glycemic indices. According to this method, for every 0.28 mmol/l of glucose exceeding 8.25 mmol/l, 1 unit of the medicine should be added. That is, each additional unit of sugar requires 2-3 units of the medicine.

Conducted studies and patient feedback indicate that the most relevant and adequate way to maintain normal blood sugar levels is self-monitoring of glucose. For this, individual glucometers and stationary devices are used.

Indications for the procedure

The use of drugs to compensate for carbohydrate metabolism disorders in the body has certain indications for use, let's consider them:

• Insulin-dependent diabetes type 1.
• Decompensation of type 2 diabetes.
• Diabetic ketoacidosis.
• Diabetic coma.
• Complex treatment of schizophrenia.
• Weight loss in endocrine pathologies.
• Diabetic nephropathy.
• Hyperosmolar coma.
• Pregnancy and childbirth with diabetes.

Type 2 diabetes mellitus is insulin-independent, although it is a metabolic disease. The pathology occurs with chronic hyperglycemia due to impaired interaction of insulin with pancreatic cells. Insulin therapy for type 2 diabetes has the following indications:

• Individual intolerance or ineffectiveness of drugs that lower blood sugar levels.
• Newly diagnosed disease with high glucose levels within 24 hours.
• Exacerbation of chronic diseases.
• Infectious diseases.
• Signs of insulin deficiency in the body.
• Severe kidney and liver dysfunction.
• Dehydration.
• Precoma and coma.
• Diseases of the hematopoietic system.
• Detection of ketone bodies in urine.
• Planned surgical intervention.

Based on the above indications, the endocrinologist draws up a treatment plan, selects the optimal dosage and recommendations regarding therapy using insulin drugs.

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Preparation

Before administering insulin, the patient must undergo special preparation. First of all, choose the method of administration - using a syringe pen or an insulin syringe with a small needle. The area of the body where the injection is planned must be treated with an antiseptic and thoroughly kneaded.

No later than half an hour after the injection, you need to eat. At the same time, it is contraindicated to administer more than 30 units of insulin per day. The optimal treatment regimen and exact dosage are selected by the attending physician, individually for each patient. If the patient's condition worsens, the dosage is adjusted.

Recommendations for insulin therapy

According to the conducted studies, the time of action of insulin preparations on the body is individual for each patient. Based on this, there are different durations of action of the drug. When choosing the optimal medication, doctors recommend focusing on the level of glycemia, while observing the prescribed diet and adhering to physical activity.

The whole point of drug treatment of diabetes is to imitate normal secretion of hormones by the pancreas. The treatment consists of food and basal secretion. The latter normalizes the level of glycemia between meals, during night rest, and also promotes the removal of sugar that enters the body outside of meals. Physical activity and hunger reduce basal secretion by 1.5-2 times.

Maximum compensation of carbohydrate metabolism with the help of a properly composed insulin therapy scheme allows to significantly reduce the risk of complications of the disease. The less fluctuations in blood sugar during the day, the better the patient's condition. Many doctors advise keeping a special diary, indicating the dose of the drug administered, the number of bread units eaten and the level of physical activity. This allows you to keep diabetes under control.

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Technique insulin therapy

Type 1 diabetes mellitus is one of the most common and dangerous diseases of the endocrine system. Due to the disruption of the pancreas and the production of hormones, glucose entering the body is not absorbed and is not broken down. Against this background, there is a sharp decrease in the immune system and complications develop.

The introduction of synthetic analogues of the hormone allows to restore normal blood sugar levels and improve the functioning of the body. As a rule, insulin therapy drugs are administered subcutaneously, in emergency cases intramuscular/intravenous administration is possible.

The technique for performing insulin therapy using a syringe is the following algorithm of actions:

• Prepare a bottle with the drug, a syringe, and a skin disinfectant.
• Treat the area of the body where the injection will be administered with an antiseptic and lightly knead it.
• Draw up the required dose of medication using a syringe and inject it under the skin (intramuscularly for large doses).
• Treat the injection site again.

