Insulin for diabetes mellitus: when is it prescribed, dosage calculation, how to inject? When to prescribe insulin for diabetes mellitus sugar levels for prescribing injections Type 2 diabetes mellitus treatment with insulin

Insulin is a hormone produced by the pancreas. It is responsible for regulating blood sugar levels. When insulin enters the body, oxidative processes are launched: glucose is broken down into glycogen, proteins and fats. If an insufficient amount of this hormone enters the blood, a disease called diabetes mellitus develops.

In the second type of diabetes, the patient needs to compensate for the constant lack of hormone with injections. When used correctly, insulin brings only benefits, but it is necessary to carefully select its dose and frequency of use.

Why do diabetics need insulin?

Insulin is a hormone designed to regulate blood glucose levels. If for some reason it becomes low, diabetes mellitus forms. In the second form of this disease, it is not possible to compensate for the deficiency with pills or proper nutrition alone. In this case, insulin injections are prescribed.

It is designed to restore the normal functioning of the regulatory system, which the damaged pancreas can no longer provide. Under the influence of negative factors, this organ begins to thin out and can no longer produce enough hormones. In this case, the patient is diagnosed with type 2 diabetes. This deviation can be caused by:

• Unusual course of diabetes mellitus;
• Extremely high glucose level – above 9 mmol/l;
• Taking sulfonylurea drugs in large quantities.

Indications for taking insulin

Disruption of the pancreas is the main reason why people are forced to take insulin injections. This endocrine organ is very important for ensuring normal metabolic processes in the body. If it stops functioning or does so partially, failures occur in other organs and systems.

The beta cells that line the pancreas are designed to produce natural insulin. Under the influence of age or other diseases, they are destroyed and die - they can no longer produce insulin. Experts note that people with type 1 diabetes also need such therapy after 7-10 years.

The main reasons for prescribing insulin are as follows:

• Hyperglycemia, in which the blood sugar level rises above 9 mmol/l;
• Depletion or diseases of the pancreas;
• Pregnancy in a woman suffering from diabetes;
• Forced drug therapy with drugs that contain sulfonylurea;
• Exacerbation of chronic diseases affecting the pancreas.

Insulin therapy is prescribed to people who are rapidly losing weight.

This hormone also helps to more painlessly endure inflammatory processes in the body of any nature. Insulin injections are prescribed to people with neuropathy, which is accompanied by severe pain, as well as atherosclerosis. To maintain normal functioning of the body, insulin therapy is indicated for pregnant and lactating women.

Due to their own ignorance, many patients try not to start insulin therapy for as long as possible. They believe that this is a point of no return, which indicates a serious pathology. In reality, there is nothing wrong with such injections. Insulin is a substance that will help your body function fully and help you forget about your chronic disease. With the help of regular injections, you will be able to forget about the negative manifestations of type 2 diabetes.

Types of insulin

Modern drug manufacturers put on the market a huge number of drugs based on insulin. This hormone is intended exclusively for maintenance therapy for diabetes mellitus. Once in the blood, it binds glucose and removes it from the body.

Today, insulin comes in the following types:

• Ultra-short action - acts almost instantly;
• Short-acting – characterized by a slower and smoother effect;
• Medium duration - begin to act 1-2 hours after administration;
• Long-acting is the most common type, which ensures normal functioning of the body for 6-8 hours.

The first insulin was developed by humans in 1978. It was then that English scientists forced E. coli to produce this hormone. Mass production of ampoules with the drug began only in 1982 in the USA. Until this time, people with type 2 diabetes were forced to inject themselves with pork insulin. This therapy constantly caused side effects in the form of serious allergic reactions. Today, all insulin is of synthetic origin, so the medicine does not cause any side effects.

Drawing up an insulin therapy regimen

Before consulting a doctor to draw up an insulin therapy regimen, it is necessary to conduct a dynamic study of blood sugar levels.

To do this, you need to donate blood for glucose every day for a week.

After you receive the results of the study, you can go to a specialist. To get the most accurate results, start leading a normal and healthy lifestyle several weeks before taking your blood.

If, while following a diet, the pancreas still requires an additional dose of insulin, it will not be possible to avoid therapy. Doctors, in order to formulate correct and effective insulin therapy, answer the following questions:

1. Do you need insulin injections at night?
2. If necessary, the dosage is calculated, after which the daily dose is adjusted.
3. Do I need long-acting insulin injections in the morning?
   To do this, the patient is admitted to a hospital and undergoes an examination. He is not given breakfast and lunch; the body's reaction is being studied. After this, long-acting insulin is administered in the morning for several days, and the dose is adjusted if necessary.
4. Do you need insulin injections before meals? If yes, then which ones are needed and which ones are not.
5. The starting dosage of short-acting insulin before meals is calculated.
6. An experiment is being conducted to determine how long before a meal you need to inject insulin.
7. The patient is taught to administer insulin to himself.

It is very important that the development of insulin therapy is carried out by a qualified attending physician.

Remember that long-acting and short-acting insulin are two different drugs that are taken independently of each other.

The exact dosage and time of administration are calculated for each patient individually. Some of them only need injections at night or in the morning, while others require constant maintenance therapy.

Constant insulin therapy

Type 2 diabetes mellitus is a chronic, progressive disease in which the ability of the beta cells of the pancreas to produce insulin gradually decreases. It requires constant administration of a synthetic drug to maintain normal blood glucose levels. Take it into account. That the dose of the active substance must be constantly adjusted - usually increased. Over time, you will reach the maximum dose of the pills. Many doctors do not like this dosage form as it constantly causes serious complications in the body.

When the dose of insulin is higher than that of tablets, the doctor will finally switch you to injections. Keep in mind that this is ongoing therapy that you will receive for the rest of your life. The dosage of the drug will also change, as the body quickly gets used to the changes.

The only exception is when a person constantly adheres to a special diet.

In this case, the same dose of insulin will be effective for him for several years.

This phenomenon usually occurs in those people whose diabetes was diagnosed early enough. They must also maintain normal pancreatic activity, especially the production of beta cells. If a diabetic was able to bring his weight back to normal, he eats right, exercises, and does everything possible to restore the body, he can get by with minimal doses of insulin. Eat right and lead a healthy lifestyle, then you won’t have to constantly increase your insulin dose.

High doses of sulfonylureas

To restore the activity of the pancreas and islets with beta cells, drugs based on sulfonylurea are prescribed. This compound provokes this endocrine organ to produce insulin, which keeps blood glucose levels at an optimal level. This helps maintain all processes in the body in a normal state. The following medications are usually prescribed for this purpose:

• Diabetes;

All these drugs have a powerful stimulating effect on the pancreas. It is very important to follow the dosage prescribed by your doctor, as taking too much sulfonylurea can damage the pancreas. If insulin therapy is carried out without this medicine, pancreatic function will be completely suppressed in just a few years. It will retain its functionality for as long as possible, so you will not have to increase your insulin dose.

Medicines intended to support the body with type 2 diabetes mellitus help restore the pancreas, as well as protect it from the pathogenic influence of external and internal factors.

It is very important to take medications only in those therapeutic doses prescribed by your doctor.

Also, to achieve the best effect, you must follow a special diet. With its help, it will be possible to reduce the amount of sugar in the blood, as well as achieve an optimal balance of proteins, fats and carbohydrates in the body.

Therapeutic effect of insulin

Insulin is an important part of the life of people with type 2 diabetes. Without this hormone, they will begin to experience serious discomfort, which will lead to hyperglycemia and more serious consequences. Doctors have long established that proper insulin therapy helps relieve a patient from the negative manifestations of diabetes mellitus, as well as significantly prolong his life. With the help of this hormone, it is possible to bring the concentration of glucose hemoglobin and sugar to the proper level: on an empty stomach and after meals.

