Schemes and regimens of insulin therapy in children, adults, during pregnancy

Normally, the secretion of inulin occurs continuously and is approximately 1 unit of hormone per hour. This indicator is basal or background secretion. The ingestion of food provokes a rapid, that is, a bolus increase in the concentration of the hormone many times over. Stimulated secretion is 1-2 units for every 10 g of carbohydrates taken. In this case, the body observes a balance between the concentration of the pancreatic hormone and the need for it.

Patients with the first types of the disease need substitution therapy, which mimics the secretion of the hormone under physiological conditions. To do this, use different types of drugs at different times. The number of injections can reach 4-6 per day. Patients with a second type of diabetes, but with a preserved beta-cell function, need 2-3 fold administration of the drug to maintain compensation.

The mode of insulin therapy is individual for each patient and depends on the main goal of glycemic control. To date, there are such treatment regimes:

1. Introduction of the drug once a day - is used in the treatment of patients with both the first and the second type of disease.
2. Administration of the drug 2 times a day is one of the most common regimens for patients with the first type of diabetes. The dosage of the drug is approximately the same: 2/3 of the dose before breakfast and 1/3 before the last meal.
3. Several injections per day - the patient has a free regime of the day, since the time of food and injections is not strictly established. The medication is administered 3 or more times a day.

Under normal conditions, 40% of the total dose of the drug is administered before bedtime. Medications of medium duration and long-term action are used. The remaining dose is applied 30 minutes before each meal 2-3 times a day. Most often, they use normal and intensive regimes.

Schemes of insulin therapy

The endocrinologist is engaged in selection of an optimum mode of introduction of a preparation and drawing up of the scheme of insulin therapy. The doctor's task is to achieve maximum compensation of carbohydrate metabolism with minimal daily fluctuations in glucose level and the lowest risk of complications of the disease.

When preparing the treatment regimen, the following factors are taken into account:

• The form of diabetes mellitus: compensated, uncompensated.
• Type of insulin used and dosage of the drug. The higher the dose, the slower the absorption, but the longer the action of the drug.
• Place of injection - when injected into the thigh, the rate of absorption is higher than when injected into the shoulder. In this case, injections in the abdomen are more effective than injections in the shoulder, which have a minimum rate of absorption.
• Method of administration of drugs and features of local blood flow. Intramuscular injection is characterized by rapid absorption, but short action, subcutaneous injection is reversed.
• Muscular activity and local temperature - an easy preliminary massage of the injection site increases the rate of absorption of the drug. This effect is observed even at elevated body temperature.

Most often, patients resort to the use of such schemes of insulin therapy:

1. Traditional - daily administration of the drug with a minimum number of injections, but in the same dosage. Short and long-acting drugs are used in the ratio of 30:70, that is 2/3 of the daily dose before breakfast and 1/3 before dinner. This scheme is suitable only for limited groups of patients, as it does not provide a full compensation of the hormone, because the needs for it can change throughout the day.
2. Intensive - corresponds to the physiological secretion of the hormone. It consists of long-acting injections in the morning and in the evening, as well as short-acting injections applied before each meal.

To draw up a treatment regimen, you need to determine the level of glycemia and regularly monitor it. This will allow you to choose the most effective dosage. Patients are also advised to keep a special diary, writing down the consumed carbohydrate units, the amount of hormone injected, the physical activity and the complications that arise. Thanks to this, it is possible to analyze treatment errors and systematize the knowledge gained.

About pump insulinotherapy, read this article.

Virtuosic insulin therapy

Another way to treat diabetes is a regimen of so-called virtuoso insulin therapy. This method was developed by the Peruvian physician Jorge Canales, who from childhood suffered from this pathology. His technique is based on the study of the whole complex of substances released by beta cells of the pancreas. Canales has proved that each of the products produced by the body, like insulin, has biological activity and is important in metabolic disorders.

Virtuosic insulin therapy allows you to select the most accurate dosage of the hormone administered for patients with type 1 and type 2 diabetes mellitus. The essence of the methodology in using the coefficients:

• Nutritional is the coefficient per unit of bread, that is, the necessary amount of insulin for the assimilation of 1 unit of carbohydrates.
• Correction is a glycemic index, that is, the amount of insulin per 1 mmol / L of glucose in the blood, exceeding the norm.

