Medical dictionary

Insulin therapy

Insulin therapy - these are comprehensive measures that compensate for violations in the body carbohydrate metabolism, such measures are the introduction of drugs insulinusually with injection.

Clinical insulin therapy is used for:

  • Treatment diabetes mellitus (most often)
  • Individual mental illness
  • In some other cases

Today, there are many insulin preparations that vary in degree of purification, duration of action, species specificity.

For the appointment of insulin therapy, the following indications may be:

  • Type 1 diabetes
  • Decompensation of type 2 diabetes
  • Lack of other treatment outcomes for type 2 diabetes
  • Weight loss for diabetes
  • Pregnancy and childbirth during diabetes
  • Diabetic Nephropathy
  • Hyperlacticemic coma
  • Diabetic hyperosmolar coma
  • Ketoacidosis

The essence of insulin therapy

The exposure time of insulin to the human body is strictly individual, therefore, there are various insulins according to the duration of exposure. The choice of this type of therapy requires taking a certain dose of insulin, checking glycemia, following a certain diet, and physical activity. The maximum compensation for carbohydrate metabolism should be achieved when choosing insulin therapy, the less fluctuations in blood glucose during the day, the lower the risk of complications.

During the selection of the dose of insulin, the patient starts a special diary, which indicates the amount of eaten bread carbohydrates, the level of physical activity, the frequency of occurrence of unforeseen conditions and, of course, the administered dose of the drug.

The essence of insulin therapy is to simulate the normal secretion of insulin, which includes:

  • Food secretion
  • Basal secretion

Basal normalizes the level of glycemia during sleep and between meals, it helps to eliminate glucose, which was received outside the meal. Hunger and physical activity can reduce basal secretion by up to two times.

The level of postprandial glycemia corresponds to the secretion of food insulin.

Insulin therapy methods

The main principle of insulin therapy is that the daily dose should be as close to physiological as possible. During the day, 70-80% of all insulin is injected, the rest - late at night. This technique allows you to simulate the real picture of production hormone.

Daily fluctuations in insulin requirements significantly affect dose selection. The physiological characteristics of each person are different, for the assimilation of one bread unit, someone needs half a unit of insulin, and someone needs 4. To determine this indicator after the main meals, glucose in the blood is measured, and knowing the amount of bread units consumed, you can determine the amount required insulin. In the event that glucose is higher than normal, it is necessary to increase the dose of insulin by several points, and so on, until the indicator returns to normal.

Knowledge of personal insulin needs is a prerequisite for effective therapy and compensation of carbohydrate metabolism. If the patient knows about his norm of the drug per 1 bread unit, he can safely administer the required amount of insulin.

Correction of insulin doses can be carried out by glycemia. Based on this method, for every 0.28 mmol / L of sugar in case of excess of 8.25 mmol / L, an additional 1 unit must be added. Thus, for each additional unit of glucose, 2-3 units of insulin are administered.

Correction by glucosuria Now it’s practically not used, since there are more accurate methods.

The most adequate method to date is glucose self-monitoring, which can be carried out using individual and stationary devices.

Types of Insulin Therapy

1. Traditional

In this case, the introduction of insulin for a long and short-term action. Such drugs are administered 1-2 times a day. With the labile course of diabetes, this is the method used.

Benefits:

  • Ease of introduction
  • Understanding the essence of treatment by patients and relatives
  • Possibility of treatment under the control of a glucosuric profile
  • There is no need for constant monitoring of glycemia (1-2 times a week)

Disadvantages:

  • Strict diet based on insulin dose
  • The need to comply with the regime of the day, the level of physical activity
  • The risk of developing atherosclerosis, arterial hypertension, hypokalemia
  • Eating 5-6 times a day strictly at the time of administration of the drug

Indications:

  • People with mental disorders
  • Elderly people
  • Undisciplined patients

Dose calculation

  • First, the average daily dose of the drug is calculated
  • Then it is distributed: 2/3 before breakfast, 1/3 before the last meal. In this case, long-acting insulin is 60-70%, short-acting - 30-40%.

2. Intensified insulin therapy

In the absence of strong psycho-emotional stress and the absence of obesity, the dose of insulin is calculated based on body weight: 0.5-1 units / kg. In this way, physiological secretion is simulated. Requirements for this type of insulin therapy: the drug should imitate basal secretion, peaks of secretion after a meal, the dose should be enough for glucose utilization.

The daily dose is divided between insulin short (introduced after meals, depending on the bread units consumed) and extended (usually introduced in the morning and evening, imitating basal secretion) actions.

Benefits

  • Imitation of insulin secretion: basal and food
  • Metabolism control, which helps prevent complications
  • High quality of life

disadvantages

  • The cost of additional funds for self-monitoring equipment and training
  • Tendency to hypoglycemia
  • Constant self-control
  • The need for proper measurement training

Introduction scheme

  • First, calculate the number of calories per day
  • Calculation of carbohydrates is made in bread units, fats and proteins - in grams
  • The daily dose of insulin distributed throughout the day is calculated.

Methods of drug administration

There are several devices that can be used to administer insulin: metering pump, syringe pen, classic insulin syringe. Using a pen syringe is the most common method of administering the drug in our country. This is due to the fact that the syringe pen is the least painful to use, it is convenient to store, and just inject insulin.

In Western Europe and the United States, a metering pump is used more often than in Russia, but even there the number of patients in the pump does not exceed five percent. This is due to difficulties in use, which often cover all the benefits. The selection of the operating mode of the device is also often a daunting task.

The main advantage of the pump is the constant administration of insulin throughout the day, imitation of natural secretion, the ability to control glycemia, the absence of the need to administer the drug on its own, and the reduction in the risk of complications.

The number of people who use this method is constantly growing, and it is considered the most promising and accurate.

Watch the video: Insulin Treatment in Patients with Type 2 Diabetes (January 2020).

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