Insulin for diabetics is the only remedy that will help them feel good and forget about their illness. Properly selected therapy can stop the development of the disease and also prevent the development of serious complications. Insulin in the right doses is not capable of harming the body, but an overdose can cause hypoglycemia and hypoglycemic coma, which requires urgent medical attention. Therapy with this hormone causes the following therapeutic effect:

1. Reducing blood sugar levels after meals and on an empty stomach, getting rid of hyperglycemia.
2. Increased production of hormones in the pancreas in response to food intake.
3. Decreased metabolic pathway, or gluconeogenesis. Thanks to this, sugar is removed faster from non-carbohydrate components.
4. Decreased lipolysis after meals.
5. Reduction of glycated proteins in the body.

Complete insulin therapy has a beneficial effect on metabolic processes in the body: lipid, carbohydrate, protein. Also, taking insulin helps activate the suppression and storage of sugar, amino acids and lipids.

Type 2 diabetes mellitus is commonly called non-insulin dependent. But today it has been established that almost all patients suffering from this type of diabetes require the use of insulin at a certain stage of the disease. In the treatment of type 2 diabetes, the main thing is not to miss the moment and prescribe insulin in a timely manner.

Worldwide, the leading treatment for diabetes is insulin therapy. It helps to significantly improve the well-being of diabetics, delay the onset of complications and prolong life.

• temporarily - to prepare the patient for surgery or in the event of severe infectious diseases;
• constantly – if glucose-lowering drugs in tablets are ineffective.

The duration of the period from the first symptoms of type 2 diabetes to the need for constant insulin administration directly depends on 2 factors. Namely, from a decrease in the performance of beta cells and increased insulin resistance. The constant state significantly reduces the duration of this period.

In other words, the worse a person controls type 2 diabetes (sticks to a diet and takes glucose-lowering medications), the faster insulin will be prescribed.

For diabetics, there are a number of factors that increase insulin resistance: concomitant diseases, use of drugs with negative metabolic effects, weight gain, low physical activity, frequent worries and worries. Together with lipo- and glucotoxicity, they accelerate the decline in beta cell performance in patients with type 2 diabetes.

Indications for insulin therapy

With an increasing decrease in the secretion of beta cells and the ineffectiveness of tableted hypoglycemic drugs, insulin is recommended in monotherapy or in combination with tableted glucose-lowering drugs.

Absolute indications for prescribing insulin:

• signs of insulin deficiency (eg, weight loss, symptoms of decompensated type 2 diabetes);
• the presence of ketoacidosis and (or) ketosis;
• any acute complications of type 2 diabetes mellitus;
• exacerbations of chronic diseases, acute macrovascular pathologies (stroke, gangrene, heart attack), the need for surgical treatment, severe infections;
• newly diagnosed type 2 diabetes, which is accompanied by high sugar during the day and on an empty stomach, not taking into account body weight, age, or the expected duration of the disease;
• newly diagnosed type 2 diabetes mellitus in the presence of allergies and other contraindications to the use of sugar tablets. Contraindications: hemorrhagic diseases, pathology of kidney and liver functions;
• pregnancy and lactation;
• severe impairment of the kidneys and liver;
• lack of favorable sugar control during treatment with maximum doses of tableted hypoglycemic drugs in acceptable combinations and doses along with sufficient physical activity;
• precoma, coma.

Insulin therapy is prescribed for patients with type 2 diabetes mellitus with the following laboratory parameters:

• fasting blood sugar level above 15 mmol/l in patients with suspected diabetes;
• plasma concentration of C-peptide below 0.2 nmol/l after an intravenous test with 1.0 mg of glucagon;
• despite the use of maximum daily doses of tableted drugs for sugar, the fasting blood glucose level is above 8.0 mmol/l, after meals is above 10.0 mmol/l;
• the level of glycosylated hemoglobin is constantly above 7%.

The main advantage of insulin in the treatment of type 2 diabetes is its effect on all parts of the pathogenesis of this disease. First of all, this helps to compensate for the lack of endogenous production of the hormone insulin, which is observed with a progressive decrease in the functioning of beta cells.

Mechanisms of action and effects of insulin

Insulin therapy is carried out to eliminate glucose toxicity and correct the producing function of beta cells with average levels of hyperglycemia. Initially, dysfunction of the beta cells located in the pancreas and producing insulin is reversible. Endogenous insulin production is restored when sugar levels decrease to normal levels.

Early administration of insulin to type 2 diabetics is one of the treatment options for insufficient glycemic control at the stage of diet and exercise therapy, bypassing the stage of tablet drugs.

This option is preferable for diabetics who prefer insulin therapy rather than the use of glucose-lowering drugs. And also in patients with underweight and suspected latent autoimmune diabetes in adults.

Successful reduction of liver glucose production in type 2 diabetes mellitus requires suppression of 2 mechanisms: glycogenolysis and gluconeogenesis. Insulin administration can reduce hepatic glycogenolysis and gluconeogenesis, as well as increase the sensitivity of peripheral tissues to insulin. As a result, it becomes possible to effectively “fix” all the main mechanisms of the pathogenesis of type 2 diabetes.

Positive results of insulin therapy for diabetes mellitus

There are also positive aspects of taking insulin, namely:

• reducing sugar levels on an empty stomach and after meals;
• increased production of pancreatic insulin in response to glucose stimulation or food intake;
• decreased gluconeogenesis;
• liver glucose production;
• inhibition of glucagon secretion after eating;
• changes in lipoprotein and lipid profiles;
• suppression of lipolysis after eating;
• improvement of anaerobic and aerobic glycolysis;
• reduction of glycation of lipoproteins and proteins.

Treatment of diabetics is primarily aimed at achieving and long-term maintenance of target concentrations of glycosylated hemoglobin, fasting and postprandial blood sugar. The result of this will be a reduction in the possibility of development and progression of complications.

The introduction of insulin from outside has a positive effect on carbohydrate, protein and fat metabolism. This hormone activates the deposition and suppresses the breakdown of glucose, fats and amino acids. It reduces sugar levels by increasing its transport into the middle of the cell through the cell membrane of adipocytes and myocytes, as well as by inhibiting the production of glucose by the liver (glycogenolysis and gluconeogenesis).

In addition, insulin activates lipogenesis and suppresses the use of free fatty acids in energy metabolism. It inhibits proteolysis in muscles and stimulates protein production.

Insulin dose calculation

The dose of the drug is selected strictly individually. It is based on the diabetic’s weight, clinical picture and daily glucose profile. The need for this hormone depends on the degree of insulin resistance and the secretory capacity of beta cells, reduced due to glucose toxicity.

Patients with type 2 diabetes with concomitant obesity require a higher dose of insulin than others to achieve control. The number of injections and the dose of insulin per day depend on the blood sugar level, the general condition of the diabetic and the diet.

Bolus insulin therapy is most often recommended. This is when human insulin analogue (or short-acting insulin) is injected several times a day. It is possible to combine short- and intermediate-acting insulin (2 times a day or before bedtime) or a long-acting insulin analogue (used before bedtime).

The most commonly prescribed insulin therapy is bolus insulin, in which short-acting insulin (or human insulin analogue) is used several times a day. A complex of short- and intermediate-acting insulin (before bedtime or 2 times a day) or a long-acting insulin analogue (before bedtime) is possible.

Insulin administration

The insulin solution is injected subcutaneously. The injection site must first be massaged well. The injection sites must be alternated every day.

The injection is performed by the patient himself; for this purpose, a special spitz with a thin needle or a syringe pen is used. If possible, preference should be given to a syringe pen.