The syringe can be replaced with a more convenient injection device - a syringe pen. It has a special needle that reduces the pain from the injection to a minimum. Its ease of use allows you to give injections at any time and in any place. In addition, some syringe pens have vials with insulin, which makes it possible to combine medications using different therapy regimens.

If the medicine is injected under the skin in the abdomen (to the right or left of the navel), it is absorbed much faster. When injected into the thigh, absorption is slow and incomplete. Injection into the buttocks and shoulder is intermediate in absorption rate between injection into the abdomen and thigh. Long-acting insulin should be injected into the thigh or shoulder, and short-acting insulin should be injected into the abdomen.

Long-term administration of the drug to the same site causes degenerative changes in the subcutaneous fat tissue, which negatively affects the absorption process and the effectiveness of drug therapy.

Rules of insulin therapy

Like any treatment method, insulin therapy has a number of rules that must be followed during its implementation.

1. The amount of sugar in the blood in the morning and after meals should be maintained within normal limits, which are individual for each person. For example, for pregnant women, glucose should be within 3.5-6.
2. The introduction of the hormone is aimed at simulating its normal fluctuations in a healthy pancreas. Short insulin is used before meals, and medium or long insulin is used during the day. Short and medium insulin is administered after sleep, short insulin is administered before dinner, and medium insulin is administered before sleep.
3. In addition to following the dosage of the medication, it is necessary to maintain a healthy diet and maintain physical activity. As a rule, the endocrinologist develops a nutrition plan for the patient and provides glycemic tables that allow monitoring the treatment process.
4. Regular monitoring of glucose levels. It is better to carry out the procedure both before and after meals, as well as in case of hypoglycemia/hyperglycemia. For measurements, you should purchase a personal glucometer and filter strips for it.
5. The insulin dosage should vary depending on the amount of food consumed, time of day, physical activity, emotional state and the presence of concomitant diseases. That is, the dose is not fixed.
6. Any changes regarding the type of medication used, its dosage, route of administration, as well as your well-being, should be discussed with your doctor. Contact with your endocrinologist should be constant, especially if there is a risk of emergency situations.

The above rules allow you to maintain the normal state of the body in such a serious metabolic disorder as diabetes.

Insulin therapy in psychiatry

Treatment with insulin preparations in psychiatry has the following indications for use:

• Psychoses.
• Schizophrenia.
• Hallucinations.
• Delusional syndrome.
• Catatonia.
• Hebephrenia.

Insulin shock therapy has a pronounced antidepressant effect, reduces or completely eliminates the symptoms of apathetic abulia and autism. It helps to normalize energy potential and emotional state.

Treatment of schizophrenic disorder by this method consists of several stages. The first injection is given to the patient in the morning on an empty stomach with an initial dosage of 4 units and is increased daily to 8 units. The peculiarity of this scheme is that injections are given five days in a row with a two-day break and then the course is continued.

1. The first stage consists of introducing the patient into a state of hypoglycemia for 3 hours. To restore the glucose level, the patient is given a tea drink that contains at least 150 g of sugar. A carbohydrate-rich diet is also necessary, which will finally normalize the condition.
2. The second stage of treatment consists of increasing the dosage of the drug and a longer period of unconsciousness of the patient. To normalize the patient's condition, a drip is given for intravenous administration of 20 ml of 40% glucose solution. As soon as the patient regains consciousness, he is given sugar syrup and a hearty breakfast.
3. The third stage of therapy involves further increasing the dosage. This provokes a condition that borders on stupor (complete depression) and coma. The patient can remain in this position for no more than 30 minutes, as there is a risk of developing irreversible consequences. To eliminate hypoglycemia, glucose drips are used.

During treatment, it should be taken into account that insulin shock therapy threatens the patient with the following problems:

• Convulsions similar to epileptic seizures.
• Prolonged coma.
• Recurrent comatose state after recovery from insulin coma.

The course of treatment consists of 20-30 sessions, during which the patient falls into a soporific-comatose state. Due to the danger of this method and the risk of developing serious complications, it has not received wide distribution in psychiatry.

