Sugar
02.09.2018

Insulin or pills, which is better? Life on insulin: why are pills better than injections, and why is diet a must?

Experience shows that it is extremely difficult to switch a diabetic patient to insulin injections. The stumbling block is the many myths that exist around insulin therapy. Not only among patients, but also among doctors.

A word from our expert, the head of the department of program training and treatment of the Institute of Diabetes of the Federal State Budgetary Institution "Endocrinological science Center» Ministry of Health of the Russian Federation, Dr. medical sciences Alexander Mayorov.

Modern treatment, so fewer complications? The complexities of diabetes are still a huge challenge, although they have certainly changed. Today there are almost no cases of the so-called. Rapid complications of diabetes, such as hypoglycemia or coma, caused by blood sugar levels that are too high. Much fewer patients goes to the hospital because of diabetes itself. Late complications diabetes, such as diabetic foot, retinopathy, kidney disease and cardiovascular disorders have not yet been saved.

Is this how the cost of diabetes treatment decreases and increases? They are getting bigger and bigger. Also because the number of diabetic patients is increasing at an alarming rate. The battle in the field of diabetes was announced in December last year. United Nations, when it became clear that even for highly developed countries such as the United States, treating the disease and its complications had become a huge financial burden.

Myth 1: Insulin therapy is an extreme option.Tablets are more convenient to take.

In fact. Tablet medications, some of which stimulate the production of your own insulin (a hormone that lowers blood glucose levels), and others eliminate insulin resistance (the body's immunity to it), are indeed more convenient to take. But we must understand that someday the stage will come when the patient will no longer have enough insulin and the pills will not be able to reduce blood glucose levels.

Do people with diabetes in Poland have access to modern methods treatment? All modern medicines from insulin and oral antidiabetics are registered with us, although not all are fully or partially reimbursed. However, any person suffering from diabetes can benefit from it as per the recommendations of the diabetologist and the wealth of their wallet.

Do diabetologists always have to have diabetes? There is no doubt that children, adolescents and some adults with type 1 diabetes, who make up 10 percent, should be managed by a diabetologist. However, this is not always possible due to the difficult access of patients from small towns to medical specialists. Even if a patient is treated by his/her doctor every day, he/she must report to the diabetologist periodically. Only this specialist can attribute it to the study of glycated hemoglobin, which determines the level of diabetes over the last three months of therapy.

That's just nature diabetes mellitus Type 2: over time, the supply of beta cells in the pancreas, responsible for producing insulin, is depleted. Which is immediately reflected in blood glucose levels. This is evidenced by such an indicator as glycated hemoglobin (HbA1c), which reflects (but is not equal to it!) average level blood glucose for 3 months. All patients with diabetes should have it tested regularly in the laboratory. If this indicator exceeds the permissible value (up to 6.5% in people over 50 years old, up to 7% in people under 70 years old and up to 7.5% in people over 70 years old) against the background long-term treatment maximum doses of tablet drugs, there can be no two opinions: the patient must receive insulin. Ideally, this is 30-40% of patients with type 2 diabetes mellitus, usually with a history of the disease of more than 10 years, or even less, given that at first diabetes occurs secretly.

It is the result of this study that reveals the truth about whether a diabetic patient is effective or not. Is this the gold standard in the fight against diabetes? The World Health Organization said this. In addition, some patients with type 2 diabetes, especially those with complications treated with pills and insulin, should undergo periodic consultations with diabetologists. This group of people with diabetes must be constantly under the care of family doctors, because we do not have enough diabetologists to care for the almost half a million people with diabetes in Poland.

In practice, 23% of patients with type 2 diabetes mellitus in our country receive insulin therapy, many of whom switch to it 12-15 years after the onset of the disease, when their blood glucose level is already off the charts, and the glycated hemoglobin level reaches 10% and higher. Moreover, the majority of those who decide to switch to insulin already have serious (primarily vascular) complications of diabetes. Experts do not hide: despite the fact that Russia now has all modern medical technologies (including new tablet and injectable drugs, which reduce blood glucose only when necessary), compensation for carbohydrate disorders in our country does not yet reach international standards. There are many reasons. One of them is patients’ fear of insulin injections, which they will have to do for the rest of their lives.

However, your family doctor should check your glycemic hemoglobin every six months for each of your diabetic patients because there is no other reliable way to monitor your health. What's next to oral medications and insulin as the basis for treating diabetes? First of all, diet and physical exercise. This is one of the elements of education for patients that our Association faces. When that's not enough, you need to enable tablets. At some stage, diabetic patients with diabetes turn to insulin.

Myth 2: Insulin therapy is a lifelong commitment to injections.