Pros of using a syringe pen:

• it has a very thin needle, the use of which makes the insulin injection almost painless;
• compactness – the device is convenient and easy to carry;
• insulin in a syringe pen is not destroyed, it is protected from the effects of temperature and other environmental factors;
• The device allows you to individually prepare and use mixtures of insulin preparations.

No more than 30 minutes should pass between administering insulin and eating. No more than 30 units are allowed to be administered at a time.

Types of treatment: monotherapy and combination therapy

For the treatment of type 2 diabetes, there are 2 types of therapy: monotherapy with insulin and combined with glucose-lowering drugs in tablets. The choice can only be made by a doctor, based on his knowledge and experience, as well as on the characteristics of the patient’s general condition, the presence of concomitant diseases and drug treatment.

When monotherapy with glucose-lowering tablets does not lead to adequate control of blood sugar levels, combination therapy with insulin and tablet drugs is prescribed. As a rule, they are combined as follows: insulin with sulfonylureas, insulin with meglitinides, insulin with biguanides, insulin with thiazolidinediones.

The advantages of combined regimens include increased sensitivity of peripheral tissues to insulin, rapid elimination of glucotoxicity, and increased endogenous insulin production.

Insulin monotherapy for type 2 diabetics using a traditional or intensified regimen. Significant progress in endocrinology is associated with a huge selection of insulins, which makes it possible to satisfy all the patient’s needs. For the treatment of type 2 diabetes, any insulin administration regimen that can successfully control blood sugar levels and protect against unwanted hypoglycemia is acceptable.

Insulin administration regimens

The choice of insulin administration regimen depends on the patient’s age, concomitant diseases, mood for treatment, social status and financial capabilities.

The traditional regimen implies a strict diet for a diabetic, as well as the same food every day according to the time of intake and the amount of carbohydrates. The administration of insulin injections is fixed in time and dose.

With this regimen, the patient may not often measure his blood sugar. The disadvantage of this scheme is that there is no flexible adaptation of the amount of insulin to changing blood sugar levels. The patient is tied to a diet and injection schedule, which prevents him from leading a full lifestyle.

The traditional insulin therapy regimen is used in the following categories:

• elderly diabetics;
• patients who cannot independently use a glucometer and control their sugar;
• diabetics suffering from mental illness;
• patients requiring constant outside care.

An intensified scheme is aimed, through injections, at imitating normal natural insulin production. There are many benefits of using this regimen for a diabetic, but it is a little more difficult to apply.

Principles of intensified insulin administration:

• basal-bolus method of insulin therapy;
• a non-strict diet, adapting each dose of insulin to a specific food and the amount of carbohydrates eaten;
• the need to measure blood sugar levels several times a day.

Complications of insulin therapy

Sometimes complications occur during the treatment of type 2 diabetes:

• allergic reactions;
• hypoglycemic conditions;
• post-insulin lipodystrophies.

Complications develop, as a rule, due to non-compliance with the rules for administering insulin.

The main goal of treating type 2 diabetes is to maintain normal blood glucose levels, delay complications, and increase life expectancy.

All this can be achieved with timely prescribed insulin therapy. Modern drugs have proven their effectiveness and safety when prescribed even for severe forms of diabetes.

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 sugar content. Here we are talking about a significant increase of more than 9 mmol;
• errors in treatment, these may be non-standard forms;
• too many 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.

Insulin is prescribed in the absence of compensation for diabetes mellitus. That is, if it is impossible to achieve target blood sugar levels with the help of pills, proper nutrition and lifestyle changes.

Most often, the prescription of insulin is associated not so much with violation of doctors’ recommendations, but with depletion of the pancreas. It's all about her reserves. What does this mean?

The pancreas contains beta cells that produce insulin.

Under the influence of various factors, the number of these cells decreases every year - the pancreas is depleted. On average, pancreatic depletion occurs 8 years after the diagnosis of type 2 diabetes mellitus.

Factors contributing to pancreatic depletion:

• High blood sugar (more than 9 mmol);
• High doses of sulfonylureas;
• Non-standard forms of diabetes.

Diabetes is a condition in which the pancreas is unable to secrete enough insulin to help you maintain normal blood glucose (or blood sugar) levels, which is transported to various parts of our body to provide energy.

The causes of insulin deficiency vary, but the most common is type 2 diabetes. The main risk factors in this case are family history, weight and age.

In fact, most overweight or obese people in the Western world do not have to worry about developing diabetes. Although weight is very important, it is not the main risk factor for its development. The foods you eat are usually more important than your weight itself. For example, you should limit the amount of sugary drinks you consume, including sodas, fruit juices, and even sweet tea.

Mechanisms of action and effects of insulin

Insulin therapy is carried out to eliminate glucose toxicity and correct the producing function of beta cells with average levels of hyperglycemia. Initially, dysfunction of the beta cells located in the pancreas and producing insulin is reversible. Endogenous insulin production is restored when sugar levels decrease to normal levels.

Early administration of insulin to type 2 diabetics is one of the treatment options for insufficient glycemic control at the stage of diet and exercise therapy, bypassing the stage of tablet drugs.

This option is preferable for diabetics who prefer insulin therapy rather than the use of glucose-lowering drugs. And also in patients with underweight and suspected latent autoimmune diabetes in adults.

Successful reduction of liver glucose production in type 2 diabetes mellitus requires suppression of 2 mechanisms: glycogenolysis and gluconeogenesis. Insulin administration can reduce hepatic glycogenolysis and gluconeogenesis, as well as increase the sensitivity of peripheral tissues to insulin. As a result, it becomes possible to effectively “fix” all the main mechanisms of the pathogenesis of type 2 diabetes.

Positive results of insulin therapy for diabetes mellitus

There are also positive aspects of taking insulin, namely:

• reducing sugar levels on an empty stomach and after meals;
• increased production of pancreatic insulin in response to glucose stimulation or food intake;
• decreased gluconeogenesis;
• liver glucose production;
• inhibition of glucagon secretion after eating;
• changes in lipoprotein and lipid profiles;
• suppression of lipolysis after eating;
• improvement of anaerobic and aerobic glycolysis;
• reduction of glycation of lipoproteins and proteins.

Treatment of diabetics is primarily aimed at achieving and long-term maintenance of target concentrations of glycosylated hemoglobin, fasting and postprandial blood sugar. The result of this will be a reduction in the possibility of development and progression of complications.

The introduction of insulin from outside has a positive effect on carbohydrate, protein and fat metabolism. This hormone activates the deposition and suppresses the breakdown of glucose, fats and amino acids. It reduces sugar levels by increasing its transport into the middle of the cell through the cell membrane of adipocytes and myocytes, as well as by inhibiting the production of glucose by the liver (glycogenolysis and gluconeogenesis).

In addition, insulin activates lipogenesis and suppresses the use of free fatty acids in energy metabolism. It inhibits proteolysis in muscles and stimulates protein production.

Reasons for treatment with hormonal injections

Heredity; - age (the older a person is, the greater the likelihood of getting sick); - obesity; - nervous strain; - diseases that destroy beta cells of the pancreas that produce insulin: pancreatic cancer, pancreatitis, etc.; - viral infections: hepatitis, chicken pox, rubella, influenza, etc.

If you think about it, at first it’s not clear why diabetics should be given hormonal injections. The amount of this hormone in the body of a sick person generally corresponds to the norm, and often it is significantly exceeded.

But the matter is more complicated - when a person has a “sweet” disease, the immune system attacks the beta cells of the human body, and the pancreas, which is responsible for insulin production, suffers. Such complications occur not only in type 2 diabetics, but also in type 1 diabetics.

As a result, a large number of beta cells die, which significantly weakens the human body.

