Type 1 diabetes insulin therapy: description and treatment principle

In the article, we will consider what insulin therapy of type 1 diabetes is.

Insulin is the only hormone that can lower blood sugar, stimulate the absorption and elimination of glucose from tissues, and prevent the formation of ketane bodies, with an excess of which ketoacidosis develops - a dangerous disease that is a complication of diabetes.

The most applicable and progressive method of therapy is insulin therapy. It aims to compensate for the failure of carbohydrate metabolism by introducing special drugs.

Insulin therapy is used for diabetes mellitus most often of type 1, for a short treatment of type 2 diabetes, before surgery, if the use of other sugar-lowering drugs does not give a result.

Indications

What are the indications for insulin therapy for diabetes? This is a common question. We will understand it in more detail.

The main indications are:

1. Type 1 diabetes.
2. Quick weight loss for patients in a short period of time.
3. Inefficiency of therapy with oral drugs that reduce sugar in type 2 diabetes.
4. Existence of exacerbated chronic pathologies in a diabetic.
5. The presence in the patient's body of purulent infectious processes.
6. Coma.
7. Ketoacidosis.

Insulin therapy for gestational diabetes will be discussed below.

Scheme

Insulin therapy of type 1 diabetes is carried out according to a certain scheme, which is developed by an endocrinologist. The doctor determines the type of insulin necessary for treatment (prolonged or fast), dosage, time of administration of the drug.

There can be no standard treatment regimen, for each patient it is developed individually and only after studying the sugar levels in the previous week.

If the doctor recommends therapy without reading the blood counts, it is better to refuse treatment and consult another specialist. Otherwise, you can get a variety of kidney diseases and increase the likelihood of amputation of the lower extremities.

The endocrinologist must determine what type of insulin is necessary to normalize fasting glycemic indices, whether fast insulin injections are needed, or if a diabetic needs short-term, prolonged insulin.

WHO reports that about 2 million people die from diabetes and its consequences worldwide every year. The lack of qualified treatment leads to the development of various complications, the gradual destruction of the body.

The following complications of the pathology are most common: ketoacidosis, hypoglycemia, trophic ulcers, retinopathy, nephropathy, diabetic gangrene. In addition, diabetes can cause cancer. Almost every complication leads to the death of a diabetic in the fight against painful pathology or turns him into a disabled person.

To prescribe the right treatment, the endocrinologist will need to measure the patient's glycemia for the entire previous week, as well as a description of the circumstances surrounding the measurement:

1. Eating time.
2. Characteristics and quantity of consumed products.
3. The presence of physical activities, their duration.
4. Dosage and time of use of oral anti-diabetes medications.
5. The presence of other pathologies, infectious diseases.
6. Decrease, increase sugar at night. Such a measurement is required to determine the need for the use of prolonged-acting insulin.

The patient needs to measure sugar before bedtime and on an empty stomach. At the same time, it is important to record all indicators in writing and build graphs, which are then provided to the endocrinologist.

Carrying out insulin therapy of type 1 diabetes mellitus

Often it is preferable to use injections rather than tablets. This is due to the fact that after oral use, the active substance is rapidly destroyed in the digestive tract. The insulin preparations currently used for treatment are obtained either by the biosynthetic or semi-synthetic method.

Pork and bovine insulin used to be used, but long studies have proved that these drugs negatively affect human health, provoking allergic responses.

Currently, it is possible to obtain a hormone having a high degree of purification. In the substance obtained by the biosynthetic method, there are no harmful impurities.

After treatment, some components are added to human insulin:

1. Crystallizing.
2. Disinfectants.
3. Prolonging action.
   

Basic principles

Before starting insulin therapy for type 2 diabetes mellitus, it is important to study the basic principles and rules of treatment:

1. Before the introduction of the drug, it is necessary to carefully stretch the intended injection site.
2. Use syringes with a thin needle or special pen syringes.

The latter have several advantages:

1. They are convenient to use, an injection can be carried out almost anywhere and at any time.
2. They have a specially designed needle that can reduce pain during the injection.