In fact. You can stop taking insulin at any time. And... again return to the previous high blood glucose levels, risking life-threatening complications. Meanwhile, with properly selected insulin therapy, the life of patients with diabetes mellitus is practically no different from life healthy person.

And this - in most cases - is the normal course of things. Patients receiving insulin are more aware of the complications that threaten them. They know that there are people and analogues. They know that the analogues are most similar to the insulin produced in the human body. In the past, insulin has been used to save the lives of diabetics, and today it is designed to mimic the natural rhythm of its secretion to protect a person from the complications of diabetes. And it is the therapy of analogues of short and long acting imitates the rate of insulin secretion by the pancreas, so it is best to prevent sugar spikes and hypoglycemia, which are the main causes of complications.

And modern reusable dosing devices for administering insulin with the thinnest needles make it possible to minimize the inconvenience caused by the need for constant injections.

At the same time, insulin therapy is prescribed not only to those whose own insulin reserves are almost exhausted. The reasons for its temporary appointment may be:

What are the barriers associated with switching from insulin to insulin? The problem that needs to be addressed is patient resistance to switching from insulin to pills. This is mainly due to the fear of doing the same injection yourself. Meanwhile, modern pens and very thin needles give insulin almost painlessly. On the other hand, switching to insulin too late has a negative impact on the patient's health, leading to difficult treatment, often irreversible complications.

How many people have diabetes in Poland?

Jacek Sieradski, President of the Polish Diabetes Association - treatment of diabetic complications costs the state budget up to eight times more than even the most modern one. And no one considers the cost of suffering patients. There will always be insulin in diabetes therapy open topic. Waldemar Karnafel, Head of the Department and Department of Gastroenterology and Mood Disorders, Medical University of Warsaw Medical University in Central clinical hospital in Warsaw. In Poland there are 2 million 200 thousand.

  • pneumonia, severe flu and other serious somatic diseases that occur in a patient with diabetes;
  • contraindications for prescribing tablet drugs (for example, if a person has drug allergy or the kidneys or liver are not in order);
  • the desire of a patient with type 2 diabetes to lead a more free lifestyle or the inability to follow a diet due to an irregular work schedule, etc.

Myth 3: It is not necessary to follow a diet during insulin therapy.

In fact. Taking insulin does not mean giving up balanced diet aimed at reducing the sugar-increasing effect of consumed products, and when overweight body - from the principles of low-calorie nutrition, which we wrote about in previous issues of AiF. Health" (see Nos. 21 and 22).

Diabetics. About 600 thousand. Insulin is obtained from them. Of this, almost 300 thousand. Take the same insulin, the remaining 300 thousand. Receives insulin in combination with oral antidiabetic medications. This is especially true for patients with type 1 diabetes who are treated with insulin alone.

For example, checking sugar levels in patients with strips. Stripes are necessary, checking your sugar levels affects the prognosis. Patients who are treated with tablets only require fewer of these strips because the glucose test does not affect the glucose prediction. If this is the case, therapy should correct it.

By the way, the diet must also be followed because, after switching to insulin and improving blood glucose levels, many patients begin to gain a little weight. But, if the patient strictly follows the doctor’s instructions and adheres to balanced nutrition, his weight will remain stable. And insulin doses will not increase.

Myth 4: Insulin can make a diabetic person's condition worse.

In fact. Some patients with type 2 diabetes mellitus come to this conclusion by mistakenly associating the complications of the disease that coincided with the prescription of insulin therapy. Like, a neighbor in the country started taking insulin and... went blind.

Last year, a meta-analysis was conducted that confirmed these principles. Screening for type 2 diabetes is primarily educational. The patient eats food and does not know how his body reacts. Thus, it checks your sugar levels before and after meals. Some things need to be tested to know in the future that, such as drinking milk or drinking white cheese increases sugar levels.

Why are there so many types of insulin?

It's like a T-shirt: it adheres to the body or not. And everyone with diabetes is a little different too. 25 percent. For example, patients with diabetes are subject to variability. When was it used? intensive therapy insulin, there were fewer microvascular complications, but each of the four patients had the same dose of insulin, the same physical dose, which did not produce the same results. The glucose level “jumped” and fell. This is the so-called. Glycemic variability.

In fact, it is not insulin therapy that leads to such a development of events in a person, but a long existence under high level blood glucose, in fact, in conditions of insulin deficiency, not compensated by treatment.

International medical practice says the opposite: the quality and life expectancy of patients with type 2 diabetes mellitus who take adequate treatment (including insulin) before they develop vascular complications are today often even higher than those of their relatively healthy peers.