Contraindications to the procedure

Treatment of insulin-dependent forms of diabetes, like any drug therapy, has certain limitations. Let's consider the main contraindications to the use of insulin:

• Acute forms of hepatitis.
• Cirrhosis.
• Ulcerative lesion of the stomach and duodenum.
• Urolithiasis.
• Hypoglycemia.
• Nephritis.
• Pancreatitis.
• Decompensated heart defects.

Particular caution should be exercised when treating patients with cerebrovascular accidents, thyroid disease, renal failure, and Addison's disease.

It is also necessary to take into account individual intolerance to certain types of the drug and the risk of developing allergic reactions to insulin components. Inhalation forms of the drug are contraindicated for pediatric patients, as well as for bronchitis, bronchial asthma, emphysema and patients who have smoked in the last 6 months.

During insulin therapy, it is necessary to take into account the tendency of insulin to interact with other drugs. Its activity increases significantly when used with oral hypoglycemic drugs, ethanol, b-adrenoblockers. When interacting with glucocorticosteroids, there is a high risk of developing hyperglycemia.

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Nutrition during insulin therapy

The diet for diabetes mellitus depends entirely on the insulin therapy regimen. The number of meals is calculated based on the insulin dosage, the type of hormone administered, the injection site, and the patient's body characteristics. The diet should contain a physiological amount of calories, as well as the required amount of proteins, fats, carbohydrates, and other nutrients. All these factors determine the frequency and time of meals, the distribution of carbohydrates (bread units) among meals.

Let's consider the nutritional features of different carbohydrate metabolism compensation schemes:

• An ultra-fast-acting drug - taken 5 minutes before meals, reduces glucose in 30-60 minutes.
• Short-acting insulin is administered 30 minutes before meals, with the maximum decrease in glucose occurring after 2-3 hours. If carbohydrate food is not consumed after the injection, hypoglycemia develops.
• Medium- and prolonged-action drugs lower sugar levels within 5-8 and 10-12 hours.
• Mixed insulins are short-acting and intermediate-acting injections. After administration, they cause a maximum decrease in glucose twice and require carbohydrate compensation through food.

When drawing up a diet, not only the type of medication administered is taken into account, but also the frequency of injections. Particular attention is paid to such a concept as a bread unit. This is a conditional estimate of the amount of carbohydrates in products. For example, 1 bread unit is 10-13 g of carbohydrates excluding dietary fiber, but taking into account ballast substances or 20-25 g of bread.

1. Double administration – 2/3 of the daily dose is administered in the morning and 1/3 in the evening.

• The first breakfast should contain 2-3 bread units, since the medicine has not yet begun to work.
• A snack should be 4 hours after the injection and consist of 3-4 bread units.
• Lunch – 6-7 hours after the last administration of the medicine. As a rule, this is a dense meal of 4-5 bread units.
• Snack – sugar levels may be slightly elevated, so no more than 2 bread units should be consumed.
• The last meal is a hearty dinner of 3-4 bread units.

This five-meal-a-day scheme is most often used with a small daily dose of administered insulin.

2. Five-time administration of the drug - before breakfast and before bedtime, an intermediate-action drug is used, and before main meals - a short-acting one. This scheme requires six meals a day, that is, three main meals and three snacks. After the introduction of the intermediate-action hormone, it is necessary to eat 2 bread units to minimize the risk of hypoglycemia.
3. Intensive insulin therapy – this regimen is characterized by multiple administration of the drug at a time convenient for the patient. The patient’s task is to take into account the number of bread units during the first meals and control the blood glucose level. Many patients with this scheme switch to a preventive or liberalized diet No. 9.

Regardless of the diet, one meal should not exceed 7 bread units, i.e. 80-85 g of carbohydrates. At the same time, simple, i.e. refined carbohydrates should be excluded from the diet and the dosage of complex carbohydrates should be calculated correctly.

Reviews

Numerous reviews from patients diagnosed with type 1 or 2 diabetes confirm the effectiveness of insulin therapy when administered correctly. The success of treatment depends on the correctness of the selected medication, the carbohydrate metabolism compensation regimen, and adherence to dietary nutrition.