If we talk about the causes of pathology, obesity is often to blame when a person eats poorly, moves little and his lifestyle can hardly be called healthy. It is known that a large number of elderly and middle-aged people suffer from excess weight, but the “sweet” disease does not affect everyone.

So why is it that sometimes a person is affected by pathology and sometimes not? It is largely a matter of genetic predisposition; autoimmune attacks can be so severe that only insulin injections can help.

Types of insulin

Currently, insulins are distinguished by the time of their action. This refers to how long it will take for the drug to lower blood sugar levels. Before prescribing treatment, it is imperative to individually select the dosage of the drug.

Due to the fact that diabetes mellitus has many different etiologies, symptoms, complications, and, of course, types of treatment, experts have created a fairly comprehensive formula for classifying this disease. Let's consider the types, types and degrees of diabetes.

I. Diabetes mellitus type 1 (insulin-dependent diabetes, juvenile diabetes).

Most often, this type of diabetes is observed in young people, often thin. It's going hard.

The reason lies in antibodies produced by the body itself, which block the β-cells that produce insulin in the pancreas. Treatment is based on constant intake of insulin, through injections, as well as strict adherence to a diet.

It is necessary to completely exclude the use of easily digestible carbohydrates (sugar, sugar-containing lemonades, sweets, fruit juices) from the menu.

The normal concentration of glucose in the blood of a healthy person is no less than 3.6 and no more than 6.1 mmol per liter during sleep and hunger (fasting), and no more than 7.0 mmol per liter after eating. In pregnant women, maximum levels can increase by 50-100% - this is called gestational diabetes. After childbirth, glucose levels usually normalize on their own.

In patients with mild forms of the disease, glucose levels during sleep and fasting are usually 10-30% higher than in healthy people. After eating, this figure may exceed the norm by 20-50%.

The mild form of insulin-dependent diabetes does not require the patient to inject insulin daily. It is enough to follow a very low carbohydrate diet, exercise and take pills that stimulate more intense production of the hormone by pancreatic cells.

In people with moderate diabetes, blood sugar levels during sleep and hunger exceed the norm by 30-50%, and after eating can increase by 50-100%. With such diabetes, it is necessary to carry out daily insulin therapy with short and medium insulins.

In patients with a severe form of the disease, or type 1 diabetes, glucose levels at night and during hunger are increased by 50-100%, and after meals - several times. Such patients need to administer insulin before each meal, as well as before bedtime and at noon.

Drugs intended for insulin therapy vary in type and duration of action.

Insulin is divided into 4 types:

1. Bullish.
2. Pork.
3. Modified porcine (“human”).
4. Human, created through genetic engineering.

The very first, in the 20s of the last century, was obtained from the tissues of the pancreas of cattle. Bovine hormone differs from human hormone in three amino acids, so when used it often causes severe allergic reactions. It is currently banned in most countries of the world.

In the middle of the last century, sugar-lowering hormone began to be isolated from the internal organs of pigs. The pork hormone differed from the human hormone in just one amino acid, so it was less likely to cause allergies, but with prolonged use it increased the body's insulin resistance.

In the 80s of the 20th century, scientists learned to replace a different amino acid in the pig hormone with an identical one contained in the human hormone. This is how “human” insulin preparations were born.

They practically do not cause unwanted effects and are currently the most widespread.

With the development of genetic engineering, they learned to grow human sugar-lowering hormone inside genetically modified bacteria. This hormone has the most powerful effect and has no side effects.

Based on the duration of action, insulins are divided into 4 types:

1. Short.
2. Ultrashort.
3. Average.
4. Long-acting.

Short-acting drugs have a hypoglycemic effect for 6-9 hours. The duration of action of ultra-short insulins is 2 times less. Both types of drugs are used to lower blood sugar levels after meals. In this case, you need to inject short drugs half an hour before meals, and ultra-short ones - 10 minutes.

Medium-acting drugs retain their therapeutic effect for 11-16 hours. They need to be administered every 8-12 hours, at least one hour before meals.

Long-acting drugs can reduce sugar within 12-24 hours. They are designed to control night and morning glucose levels.

In recent years, the idea has become increasingly common that diabetes mellitus is a very individual disease, in which the treatment regimen and compensation goals should take into account the patient’s age, his diet and work habits, concomitant diseases, etc. And since no two people are the same, there can be no completely identical recommendations for diabetes management.

Elena Vainilovich,

Candidate of Medical Sciences,

endocrinologist of the highest category

People suffering from this form of diabetes are wondering at what blood sugar level insulin is prescribed?

As a rule, in this case it is vital for maintaining the ability of the pancreas to produce human insulin. If the patient does not receive appropriate treatment, he may simply die.

Diabetes mellitus of this common type is much more complicated than the second type. If it is present, the amount of insulin produced is quite negligible or completely absent.

That is why the patient’s body is not able to cope with the increased sugar level on its own. Low levels of the substance pose a similar danger - this can lead to an unexpected coma and even death.

Do not forget about regular monitoring of sugar levels and undergoing routine examinations.

Since a person with the first form of the disease simply cannot live without insulin, it is necessary to take this problem seriously.

If the patient does not have problems with excess weight and does not experience excessive emotional overload, insulin is prescribed ½ - 1 unit once a day, calculated per 1 kg of body weight. In this case, intensive insulin therapy acts as a simulator of natural hormone secretion.

The rules for insulin therapy require the following conditions to be met:

• the drug must be supplied to the patient’s body in an amount sufficient to utilize glucose;
• externally administered insulins should become a complete imitation of basal secretion, that is, that produced by the pancreas (including the highest point of secretion after a meal).

The requirements listed above explain insulin therapy regimens in which the daily dosage of the drug is divided into long- or short-acting insulins.

Long insulins are most often administered in the mornings and evenings and absolutely imitate the physiological product of the functioning of the pancreas.

Taking short-term insulin is advisable after eating a meal rich in carbohydrates. The dosage of this type of insulin is determined individually and is determined by the amount of XE (bread units) at a given meal.

Based on the duration of action, all insulins can be divided into the following groups:

• ultra-short action;
• short acting;
• medium action;
• prolonged action.

Ultra-short insulin begins to act within 10-15 minutes after the injection. Its effect on the body lasts for 4-5 hours.

Short-acting drugs begin to act on average half an hour after injection. The duration of their influence is 5-6 hours. Ultra-short insulin can be administered either immediately before or immediately after meals. Short-acting insulin is recommended to be administered only before meals, as it does not begin to act so quickly.

When intermediate-acting insulin enters the body, it begins to reduce sugar only after 2 hours, and the time of its total action is up to 16 hours.

Long-acting medications (long-acting) begin to affect carbohydrate metabolism after 10–12 hours and are not removed from the body for 24 hours or more.

All these drugs have different tasks. Some of them are administered immediately before meals to stop postprandial hyperglycemia (increased sugar after eating).

Intermediate- and long-acting insulins are administered to maintain target sugar levels continuously throughout the day. Doses and mode of administration are selected individually for each diabetic, based on his age, weight, characteristics of the course of diabetes and the presence of concomitant diseases.

There is a government program for the distribution of insulin to patients suffering from diabetes, which provides free access to this medicine to all those in need.

There are many types and names of insulin for treating diabetes on the pharmaceutical market today, and over time there will be even more. Insulin is divided according to the main criterion - how long it takes to reduce blood sugar after an injection. The following types of insulin exist:

• ultra-short - act very quickly;
• short - slower and smoother than short ones;
• average duration of action (“average”);
• long-acting (extended).

In 1978, scientists were the first to use genetic engineering to force Escherichia coli to produce human insulin. In 1982, the American company Genentech began its mass sale.

Previously, bovine and porcine insulin were used. They are different from humans, and therefore often caused allergic reactions.