After administration of insulin, the patient needs to eat, while the interval between injection and food intake should be no more than 30 minutes. Compliance with the doctor’s recommendations can reduce the likelihood of developing possible complications, improve the effectiveness of therapy.

The treatment regimen includes:

1. Short or prolonged fasting insulin injection.
2. Short-term insulin injection before lunch.
3. Fast insulin injection before dinner.
4. Sustained-release injection before bedtime.

The rate of absorption of insulin depends on several factors:

1. Solubility, temperature of the drug.
2. The amount of medication administered.
3. Physical activity of the patient.
4. The presence of a patient’s stress state.

Varieties

There are several varieties.

Intensified insulin therapy is used if the patient is not overweight and is not under constant stress. The drug is prescribed per unit per kilogram of body weight. The medicine maximally imitates the natural synthesis of insulin in the body.

During therapy of this type, certain conditions must be met:

1. The hormone must enter the body in the amount necessary for the excretion of glucose.
2. The administered drug should completely mimic the natural secretion of the hormone by the pancreas.

This technique is suitable for insulin therapy of type 1 diabetes mellitus. The requirements described above constitute a scheme for intensified insulin therapy, when the daily dose is divided into smaller injections, differentiating insulins according to their temporal effectiveness. To introduce drugs with a prolonged action should be in the morning and evening. Short-term insulin should be administered after consuming high-carb foods. Dosages of the drug are determined by the doctor.

A diabetic should measure glycemia every time before eating.

Traditional insulin therapy for diabetes mellitus is a combined technique that combines insulins with different periods of action in a single injection. The main advantage of the traditional technique is the reduction in the number of injections (1-3 per day).

The main disadvantage of this therapy is the lack of imitation of the physiological secretion of the hormone in full, so there is no absolute compensation for the failure of carbohydrate metabolism.

The patient should be administered insulin using drugs with short and prolonged action. Hormone with an average duration of approximately two thirds of the total dosage of the drug. One third are fast insulins.

Patients with type 1 diabetes need not regularly measure sugar before each meal.

Therapy with an insulin pump

An insulin pump is an electronic device that performs round-the-clock and short-term insulin injections in round-the-clock doses.

The device can function in various modes of drug administration:

1. Continuous administration of mini-dosages (with basal rate). Such a scheme allows you to provide an imitation of the background synthesis of the hormone, so that you can refuse to use prolonged insulin.
2. Bolus speed. In this case, insulin is administered at regular intervals, and the dosage is directly regulated by the patient. It is used for increased glycemic indicators, before meals.

Using bolus speed, ultrashort and short hormones can be replaced. The presence of several modes of operation of the pump allows for the most accurate imitation of insulin secretion. Replace the catheter once every three days.

The hormone enters the body through elastic pump catheters. The specialist places a special cannula under the skin at the site of the alleged insulin injection. The medicine is delivered by the device in minimal doses and at the speed that the patient has programmed. The absorption of the substance occurs instantly. Schedule changes are allowed every half hour.

By means of an insulin pump, long-term hormone is not administered. Since the patient experiences frequent fluctuations in sugar levels due to differences in absorption rates, and the pump eliminates this problem. Short-term hormone exposure is stable.

In addition, the use of the device has other positive aspects:

1. Modern devices can record data on drug injections for several months, after which they can be transferred to a computer. This function is convenient for both patients and doctors.
2. It is possible to change the rate of insulin administration in order to normalize sugar levels (for example, the drug can be turned off if hypoglycemia occurs).
3. The pump is able to continuously measure sugar, to warn the patient in case of its excess.
4. You can configure the device to administer a bolus dose not immediately, but for some time (this approach is effective if the patient has a long feast or he consumes slow carbohydrates).
5. The device allows you to calculate the bolus dosage (the patient must enter the data of their own sugar measurements and other indicators in the program of the device).
6. The number of punctures is reduced.
7. High accuracy of dosages, minimal steps of dose setting.

How is insulin therapy for type 2 and type 1 diabetes?

Treatment for various types of diabetes

The treatment regimen for type 1 diabetes is characterized by a double administration of insulin per day. Bolus insulin is administered before meals.

