Insulin therapy in diabetes mellitus

To compensate for violations of carbohydrate metabolism in the body shows insulinotherapy. Let's consider features of the given method, rules and principles of carrying out, preparations.

If you can not restore normal blood sugar values with pills, a healthy lifestyle or proper nutrition, you need insulin. Its use is directly related to the depletion of the pancreas. In the body are beta cells that produce a hormone. Under the influence of certain factors, the iron is depleted, these include:

1. The glucose level is more than 9 mmol / l. High sugar has a destructive effect on the pancreas, which ceases to produce hormones and leads to a pathology such as glucose toxicity.
2. Long-term use of high dosages of sulfonylurea. The change in the sugar level occurs on an empty stomach, but the iron remains able to produce insulin in response to taking sulfonylurea (Maninil, Diabetes, Amaral), stimulating its work
3. Non-compliance with medical recommendations for the treatment of endocrine disease. If, for a long time, the glucose level remains elevated, and a person does not follow a diet, but takes medication to normalize the blood sugar, then the beta cells of the pancreas fail. The organ is depleted, and glucose is increased regardless of the intake of food.

According to the studies, the pancreas gives a failure in 6-8 years after the diagnosis of type 2 diabetes. Introduction to the body of insulin 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 for the treatment of diabetes, but also for certain mental illnesses. This technique is indicated for type 2 diabetes before the planned operation, as well as for the treatment of a disease of the first type.

Advantages of using insulin preparations:

• The glucose level does not change over a long period of time and is within the normal range.
• The patient independently determines the amount of the drug administered.
• There are no clear recommendations regarding the regimen of taking the medicine.
• Slows down the progression of diabetes and the development of its complications.

As for the disadvantages, this method of treatment requires regular monitoring of blood sugar level with the help of a glucometer. With diabetes mild, there is a risk of its progression.

To date, in the pharmaceutical market, there are many insulin preparations that differ in their pharmacological properties, degree of purification and duration of action. Proceeding from this, all medicines and recommendations for their use should be given only by the attending physician endocrinologist.

Principles of insulin therapy

Like many medical methods, insulin therapy has certain principles, consider them:

1. The daily dose of the drug should match the physiological maximum. During the day should be administered up to 70% of the dosage, the remaining 30% - before bedtime. Such a principle allows imitating a real picture of the production of hormones by the pancreas.
2. The choice of the optimal dosage is influenced by the daily requirements for the medicine. They depend on the physiological characteristics of the body. So, for one person to master one grain unit, ½ insulin units, and another 4.
3. To determine the dose, it is necessary to measure the blood glucose level after a meal, taking into account the number of calories consumed. If the glucose is higher than the norm, then the dose of the drug is raised by several units until this indicator returns to normal.
4. Correct the dose of the drug can be by glycemic parameters. According to this method, for every 0.28 mmol / L of glucose, when exceeding 8.25 mmol / l, 1 unit of medicine should be added. That is, each additional sugar unit requires 2-3 units of the drug.

The conducted researches and responses of patients indicate that the most actual and adequate way to maintain a normal level of sugar in the blood is glucose self-control. Individual glucometers and stationary devices are used for this.

Indications for the procedure

The use of drugs to compensate for violations of carbohydrate metabolism in the body has certain indications for the conduct, consider them:

• Insulin-dependent diabetes type 1.
• Decompensation of type 2 diabetes.
• Diabetic ketoacidosis.
• Diabetic coma.
• Complex treatment of schizophrenia.
• Decreased body weight in endocrine pathologies.
• Diabetic nephropathy.
• Hyperosmolar coma.
• Pregnancy and birth in diabetes.

Diabetes mellitus type 2 is insulin-independent, although it refers to metabolic diseases. Pathology occurs with chronic hyperglycemia due to a violation of insulin interaction with pancreatic cells. Insulin therapy in the second type of diabetes has such indications for carrying out:

• Individual intolerance or ineffectiveness of drugs that lower blood sugar levels.
• The first diagnosed disease with a high level of glucose within 24 hours.
• Exacerbation of chronic diseases.
• Infectious diseases.
• Signs of insulin deficiency in the body.
• Serious disorders of the kidneys and liver.
• Dehydration of the body.
• Come and coma.
• Diseases of the hematopoietic system.
• Detection of ketone bodies in urine.
• Planned surgical intervention.

Based on the above indications, the endocrinologist makes a treatment regimen, chooses the optimal dosage and recommendations for the therapy with insulin medications.