Today, animal insulin is no longer used. Diabetes is widely treated with injections of genetically engineered human insulin.

Characteristics of insulin preparations

Since the 2000s, new long-acting types of insulin (Lantus and Glargine) began to replace intermediate-acting NPH insulin (Protafan). New extended-release types of insulin are not just human insulin, but its analogues, i.e. modified, improved, compared to real human insulin. Lantus and Glargine act longer and more smoothly, and are also less likely to cause allergies.

It is likely that replacing NPH insulin with Lantus or Levemir as your basal insulin will improve your diabetes outcomes. Discuss this with your doctor. Read more in the article “Lantus and Glargine Extended Insulin. Medium NPH-insulin protafan.”

At the end of the 1990s, ultra-short insulin analogues Humalog, NovoRapid and Apidra appeared. They entered into competition with short-acting human insulin.

Ultra-short-acting insulin analogues begin to lower blood sugar within 5 minutes after the injection. They act strongly, but not for long, no more than 3 hours.

Let's compare the action profiles of an ultra-short-acting analogue and “regular” human short-acting insulin in the picture.

Read more in the article “Ultra-short insulin Humalog, NovoRapid and Apidra. Human short-acting insulin."

Attention! If you are following a low-carbohydrate diet to treat type 1 or type 2 diabetes, human rapid-acting insulin is better than rapid-acting insulin.

How and why diabetes develops

First of all, you should pay attention to high blood sugar. 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 state of 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 a variety of modern medications help cope with this problem perfectly. 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.

Pregnant women, nursing mothers and children under 12 years of age who have been diagnosed with type II diabetes mellitus are prescribed insulin therapy with some restrictions.

Children are injected with insulin taking into account the following requirements:

• to reduce the daily number of injections, combined injections are prescribed, in which the ratio between drugs with a short and medium duration of action is individually selected;
• intensified therapy is recommended to be prescribed upon reaching the age of twelve;
• when adjusting the dosage step by step, the range of changes between the previous and subsequent injections should lie in the range of 1.0...2.0 IU.

When conducting a course of insulin therapy for pregnant women, it is necessary to adhere to the following rules:

• injections of drugs should be prescribed in the morning, before breakfast the glucose level should be in the range of 3.3-5.6 millimoles/liter;
• after a meal, the molarity of glucose in the blood should be in the range of 5.6-7.2 millimoles/liter;
• to prevent morning and afternoon hyperglycemia in type I and type II diabetes, at least two injections are required;
• before the first and last meals, injections are carried out using short- and medium-acting insulins;
• to exclude nocturnal and “pre-dawn” hyperglycemia, it is possible to inject a glucose-lowering drug before dinner, and inject it immediately before bedtime.

Features of insulin therapy for children and pregnant women

Treatment of diabetes during pregnancy is aimed at maintaining blood sugar concentrations, which should be:

• In the morning on an empty stomach – 3.3-5.6 mmol/l.
• After meals – 5.6-7.2 mmol/l.

Determining blood sugar levels over a period of 1-2 months allows you to evaluate the effectiveness of the treatment. The metabolism in the body of a pregnant woman is extremely precarious. This fact requires frequent adjustment of the insulin therapy regimen.

For pregnant women with type 1 diabetes, insulin therapy is prescribed according to the following scheme: in order to prevent morning and postprandial hyperglycemia, the patient requires at least 2 injections per day.

Short or medium insulin is administered before the first breakfast and before the last meal. Combined doses can also be used. The total daily dose must be correctly distributed: 2/3 of the total volume is intended for the morning, and 1/3 before dinner.

To prevent nighttime and dawn hyperglycemia, the “before dinner” dose is changed to an injection given immediately before bedtime.

Diabetes: symptoms

Before we find out when insulin is needed for type 2 pathology, let’s find out what symptoms indicate the development of the “sweet” disease. Depending on the type of disease and the individual characteristics of the patient, the clinical manifestations are slightly differentiated.

In medical practice, symptoms are divided into main signs and secondary symptoms. If the patient has diabetes, symptoms include polyuria, polydipsia and polygraphia. These are the three main signs.

The severity of the clinical picture depends on the body’s sensitivity to increased blood sugar, as well as on its level. It is noted that at the same concentration, patients experience different intensities of symptoms.

Let's take a closer look at the symptoms:

1. Polyuria is characterized by frequent and copious urination, an increase in the specific gravity of urine per day. Normally, there should be no sugar in urine, but in T2DM, glucose is detected through laboratory tests. Diabetics often go to the toilet at night because accumulated sugar leaves the body through urine, which leads to severe dehydration.
2. The first symptom is closely intertwined with the second - polydipsia, which is characterized by a constant desire to drink. It is quite difficult to quench your thirst, one might even say almost impossible.
3. Polygraphy is also a “thirst”, only not for liquids, but for food - the patient eats a lot, but cannot satisfy his hunger.

In type 1 diabetes, a sharp decrease in body weight is observed against the background of increased appetite. If you do not pay attention to this situation in time, the picture leads to dehydration.

Secondary signs of endocrine pathology:

• Itching of the skin, mucous membranes of the genital organs.
• Muscle weakness, chronic fatigue, little physical activity leads to severe fatigue.
• Dry mouth that cannot be relieved by fluid intake.
• Frequent migraines.
• Problems with the skin that are difficult to treat with medications.
• Numbness of the hands and feet, impaired visual perception, frequent colds and respiratory diseases, fungal infections.

Along with the main and secondary symptoms, the disease is also characterized by specific ones - a decrease in immune status, a decrease in the pain threshold, problems with erectile function in men.

When type I diabetes just begins to develop in the body of a child or teenager, it is difficult to identify immediately.

Diabetes mellitus in most cases develops gradually, and only occasionally does the disease develop rapidly, accompanied by an increase in glucose levels to a critical level with various diabetic comas.

The first signs of diabetes

Constant feeling of thirst; - constant dry mouth; - increased urine output (increased diuresis); - increased dryness and severe itching of the skin; - increased susceptibility to skin diseases, pustules; - prolonged wound healing; - sharp decrease or increase in body weight; - increased sweating; - muscle weakness.

Signs of diabetes

Frequent headaches, fainting, loss of consciousness; - blurred vision; - heart pain; - numbness of the legs, pain in the legs; - decreased sensitivity of the skin, especially on the feet; - swelling of the face and legs; - enlarged liver; - prolonged wound healing; - increased blood pressure; - the patient begins to smell of acetone.

Complications of diabetes

Diabetic neuropathy - manifested by pain, burning, numbness of the limbs. It is associated with disruption of metabolic processes in nervous tissue.

Edema. Swelling in diabetes can spread locally - on the face, legs, or throughout the body. Swelling indicates a disturbance in the functioning of the kidneys, and depends on the degree of heart failure. Asymmetrical swelling indicates diabetic microangiopathy.

Leg pain. Pain in the legs with diabetes, especially when walking and other physical activity on the legs, may indicate diabetic microangiopathy. Leg pain during rest, especially at night, indicates diabetic neuropathy. Often, leg pain in diabetes is accompanied by burning and numbness in the feet or some parts of the legs.

Diagnosis of diabetes mellitus

Measuring blood glucose levels (determination of glycemia); - measuring daily fluctuations in glycemic levels (glycemic profile); - measuring insulin levels in the blood; - glucose tolerance test; - blood test for the concentration of glycosylated hemoglobin; - biochemical blood test; - analysis urine to determine the level of leukocytes, glucose and protein; - Ultrasound of the abdominal organs; - Rehberg test.

Study of the electrolyte composition of the blood; - urine analysis to determine the presence of acetone; - fundus examination; - electrocardiography (ECG).

You can also detect deviations in the amount of sugar in your blood at home using a glucometer. You can compare the indicators using the following table.