The coefficients are calculated with a maximum accuracy of up to 4 digits after the decimal point, but separately for the time interval before breakfast, from breakfast to lunch and after the last meal. The calculated dose is rounded to 0.5 units of the injected hormone. This value is the dosage step when using an insulin syringe.

According to the research, applying the technique of virtuosic therapy, a patient with a body weight of 70 kg and measuring blood sugar 4-5 times a day can keep it within 4-7 mmol / l throughout the day.

Intensified insulin therapy

The peculiarity of this mode of administration of the drug is that the daily dose is distributed between short-acting insulin (applied after eating) and prolonged action (used in the morning and before bedtime to simulate basal secretion).

Features of the intensified method:

• Simulation of hormone secretion: basal and food.
• Prevention of complications and control of metabolic processes in the body.
• The need to learn the correct calculation of dosage and drug administration.
• Regular self-control.
• Propensity to hypoglycemia.

The hormone is calculated by the endocrinologist. The doctor takes into account the daily need for calories. The patient is prescribed a diet, according to which the calculated carbohydrates are calculated in bread units, and proteins and fats in grams. Based on all these data, the daily dosage of the drug is determined, which is distributed for the whole day.

For example, if a diabetic does only 3 injections a day, then before breakfast and dinner introduce a hormone of short and prolonged action, and before dinner - short. According to another scheme, a short and intermediate action medication is used before breakfast, short action - before dinner and intermediate action - before bedtime. Optimal scheme of administration of the drug does not exist, so each patient adjusts it to fit.

The principle of an intensified regime is the more frequent the injections, the easier it is to adapt the dosage to the needs of patients throughout the day. In any case, before each injection it is necessary to determine the level of glycemia and to correctly measure the dose of insulin. The success of treatment is based on the responsibility of the patient and his designation of the nuances of the method.

Bolus insulin therapy

In a normal state, a stable level of insulin is observed on the empty stomach in the blood, that is, the basic norm. The pancreas stimulates the hormone between meals. One part of the insulin normalizes and maintains the level of glucose in the blood, preventing her jumps, and the second part is involved in the process of digestion.

From the beginning of eating and up to 5-6 hours after eating, the body produces a so-called bolus insulin. It is thrown into the blood until all the sugar is absorbed by the cells and tissues of the body. At this point in the work included hormones of the opposite action, that is, counter regulators. They prevent changes in glucose levels.

Bolus insulin therapy is based on the accumulation of a hormone with the administration of a drug of short or prolonged action in the morning / before bedtime. This method allows to simulate the natural functioning of the affected organ.

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Traditional insulin therapy

The most common mode of insulin administration in diabetes mellitus is a traditional or combined method. It is based on combining all types of the drug in one injection.

Features of the method:

• The number of injections does not exceed 1-3 per day.
• There is no need for constant monitoring of glycemic parameters.
• Ease of carrying out.
• Suitable for elderly patients and with mental disorders, as well as for undisciplined patients.

But this technique requires strict adherence to a diet, which depends on the dosage of the medicine. It is also necessary to adhere to the regime of the day and maintain physical activity. In a day there should be 5-6 meals at a time strictly reserved for this purpose.

The daily dosage of insulin is calculated by the endocrinologist, then it is distributed according to the regime:

• 2/3 - before the first meal.
• 1/3 before the last meal.

The amount of a long-acting hormone should be in the range of 60-70%, and a short 30-40%. At the same time, patients using the traditional therapy scheme have a risk of developing atherosclerosis, hypokalemia and arterial hypertension.

Insulin therapy for type 1 diabetes mellitus

Diabetes mellitus of the first type is characterized by absolute insulin deficiency. The pancreas does not produce or produce a hormone at critically low doses, which are not capable of processing glucose. Proceeding from this, insulin therapy is a vital measure.

Treatment is based on exogenous hormone administration, without which a ketoacidotic or hyperglycemic coma develops. The drug normalizes glycemia, provides growth and full functioning of the body. Completely replaces the physiological work of the pancreas.

There are several types of insulin used to treat type 1 diabetes:

• Short action - is introduced on an empty stomach before eating. Begins to act 15 minutes after the injection, the peak of activity develops in 90-180 minutes. The duration of its operation depends on the dosage, but as a rule, it is at least 6-8 hours.
• Medium exposure - is administered in the morning and evening. The effect develops 2 hours after the injection with peak activity in 4-8 hours. It works 10-18 hours.
• Prolonged exposure - begins to work 4-6 hours after the injection, and the maximum activity develops after 14 hours. The effect of this type of drug is more than 24 hours.