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Preparation

Before the introduction of insulin, the patient must undergo special training. First of all, choose the method of administration - using a syringe pen or an insulin syringe with a small needle. The site of the body, in which it is planned to make a prick, must be treated with an antiseptic and well kneaded.

No later than half an hour after the injection you need to take food. It is contraindicated to administer more than 30 units of insulin per day. The optimal treatment regimen and the exact dosage is chosen 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. Proceeding from this there are different in duration of action of the drug. When choosing the optimal medicine, doctors recommend to focus on the level of glycemia, while respecting the prescribed diet and adhering to physical activity.

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

The maximum compensation of carbohydrate metabolism with the help of a correctly formulated scheme of insulin therapy allows to significantly reduce the risk of complications of the disease. The less fluctuation in blood sugar in the course of the day, the better the condition of the patient. Many doctors advise to keep a special diary, indicating the injected dose of the drug, the number of eaten bread units and the level of physical activity. This allows you to keep diabetes under control.

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Technique of the insulin therapy

Diabetes mellitus type I refers to one of the most common and dangerous diseases of the endocrine system. Because of disruption of the pancreas and the production of hormones, glucose entering the body is not digested and not broken down. Against this background, there is a sharp decline in the immune system and complications develop.

The introduction of synthetic analogues of the hormone, allows to restore the normal level of sugar in the blood and to regulate the functioning of the body. As a rule, preparations for insulin therapy are administered subcutaneously, in case of emergency, intramuscular / intravenous administration is possible.

The technique of insulin therapy with a syringe is such an algorithm of actions:

• Prepare a vial of the drug, a syringe, a disinfectant for the skin.
• Treat with an antiseptic and slightly melt the area of the body into which the injection will be made.
• Gather with the syringe the necessary dose of the drug and the injection under the skin (at high doses intramuscularly).
• Once again, treat the injection site.

The syringe can be replaced with a more convenient injection device - it's a syringe pen. It has a special needle, which reduces the pain from the injection to a minimum. The convenience of using it allows you to make injections at any time and in any place. In addition, some syringe-pens have vials of insulin, which makes it possible to combine medicines using different therapies.

If you inject the medicine under the skin into the abdomen (right or left of the navel), then it is so much more quickly absorbed. When injections into the thigh, the absorption is slow and not complete. Introduction to the buttocks and shoulder by the rate of absorption takes an intermediate value between a stab in the abdomen and thigh. Long-acting insulin should be injected into the hip or shoulder, and short - into the stomach.

Long-term administration of the drug in one and the same place causes degenerative changes from the subcutaneous fatty 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 should be followed when conducting it.

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 in the range of 3.5-6.
2. The introduction of the hormone is aimed at imitating its normal oscillations with a healthy pancreas. Before meals, use a short insulin, during the day is medium or long. After sleep, you enter short and medium, before dinner - short and before going to bed - medium.
3. In addition to compliance with the dosage of medication, one should adhere to a healthy diet and maintain physical activity. As a rule, the endocrinologist develops a nutritional plan for the patient and gives glycemic tables that allow monitoring the treatment process.
4. Regular monitoring of glucose levels. The procedure is best performed both before and after meals, as well as in case of hypoglycemia / hyperglycemia. For measurements, you need to purchase a personal glucometer and a strip filter to it.
5. The dosage of insulin should vary from the amount of food consumed, the time of day, physical activity, emotional state and the presence of concomitant diseases. That is, the dose is not fixed.
6. All changes regarding the type of medication used, its dosage, mode of administration, and well-being should be discussed with the attending physician. Communication with the endocrinologist should be permanent, especially if there is a risk of developing emergencies.

The above rules allow maintaining a normal state of the body with such a serious metabolic disorder as diabetes.

Insulin therapy in psychiatry

Treatment with the use of insulin drugs in psychiatry, has such indications for use:

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

Insulin-shock therapy has a pronounced antidepressant effect, reduces or completely eliminates the symptoms of apato-abulia and autism. Promotes normalization of energy potential and emotional state.

Treatment with this method of schizophrenia consists of several stages. The patient receives the first injection in the morning on an empty stomach with an initial dosage of 4 units and daily increases it to 8 units. The peculiarity of this scheme is that injections are made five days in a row with a two-day break and a further continuation of the course.