Blood sugar levels in diabetes mellitus

Treatment without injections

Many diabetics do not resort to injections because they cannot be eliminated later. But such treatment is not always effective and can cause serious complications.

Injections allow you to achieve normal levels of the hormone when pills can no longer cope. With type 2 diabetes, there is a possibility that switching back to pills is quite possible.

This happens in cases where injections are prescribed for a short period of time, for example, in preparation for surgery, during pregnancy or lactation.

Hormone injections can take the load off them and the cells have the opportunity to recover. At the same time, following a diet and a healthy lifestyle will only contribute to this. The likelihood of this option exists only if you fully comply with the diet and doctor’s recommendations. Much will depend on the characteristics of the organism.

The principles of insulin therapy are very simple. After a healthy person has eaten, his pancreas releases the required dose of insulin into the blood, glucose is absorbed by the cells, and its level decreases.

In people with diabetes mellitus types I and II, this mechanism is disrupted for various reasons, so it has to be imitated manually. To correctly calculate the required dose of insulin, you need to know how much and with what foods the body receives carbohydrates and how much insulin is needed to process them.

The amount of carbohydrates in food does not affect its calorie content, so counting calories makes sense unless type I and II diabetes is accompanied by excess weight.

Type I diabetes does not always require a diet, which cannot be said about insulin-dependent type II diabetes. This is why every person with type I diabetes should measure their blood sugar levels and calculate their insulin doses correctly.

Before starting treatment, it is necessary to conduct an accurate diagnosis of the body, because a positive prognosis for recovery depends on this.

Reducing blood sugar levels; - normalizing metabolism; - preventing the development of diabetes complications.

Treatment of type 1 diabetes (insulin dependent)

As we already mentioned in the middle of the article, in the “Classification of Diabetes Mellitus” section, patients with type 1 diabetes constantly need insulin injections, since the body cannot produce this hormone itself in sufficient quantities. There are currently no other methods of delivering insulin to the body other than injections. Insulin-based tablets will not help with type 1 diabetes.

Following a diet; - performing dosed individual physical activity (IFN).

Treatment of type 2 diabetes (non-insulin dependent)

Type 2 diabetes is treated by following a diet and, if necessary, taking antihyperglycemic drugs, which are available in tablet form.

Diet for type 2 diabetes mellitus is the main method of treatment due to the fact that this type of diabetes develops due to improper nutrition of a person. With improper nutrition, all types of metabolism are disrupted, therefore, by changing their diet, a diabetic in many cases gets better.

In some cases, with persistent types of type 2 diabetes, the doctor may prescribe insulin injections.

When treating any type of diabetes, diet therapy is a must.

A nutritionist for diabetes mellitus, after receiving tests, taking into account age, body weight, gender, lifestyle, outlines an individual nutrition program. When dieting, the patient must calculate the amount of calories, proteins, fats, carbohydrates, vitamins and microelements consumed.

The menu must be followed strictly as prescribed, which minimizes the risk of developing complications of this disease. Moreover, by following a diet for diabetes, it is possible to defeat this disease without additional medications.

The general emphasis of diet therapy for diabetes is on eating food with minimal or no content of easily digestible carbohydrates, as well as fats, which are easily converted into carbohydrate compounds.

Type of diabetes; - time of detection of the disease; - accurate diagnosis; - strict adherence by the diabetic to the doctor’s instructions.

Important! Before using folk remedies, be sure to consult your doctor!

Diabetes mellitus type 2 is a disease in every sense, the progressive prescription of insulin is just a matter of time.

At the moment, it is considered traditional to prescribe two glucose-lowering drugs. After 10-15 years of taking the pills, they move on to the final stage - insulin therapy.

The delay in this treatment method is also explained by the fact that injections need to be given, hypoglycemia may develop, and the patient may gain significant weight. However, many patients believe that the result is unstable and the effectiveness is low.

Treatment is greatly hindered by unsuccessful personal experience, when incorrectly selected treatment was the cause of frequent hypoglycemic conditions. It should be noted that prescribing a short course of insulin therapy at the very beginning of the disease can lead to long-term remission and equalization of glycemia without the need for subsequent use of glucose-lowering drugs.

However, many practicing endocrinologists do not approve of this technique and advocate stepwise therapy. Of course, there are situations where early initiation of insulin is most appropriate.

For example, if the use of glucose-lowering drugs is ineffective in the early stages, insulin is prescribed. This drug increases the quality of life and patient satisfaction with treatment several times.

Dangers of Insulin Therapy

Numerous studies have shown that hyperinsulinemia is a trigger in the development of atherosclerosis. In addition, early use of insulin as a drug can lead to the development of coronary heart disease (CHD). But today there is no accurate and reliable information about this connection.

Before starting insulin therapy, it is necessary to decide and consider several factors and characteristics that may influence this technique. From them we highlight:

• body weight;
• life prognosis;
• presence, severity of microvascular changes;
• failure of previous treatment.

In order to ensure the need for insulin therapy, it is imperative to determine the level of activity of the beta cells of the pancreas by determining the amount of synthesized C-peptide.

You need to start insulin therapy for type 2 diabetes mellitus:

• with severe hyperglycemia on high and maximum doses of glucose-lowering drugs;
• sudden loss of body weight;
• low C-peptide levels.

As a temporary treatment, insulin is prescribed when it is necessary to reduce glucose toxicity when its level in the blood is elevated. Studies have shown that insulin therapy significantly reduces the likelihood of developing microvascular complications.

treatment-simptomy.ru

All patients with type 1 diabetes, except those with very mild forms of the disease, should receive injections of rapid insulin before each meal. At the same time, they need injections of extended-release insulin at night and in the morning to maintain normal fasting sugar.

If you combine extended-release insulin in the morning and evening with injections of rapid insulin before meals, this allows you to more or less accurately simulate the functioning of the pancreas of a healthy person.

Read all the materials in the block “Insulin in the treatment of type 1 and type 2 diabetes.” Pay special attention to the articles “Extended insulin Lantus and Glargine.

Medium NPH-insulin protafan” and “Injections of rapid insulin before meals. How to lower sugar to normal if it has jumped.”

You need to have a good understanding of what long-acting insulin is used for and what fast insulin is used for. Learn the Light Exercise Method to help you maintain ideal blood sugar levels while using low doses of insulin.

If you are obese and have type 1 diabetes, then you may benefit from Siofor or Glucophage tablets to reduce your insulin dosage and make it easier to lose weight. Please discuss taking these pills with your doctor; do not prescribe them to yourself without permission.

In this article you can find the answer to the question of what type of diabetes is insulin injected for. It is known to be prescribed for both forms of the disease.

With the second type, there is a greater chance of getting better and improving the performance of the pancreas.

Treatment of type 2 diabetics requires a specific regimen. The essence of this therapy is that small doses of basal insulin are gradually added to the patient's sugar-lowering medications.

When first encountering a basal drug, which is presented in the form of a peakless analogue of long-acting insulin (for example, insulin glargine), patients should stop at a dose of 10 IU per day. It is preferable that the injections are given at the same time of day.

If diabetes continues to progress and the combination of sugar-lowering drugs (tablet form) with basal insulin injections does not lead to the desired results, in this case the doctor decides to completely switch the patient to the injection regimen.

At the same time, the use of all kinds of traditional medicine is encouraged, but any of them must be approved by the attending physician.

Children are a special group of patients, so treatment with insulin in the case of childhood diabetes always requires an individual approach. Most often, 2-3 times insulin injection regimens are used to treat children. To reduce the number of injections for young patients, a combination of drugs with short and medium exposure times is practiced.