The use of a combined treatment regimen is called the basis of bolus therapy. One of the varieties is intensified insulin therapy.

Dosage is determined by an endocrinologist who takes into account many important factors. In this case, basal insulin should occupy an average of 50% of the daily dosage. The dosage of the bolus hormone is calculated individually.

Insulin therapy for type 2 diabetes should begin with the gradual addition of small doses of protein insulin to medicines that lower sugar levels. If a prolonged-release basal hormone is prescribed for the first time, 10 IU daily dosage should be used. The introduction of the drug should be carried out at the same time.

In the absence of effectiveness from the use of such a combination and the subsequent development of pathology, the endocrinologist will propose to completely change the technique to injection.

In childhood

What does insulin therapy for diabetes in children suggest?

In the treatment of pediatric patients, short and medium-acting drugs are combined. Simple mode allows you to maintain good compensation. If the patient is more than 12 years old, he may be shown intensified insulin therapy.

The dose adjustment of the drug is carried out in stages, the results are determined within a few days. Correction of morning and evening doses should not be allowed. Choosing a method of insulin therapy for diabetes in children, the doctor relies on many factors and characteristics of the child's body.

The high quality of the drugs eliminates the likelihood of serious allergic responses, the development of lipodystrophy at the injection site. Lipodystrophy is characterized by the absence of a fat layer, it is a rather serious complication, which is difficult to treat. In this case, it is forbidden to refuse the subsequent administration of insulin.

Small diabetics with high sensitivity are shown the administration of diluted analogues. To reduce the likelihood of a sharp drop in sugar during this transition allows the correct selection of the dose.

It is necessary to monitor the condition of the child, especially in the first years of life, with special care, since the baby's reaction to the use of reliable and proven drugs can be unpredictable.

It is important to choose the right insulin therapy regimen for diabetes mellitus.

Effects

Insulin therapy can cause some complications, for example:

1. Allergic manifestations at the injection site. Itching and redness of the skin can occur after improper administration of insulin, the use of blunt needles, a cold preparation, due to the introduction of the drug in the wrong area.
2. Lipodystrophy. It is characterized by the disappearance of the subcutaneous fat layer at the injection site. The result is a slight depression.
3. Lipohypertrophy. Fat seals occur at the injection site.

Another complication is the development of hypoglycemia - a decrease in sugar levels. The patient begins to experience a strong feeling of hunger, he has increased sweating, tremor develops, and his heartbeat quickens. Such a complication develops as a result of using large doses of insulin or eating a small amount of food. Also, the development of the condition can provoke increased physical activity, shocks.

Hypoglycemia is classified according to form - into severe and mild. You can eliminate mild hypoglycemia yourself, taking carbohydrates. It passes quite quickly and almost without a trace. In severe hypoglycemia, hypoglycemic coma may occur. In this case, the patient requires emergency medical attention.

With the regular occurrence of complicated hypoglycemia, there is a risk of damage to the brain structures. When a coma lasts 6 or more hours, the death of the cerebral cortex occurs.

The use of the wrong dosage causes the patient to worsen. There is a likelihood of developing renal failure, impaired blood supply to the limbs and subsequent gangrenous lesions.

The main goal of modern insulin therapy for type 1 diabetes is to maintain a carbohydrate metabolism at a level close to normal. Constantly elevated sugar leads to serious consequences: amputation of the extremities, ketoacidosis, ketonuria, diabetes mellitus, premature death.

Gestational diabetes insulin therapy

Pregnant diabetes is called gestational. He is considered prediabetes, a predisposition to intolerance to simple sugars. However, there is a risk of true type 2 diabetes. The disease can disappear after childbirth, but sometimes it develops further. To prevent it, therapy and a thorough diagnosis are prescribed.

If the blood glucose level does not decrease, insulin therapy is prescribed for gestational diabetes mellitus in order to prevent the development of fetopathy. Also, insulin is taken at normal sugar levels, but if excessive growth of the fetus, edema of its soft tissues and polyhydramnios are detected. Injections of the drug are prescribed before bedtime and on an empty stomach.

We examined the basic principles of diabetes insulin therapy.