This is very dangerous for the patient. In biology, as in ordinary life, there is nothing free. If we are well adapted to diabetes, we have fewer microvascular complications, namely retinopathy, nephropathy, neuropathy. But we pay the bill for it. This is due to this change. And that's why this variety of insulin is necessary. The production of insulin with different action profiles leads to the fact that they mimic the early release of insulin in response to gastric irritation or its primary secretion between meals, or a combination of these two mechanisms.

A decrease in glycated hemoglobin by every 1% reduces the risk of developing complications of type 2 diabetes mellitus, such as: amputation or death from peripheral artery disease - by 43%; microvascular complications (damage to the eyes, kidneys) – by 37%; myocardial infarction – by 14%.

There is always a certain amount of glucose in the blood of every person. Deviation from the sugar norm in any direction can have serious consequences. An indicator less than the minimum indicates that the body is poisoned, and more than the maximum indicates that there is a threat of diabetes mellitus.

Animal, human and analog insulin are used. Initially, insulin was obtained by extracting the pancreas of an animal. Animal insulins were slightly different from the human form, but maintained similar activity in glycemic control. Unfortunately, they produced more allergies and insulin reactions.

Insulin is available on the Polish market short acting, intermediate acting and insulin ready mixture. Insulin analogues are modified by methods genetic engineering insulin. Compared to human insulin, they have an altered absorption profile and duration of action. These insulins are chemically derived and their action is closer to our physiology. There are short-acting and long-acting analogues.

Everyone knows that it is necessary to maintain a sufficient amount of glucose in the blood. Every person, when he has already reached adulthood or has a hereditary predisposition, must undergo regular tests. It is better to know in advance at what level of sugar insulin is prescribed, so that you can understand your own tests without explanation from doctors.

They are also ready-made, factory-prepared, short- and intermediate-acting insulins or rapid-acting insulin analogues. The insulin formula is reserved for virtually any person with type 2 diabetes who requires insulin treatment.

In a healthy person, insulin moves from the pancreas to the liver, where some of it is destroyed and the rest is distributed further: the overall mechanism seems to be the most. We insist that insulin does not pass through the liver because it is administered subcutaneously. And one patient’s body will react one way, and another will react differently. If we have diabetes first, the patient will have fewer complications.

Many people try in every possible way to postpone the day when they will have to sit tightly on the needle. Indeed, in case of diabetes mellitus, insulin is simply necessary and in fact it is good that it is possible to support the body in this way.

Sooner or later, all patients with type 2 diabetes are faced with a situation where insulin is prescribed. This helps not only to prolong life, but also to avoid dire consequences and symptoms of this disease. Diagnosis certain type must be confirmed in order to prescribe such serious medicine, otherwise it will only play a negative role.

Analogues, especially short-acting ones, are very similar to our physiology. Consequently, patients are generally not hypoglycemic. In patients with these variations, they are generally ideal. Except that when compensating for diabetes, you need to remember the brain. For example, hypoglycemia has been observed in young people with good balanced diabetes at night time. And nocturnal hypoglycemia is especially dangerous. The body loses its warning response, such as sweating, and the patient immediately loses consciousness - it is very dangerous during sleep.

What are the benefits for patients using analog insulin?

Long-acting analogues are administered to patients with type 2 diabetes when they are hypoglycemic. For patients, this is first and foremost the comfort of life. The patient, who had once suffered from hypoglycemia, panicked him. The long-acting insulin analog protects against this danger to a significant extent. Short-acting analogues are very good for glycemic control. In addition, insulin analogues are convenient to use: they are administered before meals. You can easily modify the dose. At any time, with unexpected extra food, you can introduce 1-2 units of the fast-acting analogue.

Features of insulin in the body

Initially, everything in the body is thought out in detail. The pancreas works, in which there are special beta cells. They are responsible for the production of insulin. In turn, it compensates for diabetes.

Doctors do not immediately diagnose insulin diabetes; they first try to restore health in other ways. Various medications, lifestyle changes, patients are sure to adhere very strict diet. If there is no proper result or these methods stop working over time, then insulin is necessary for diabetics. The pancreas is depleted natural ways every year and it is necessary to check the indicators in order to know exactly when to switch to insulin.

When returning to the usual amount of food per day, the analogue in the blood quickly drops to the basal level. This is an increase in the goal, not insulin. The case began in California, where the drug was launched. At first, it was euphoria, but then it was noticed that patients with pancreatitis were more likely to have pancreatic cancer. Enlarged samples are still being researched and analyzed. In Lisbon there was a debate between proponents and opponents of accretion.

He observed the effects of these drugs and found that patients had too much pancreatitis. Nutz, one of the creators of incretin, began the discussion. We can say that it was a draw. It's not entirely clear how these drugs work, and you need to be very careful. When we use a patient, we must be sure that he is healthy.

Why do people start taking insulin?