Insulin treatment is carried out according to the following plan:

1. Before making a subcutaneous injection, the injection site is slightly kneaded.
2. Eating after the injection should not be delayed by more than half an hour.
3. The maximum dose of administration cannot exceed 30 units.

In each individual case, the exact insulin therapy regimen must be drawn up by a doctor. Recently, insulin syringe pens have been used for therapy; you can use conventional insulin syringes with a very thin needle.

The use of syringe pens is more rational for several reasons:

• Thanks to a special needle, the pain from the injection is minimized.
• The convenience of the device allows you to give injections anywhere and at any time.
• Some syringe pens are equipped with vials of insulin, which allows for the possibility of combining drugs and using different regimens.

The components of the insulin regimen for type 1 and type 2 diabetes are as follows:

1. Before breakfast, the patient should administer a short- or long-acting drug.
2. The insulin injection before lunch should consist of a short-acting hormone.
3. The injection that precedes dinner includes short-acting insulin.
4. Before going to bed, the patient must administer a long-acting drug.

There are several areas of administration on the human body. The rate of absorption of the drug in each zone is different. The stomach is more susceptible to this indicator.

If the area for injection is incorrectly selected, insulin therapy may not produce positive results.

It is well known that in healthy people, insulin production occurs constantly at a relatively low level throughout the day - this is called basal, or background insulin secretion (see Fig. 11).

Figure 12. Insulin administration according to the scheme: two injections of long-acting insulin

In response to an increase in blood sugar (and the most significant change in sugar levels occurs after eating a carbohydrate meal), the release of insulin into the blood increases several times - this is called dietary insulin secretion.

When treating diabetes with insulin, on the one hand, I would like to get closer to what happens in a healthy person. On the other hand, it would be desirable to administer insulin less frequently.

Therefore, a variety of insulin treatment regimens are currently used. It is relatively rare to get good results with long-acting insulin administered once or twice a day (see.

Typically, these options are used while taking glucose-lowering tablets. It is clear that the increase in blood sugar during the day and the peaks of the maximum hypoglycemic effect of insulin do not always coincide in time and severity of the effect.

Most often, in the treatment of type 2 diabetes mellitus, a regimen is used when short- and medium-acting insulins are administered twice a day. It is called traditional insulin therapy.

In connection with the above parameters of the action of insulin drugs, this regimen requires that the patient must have three main and three intermediate meals, and it is desirable that the amount of carbohydrates in these meals be the same every day. A simpler version of this regimen would be to administer mixed insulin twice a day.

In some cases, it may be necessary to administer insulin in a manner that most closely resembles the natural insulin production of a healthy pancreas. It is called intensified insulin therapy or multiple injection regimen.

The role of basal insulin secretion is played by long-acting insulin preparations. And to replace dietary insulin secretion, short-acting insulin preparations are used, which have a rapid and pronounced hypoglycemic effect.

1. In the morning (before breakfast) - administration of short and long-acting insulin.2. In the afternoon (before lunch) - short-acting insulin.3. In the evening (before dinner) - short-term insulin.4. At night - administration of long-acting insulin.

It is possible to use one injection of the long-acting insulin analog Lantus instead of two injections of intermediate-acting insulin. Despite the increase in the number of injections, the intensified insulin therapy regimen allows the patient to be more flexible in his diet, both in terms of meal times and the amount of food.

Self-monitoring during insulin treatment

If your diabetes is so severe that you need to take rapid insulin injections before meals, then it is advisable to continuously carry out total self-monitoring of your blood sugar. If for good diabetes compensation it is enough for you to take long-acting insulin injections at night and/or in the morning, without injections of rapid insulin before meals, then it is enough to measure your sugar in the morning on an empty stomach and in the evening before bed.

However, carry out total blood sugar control 1 day a week, or better yet 2 days every week. If it turns out that your sugar is at least 0.6 mmol/l above or below the target values, then you need to consult a doctor and change something.

The article provides basic information that all patients with type 1 or type 2 diabetes who receive insulin injections need to know. The main thing is that you learned what types of insulin exist, what features they have, as well as the rules for storing insulin so that it does not spoil.

Learn what the light load method is. Use it to maintain stable blood sugar and manage with minimal doses of insulin.

Insulin therapy regimens

In order to adequately treat type 2 diabetes mellitus and switch it to insulin, a regimen of administration and dosage of the drug should be selected for the patient. There are 2 such modes.

Standard dose regimen

This form of treatment means that all dosages have already been calculated, the number of meals per day remains unchanged, even the menu and portion size are set by a nutritionist. This is a very strict routine and is prescribed to people who, for some reason, cannot control their blood sugar levels or calculate their insulin dosage based on the amount of carbohydrates in their food.

The disadvantage of this regimen is that it does not take into account the individual characteristics of the patient’s body, possible stress, poor diet, and increased physical activity. Most often it is prescribed to elderly patients. You can read more about it in this article.

Intensive insulin therapy

This regimen is more physiological and takes into account the nutritional and stress characteristics of each person, but it is very important that the patient takes a meaningful and responsible approach to calculating dosages. His health and well-being will depend on this. Intensive insulin therapy can be studied in more detail at the link provided earlier.

The main indication for prescribing the drug is a violation of the functionality of the pancreas. Since this internal organ takes part in all metabolic processes in the body, and disruption of its activity leads to problems in other internal systems and organs.

Beta cells are responsible for producing sufficient amounts of the natural substance. However, with age-related changes in the body against the background of problems with the pancreas, the number of active cells decreases, which leads to the need to prescribe insulin.

Medical statistics show that the “experience” of endocrine pathology is 7-8 years; in the vast majority of clinical cases, it requires injecting medication.

To whom and when is the drug prescribed? Let's consider the reasons for this prescription for the second type of illness:

• A hyperglycemic state, in particular, a sugar value above 9.0 units. That is, prolonged decompensation of the disease.
• Taking medications based on sulfonylurea derivatives.
• Depletion of the pancreas.
• Exacerbation of concomitant chronic pathologies.
• For diabetes mellitus Lada variety; acute conditions (infectious pathologies, severe injuries).
• Time of bearing a child.

Many patients try in every way to delay the day when they have to inject insulin. In fact, there is nothing terrible, on the contrary, because there is this method that helps those suffering from a chronic disease to live a full life.

Practice shows that sooner or later insulin is prescribed for type 2 diabetes. This point of therapy allows not only to neutralize negative symptoms, but also prevents further progression of the disease and postpones possible negative consequences.

The purpose of such a plan must be confirmed, otherwise it will play a detrimental role.

The need for insulin in the treatment of diabetes is beyond doubt. Many years of medical practice have proven that it helps prolong the patient’s life, while delaying negative consequences for a significant period of time.

Why do you need to inject the hormone? This appointment has a single goal - to achieve and maintain target concentrations of glycated hemoglobin, glucose on an empty stomach and after a meal.

In general, insulin for a diabetic is a way to help them feel good, while slowing down the progression of the underlying pathology and preventing possible chronic complications.

The use of insulin provides the following therapeutic effects:

1. The administration of the prescribed medication allows you to reduce glycemia, both on an empty stomach and after eating.
2. Increased production of hormonal substances by the pancreas in response to stimulation by sugar or food consumption.
3. Reduced gluconeogenesis is a metabolic pathway that leads to the formation of sugar from non-carbohydrate constituents.
4. Intensive production of glucose by the liver.
5. Decreased lipolysis after meals.
6. Reduced glycation of protein substances in the body.

Insulin therapy for type 2 diabetes has a beneficial effect on the metabolism of carbohydrates, lipids and proteins in the human body. It helps to activate the deposition and suppress the breakdown of sugar, lipids and amino acids.

In addition, it normalizes the concentration of indicators due to an increase in the transport of glucose to the cellular level, as well as due to the inhibition of its production through the liver.