1. The first stage consists of introducing the patient into a hypoglycemia state for 3 hours. To restore the glucose level, the patient is given a tea drink that contains at least 150 g of sugar. Also, a carbohydrate-rich diet is needed, which finally normalizes the condition.
2. The second stage of treatment consists of increasing the dosage of the drug and a longer shutdown of the patient's consciousness. To normalize the patient, a dropper is placed for intravenous administration of 20 ml of a 40% solution of glucose. Once the patient has regained consciousness, he is given sugar syrup and a hearty breakfast.
3. The third stage of therapy is to further increase the dosage. This provokes a condition that borders on copulation (total oppression) and coma. The patient can stay in this position for no more than 30 minutes, since there is a risk of development of irreversible consequences. To eliminate hypoglycemia, droppers with glucose are used.

During treatment, it should be borne in mind that insulin-shock therapy threatens the patient with such problems:

• Convulsive seizures, similar to epileptic seizures.
• A prolonged coma.
• Re-comatose state after recovery from insulin coma.

The course of treatment consists of 20-30 sessions, during which the patient falls into a soporno-coma. Because of the danger of this method and the risk of developing serious complications, it has not become widespread in psychiatry.

Contraindications to the procedure

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

• Acute forms of hepatitis.
• Cirrhosis of the liver.
• Ulcerative lesions of the stomach and duodenum.
• Urolithiasis disease.
• Hypoglycemia.
• Nephritis.
• Pancreatitis.
• Decompensated heart diseases.

Particular care should be taken when treating patients with impaired cerebral circulation, thyroid disease, kidney failure, Addison's disease.

It should also take into account the individual intolerance of certain types of the drug and the risk of allergic reactions to insulin components. Inhalation forms of the drug are contraindicated for children of childhood, as well as bronchitis, bronchial asthma, emphysema and patients who have smoked during the past 6 months.

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

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Nutrition for insulin therapy

The diet in diabetes mellitus is completely dependent on the regimen and regimen of insulin therapy. The amount of meals is calculated based on the dosage of insulin, the type of hormone administered, the injection site and the characteristics of the patient's body. The diet should contain a physiological amount of calories, as well as the necessary norm of proteins, fats, carbohydrates and other nutrients. All these factors determine the frequency and time of eating, the distribution of carbohydrates (cereal units) by meals.

Consider the peculiarities of nutrition under different schemes of compensation of carbohydrate metabolism:

• The drug ultra-fast action - is applied 5 minutes before meals, reduces glucose after 30-60 minutes.
• Short-acting insulin is injected 30 minutes before meals, with the maximum decrease in glucose occurring after 2-3 hours. If you do not consume carbohydrate food after the injection, then hypoglycemia develops.
• Preparations of medium duration and prolonged action - lower the sugar after 5-8 and 10-12 hours.
• Mixed insulins are injections of short and intermediate action. After administration twice cause a maximum decrease in glucose and require carbohydrate compensation by eating.

When drawing up a diet, not only the type of medication being administered, but also the frequency of injections is taken into account. Particular attention is paid to such a concept as a grain unit. This is a tentative estimate of the amount of carbohydrates in foods. For example, 1 bread unit is 10-13 g of carbohydrates without taking into account dietary fiber, but taking into account ballast substances or 20-25 g of bread.

1. Two-fold administration - in the morning 2/3 of the daily dose is injected, and in the evening 1/3.

• The first breakfast should contain 2-3 bread units, since the medicine has not yet begun to act.
• Snack should be 4 hours after the injection and consist of 3-4 bread units.
• Lunch - 6-7 hours after the last drug administration. As a rule, it is dense food for 4-5 grain units.
• Overshot - the sugar level can be slightly increased, so you should eat no more than 2 bread units.
• The last meal is a dense dinner of 3-4 bread units.

This scheme of five meals is most often used with a small daily intake of insulin.

2. Five-fold administration of the drug - before breakfast and before going to bed use a medication intermediate, and before the main meals - a short action. This scheme requires six meals a day, that is, three main receptions and three snacks. After the introduction of an intermediate hormone, you need to eat 2 bread units in order to minimize the risk of developing hypoglycemia.
3. Intensive insulin therapy - this regime is characterized by repeated 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 monitor the level of glucose in the blood. Many patients under this scheme switch to a preventative or liberalized diet number 9.

Regardless of the nutrition scheme, one meal should not have more than 7 bread units, that is 80-85 grams of carbohydrates. Thus it is necessary to exclude simple, that is refined carbohydrates from the diet and correctly calculate the dosage of complex carbohydrates.

Reviews

Numerous reviews of patients who were diagnosed with diabetes of grade 1 or 2 confirm the effectiveness of insulin therapy when it is performed correctly. The success of treatment depends on the correctness of the chosen medicine, the regime of carbohydrate metabolism compensation and dietary intake.