A healthy pancreas functions steadily and can produce sufficient amounts of insulin. However, over time it becomes too little. There are several reasons for this:

  • too much great content Sahara. Here we are talking about a significant increase of more than 9 mmol/l;
  • errors in treatment, these may be non-standard forms;
  • too much a large number of medications taken.

An increased amount of glucose in the blood is forced to ask the question of what is injected for diabetes mellitus; a certain type of diagnosis requires injections. Naturally, this is insulin, which is not enough in the form of a substance produced by the pancreas, but the dosage of the medicine and the frequency of administration are determined by the doctor.



First of all, you should pay attention to. Already the indicator is more than 6 mmol/l in the blood, indicating that it is necessary to change the diet. In the same case, if the indicator reaches nine, you should pay attention to toxicity. This amount of glucose practically kills pancreatic beta cells in type 2 diabetes. This condition The body even has the term glucotoxicity. It is worth noting that this is not yet an indication for prompt prescription of insulin; in most cases, doctors first try a variety of conservative methods. Often diets and varied modern drugs They are very helpful in solving this problem. How long the insulin intake will be delayed depends only on the strict adherence to the rules by the patient himself and the wisdom of each doctor in particular.

Sometimes it is only necessary to prescribe medications temporarily to restore natural insulin production, but in other cases they are needed for life.

Taking insulin

In the event that there is practically no other way out, you should definitely agree to the doctor’s prescription. In no case should you refuse injections out of fear, because without them the body simply continues to deteriorate at a tremendous speed with a diagnosis of this type. Often, after prescribing insulin, patients manage to get off the injections and go back to the pills; this happens if they succeed in getting beta cells to work in the blood and they have not completely died.

It is very important to follow the dosage and number of injections as clearly as possible; this may be a minimum amount of the drug only 1-2 times a day. Modern instruments allow you to make very quickly sterile and painless injections of this type. These are not even ordinary syringes with a minimal needle, but even special pens. Often it is enough to just fill it up and simply put it in place and press the button so that the medicine ends up in the blood.

It is worth paying attention to the places where you should inject medications. These are the arms, legs, buttocks, and also the abdomen, excluding the area around the navel. There are many places where it is quite convenient to give injections yourself in any conditions. This is important for patients who cannot afford regular nursing care or want to be as independent as possible.


When insulin is prescribed very often, almost everyone, sooner or later, will have to hear the terrible phrase from the doctor that now the treatment will consist of injections with this drug. Each patient by this time had already read a lot scary stories, and maybe he’s seen enough of amputated limbs. Very often this is associated with insulin in the blood.

In fact, you need to remember at what level of blood sugar insulin is prescribed; usually this is already a serious stage, when the pancreatic cells are poisoned and they stop working altogether. It is with their help that glucose reaches internal organs and provides energy. Without this protein, the body simply cannot exist, so if beta cells are no longer present, you just need to inject it, there is no other way out and you should not try to avoid this treatment. Toxicity is ensured precisely by the sugar level, and not by insulin; moreover, even a heart attack or stroke is possible and early death. If all the doctor’s advice is correctly followed and treatment is rational, the patient can live a long time and with many positive emotions.

Importance of dosage

When treating diabetes with insulin, patients often suffer from a variety of consequences. However, these factors appear precisely because of the sugar, and not because of the drug itself. Most often, people simply deliberately reduce the dosage prescribed by the doctor, which means they continue to maintain sugar at a high level. There's no need to be afraid professional doctor will never prescribe too much medicine to bring reduced level Sahara.

Serious problems can arise as a result of refusing insulin or violating the dosage:

  • ulcers on the feet, which later even lead to amputation, tissue necrosis occurs, death is accompanied by severe pain;
  • blindness, sugar acts as a toxic substance on the eyes;
  • poor kidney function or even kidney failure;
  • heart attacks and strokes.

All these are irreversible processes. It is imperative to start taking insulin in a timely manner, as well as to correctly observe the number of injections and its dosage.

The high level of sugar that is constantly maintained in the blood leads to serious destruction in the body and the worst thing is that they are not reversible, necrosis, blindness, etc. cannot be cured, but correct dosage you can only stop the process.

Consequences of insulin

There are a huge number of myths around insulin. Most of them are lies and exaggeration. Indeed, everyday injections cause fear, and his eyes are big. However, there is one true fact. This is primarily because insulin leads to obesity. Indeed, this protein sedentary life leads to weight gain, but this can and even must be fought.

Even with such a disease, it is imperative to maintain active image life. IN in this case movement is an excellent prevention of obesity, and can also help reawaken the love of life and distract from worries about your diagnosis.

You also need to remember that insulin does not exempt you from dieting. Even if sugar has returned to normal, you must remember that the tendency to this disease eat and you can’t relax and allow anything to be added to your diet.
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