The scheme of the drug administration and its dosage is calculated by the attending physician, taking into account a number of factors. The patient is shown basal medication 1-2 times a day, and before each meal - bolus. Combination of these regimens is called a basis-bolus method, that is, multiple administration of a hormone. One of the types of this method is intensive insulin therapy.

The approximate scheme of hormone administration for type 1 diabetes looks like this:

• Before breakfast - short and long-acting insulin.
• Before dinner - a short action.
• Before dinner - a short action.
• Before going to bed - prolonged.

According to the studies, a timely and carefully planned treatment regimen in 75-90% of cases of the disease makes it possible to transfer it to the stage of temporary remission and stabilize further flow, minimizing the development of complications.

Insulin therapy for type 2 diabetes mellitus

The second type of diabetes is insulin-independent, that is, the body does not need additional hormone. But in some cases, the immune system attacks the beta cells of the pancreas. Because of this, a significant part of the cells that produce the hormone dies. This happens when unbalanced and unhealthy diet, a sedentary lifestyle, regular emotional stress.

The main indications for insulin therapy for type 2 diabetes are:

• Exacerbation of chronic diseases or infectious infections of the body.
• Upcoming surgical intervention.
• Ketone bodies in the urine.
• Signs of insulin deficiency.
• Disturbances on the part of the kidneys, liver.
• Pregnancy and lactation.
• Dehydration of the body.
• Come on, coma.

In addition to the above indications, insulin is prescribed for the first time diagnosed with diabetes and high glucose levels on an empty stomach, which persists throughout the day. Additional hormone administration is necessary for glycated hemoglobin above 7%, the C-peptide accumulation is below 0.2 nmol / L, after internal administration of 1.0 mg glucagon.

Treatment takes place according to the scheme developed by the doctor. The essence of therapy in the gradual increase in basal dosage. There are such basic modes of insulin administration:

• One injection of a medication of medium duration or prolonged action before breakfast or before bedtime.
• A mixture of medium-sized and long-acting insulin in a proportion of 30:70 in the single-prick mode before breakfast or before dinner.
• A combination of intermediate or short / ultrashort action preparations before each meal, that is, 3-5 injections per day.

When using hormones of prolonged action, a dosage of 10 units per day is recommended, preferably at the same time. If the pathological condition continues to progress, the patient is transferred to the full regime of insulin therapy. Continuous introduction of synthetic hormone is necessary for patients who do not take tablets to reduce blood sugar and do not adhere to the basic nutrition recommendations.

Insulin therapy in pregnancy

Diabetes mellitus that occurs during pregnancy is not a complete disease. Pathology indicates a predisposition to intolerance to simple sugars and is a risk of developing type 2 diabetes. After the birth, the disease can disappear or further progress.

In most cases, pancreatic disorders are associated with changes in the hormonal background. There are also a number of factors contributing to the development of the disease:

• Excess body weight.
• Metabolic disorders.
• Age of the woman in childbirth is older than 25 years.
• Diabetes in the anamnesis.
• Polyhydramnios and other.

If the gestational diabetes is long and the glucose level does not decrease, then the doctor prescribes insulin therapy. At pregnancy I can appoint insulin and at normal indicators of sugar. Injections are shown in such cases:

• Severe swelling of soft tissues.
• Excess growth of the fetus.
• Polyhydramnios.

Since the metabolic processes in the body of the future mother are not stable, frequent dosage adjustment is carried out. Typically, the drug is administered before breakfast 2/3 of the dose, that is, on an empty stomach and at bedtime 1/3 dosage. Insulin therapy in gestational diabetes consists of short-acting and long-acting drugs that combine with each other. For women with the first type of diabetes, injections are done 2 or more times a day. Regular injections are necessary to prevent morning and postprandial hyperglycemia.

To ensure successful delivery of gestational diabetes, it is necessary to monitor glucose indices during the entire period of drug compensation for carbohydrate metabolism, and also within 2-3 months after delivery. In addition, one should strictly adhere to medical prescriptions, since there is a risk of developing macrosomia, that is, a state where natural births are impossible and a cesarean section is performed.