The hormone promotes active lipogenesis, suppresses the utilization of free fatty acids in energy metabolism, stimulates the production of proteins, and inhibits proteolysis in muscles.

Modern methods of intensified insulin therapy imitate the natural, physiological secretion of the hormone insulin by the pancreas. It is prescribed if the patient is not overweight and when there is no likelihood of psycho-emotional overload, at a daily rate of 0.5-1.0 IU (international units of action) of the hormone per 1 kilogram of body weight.

In this case, the following requirements must be met:

• the drug must be injected in doses sufficient to completely neutralize excess saccharides in the blood;
• Externally administered insulin in diabetes mellitus should fairly fully imitate the basal secretion of the hormone secreted by the islets of Langerhans, which peaks after a meal.

Based on these principles, an intensified technique is developed when the daily, physiologically necessary dose is divided into smaller injections, differentiating insulins according to the degree of their temporary effectiveness - short-term or prolonged action.

The latter type of insulin must be injected at night and in the morning, immediately after waking up, which quite accurately and completely imitates the natural functioning of the pancreas.

Short-acting insulin injections are prescribed after meals with a high concentration of carbohydrates. As a rule, a single injection is calculated individually according to the number of conventional bread units that are equivalent to a meal.

Traditional (standard) insulin therapy is a method of treating patients with diabetes mellitus when short-acting and long-acting insulins are mixed in one injection. The advantage of this method of administering the drug is considered to be the minimization of the number of injections - usually it is necessary to inject insulin 1-3 times a day.

The main disadvantage of this type of treatment is the lack of 100% imitation of the physiological secretion of the hormone by the pancreas, which makes it impossible to fully compensate for defects in carbohydrate metabolism.

The standard scheme for using traditional insulin therapy can be presented as follows:

1. The body's daily need for insulin is administered to the patient in the form of 1-3 injections per day:
2. One injection contains medium- and short-acting insulins: the share of short-acting insulins is 1/3 of the total amount of the drug;

Intermediate-acting insulin accounts for 2/3 of the total injection volume.

Pump insulin therapy is a method of introducing a drug into the body when a traditional syringe is not required, and subcutaneous injections are carried out with a special electronic device - an insulin pump, which is capable of injecting ultra-short and short-acting insulins in the form of microdoses.

The insulin pump quite accurately simulates the natural flow of the hormone into the body, for which it has two operating modes.

• basal administration mode, when microdoses of insulin enter the body continuously in the form of microdoses;
• bolus mode, in which the frequency and dosage of drug administration is programmed by the patient.

The first mode allows you to create an insulin-hormonal background that is closest to the natural secretion of the hormone by the pancreas, which makes it possible not to inject long-acting insulins.

The second mode is usually used immediately before meals, which makes it possible to:

• reduce the likelihood of an increase in the glycemic index to a critical level;
• allows you to refuse to use drugs with an ultra-short duration of action.

When both modes are combined, the natural physiological release of insulin in the human body is simulated as accurately as possible. When using an insulin pump, the patient must know the basic rules for using this device, for which it is necessary to consult with the attending physician.

In addition, he must remember when it is necessary to change the catheter through which subcutaneous insulin injections occur.

For insulin-dependent patients (type I diabetes) it is prescribed to completely replace the natural secretion of insulin. The most common scheme for administering the drug by injection is when it is necessary to inject:

• basal insulin (medium and long-acting) – once or twice a day;
• bolus (short-term) – immediately before a meal.

Basal insulins:

• extended period of action, "Lantus" ("Lantus" - Germany), "Levemir FlexPen" ("Levemir FlexPen" - Denmark) and Ultratard HM (Ultratard HM - Denmark);
• medium term "Humulin NPH" (Switzerland), "Insuman Basal GT" (Germany) and "Protaphane HM" (Denmark).

Bolus drugs:

• short-acting insulins “Actrapid HM Penfill” (“Actrapid HM Penfill” – Denmark);
• ultra-short period of action "NovoRapid" (Denmark), "Humalog" (France), "Apidra" (France).

The combination of bolus and basal injection regimens is called a multiple regimen and is one of the subtypes of intensified therapy. The dosage of each injection is determined by doctors based on the tests performed and the general physical condition of the patient.

Properly selected combinations and doses of individual insulins make the human body less critical of the quality of food consumed. Typically, the share of long-acting and intermediate-acting insulins is 30.0% -50.0% of the total dose of the administered drug.

Bolus inulin requires individual dose selection for each patient.

Typically, insulin therapy for type II diabetes mellitus begins with the gradual addition of drugs that reduce the level of saccharides in the blood to the usual medicinal media prescribed for drug therapy of patients.

For treatment, drugs are prescribed whose active ingredient is insulin glargine (Lantus or Levemir). In this case, it is advisable to inject the injection solution at the same time.

The maximum daily dosage, depending on the course and degree of neglect of the disease, can reach 10.0 IU.

If there is no improvement in the patient’s condition and diabetes progresses, and drug therapy according to the scheme “oral hypoglycemic drugs injections of balsa insulin” does not give the desired effect, proceed to therapy, the treatment of which is based on the injection use of insulin-containing drugs.

Today, the most common is an intensified regimen, in which drugs must be injected 2-3 times a day. For the most comfortable condition, patients prefer to minimize the number of injections.

From the point of view of therapeutic effect, the simplicity of the regimen should ensure maximum effectiveness of antihyperglycemic drugs. Efficiency assessment is carried out after injections for several days.

In this case, combining the morning and late doses is undesirable.

If insulin obtained by genetic engineering methods is sufficiently safe and well tolerated by patients, certain negative consequences are possible, the main of which are:

• the appearance of allergic irritations localized at the injection site associated with improper acupuncture or administration of a drug that is too cold;
• degradation of the subcutaneous layer of fatty tissue in injection areas;
• the development of hypoglycemia, leading to intensified sweating, a constant feeling of hunger, and increased heart rate.

Insulin therapy, according to European diabetologists, should begin not too early and not too late. Not a bad idea, because secretory failure may be secondary to insulin insensitivity, and also because of the risk of hypoglycemia. It is not too late because it is necessary to achieve the desired adequate glycemic control.

It is assumed that you already have the results of total self-monitoring of blood sugar in a diabetic patient for 7 days in a row. Our recommendations are intended for diabetics who follow a low-carbohydrate diet and use a low-impact method.

If you follow a “balanced” diet that is overloaded with carbohydrates, then you can calculate insulin dosages in simpler ways than those described in our articles. Because if the diet for diabetes contains an excess of carbohydrates, then it will still not be possible to avoid spikes in blood sugar.

How to create an insulin therapy regimen - step-by-step procedure:

1. Decide whether long-acting insulin injections are needed at night.
2. If extended-release insulin injections are needed at night, then calculate the starting dosage and then adjust it in the following days.
3. Decide whether you need long-acting insulin injections in the morning. This is the most difficult thing because for the experiment you need to skip breakfast and lunch.
4. If extended-release insulin injections are needed in the morning, then calculate the starting dosage of insulin for them, and then adjust it over the course of several weeks.
5. Decide whether rapid insulin injections are needed before breakfast, lunch and dinner, and if so, before which meals they are needed and which ones not.
6. Calculate the starting dosages of short-acting or ultra-fast insulin for injections before meals.
7. Adjust the dosage of short-acting or ultra-fast insulin before meals, based on the results of the previous days.
8. Conduct an experiment to find out exactly how many minutes before meals you need to inject insulin.
9. Learn to calculate the dosage of short-acting or ultra-fast insulin for cases when you need to normalize high blood sugar.

How to complete steps 1-4 - read the article “Lantus and Levemir - long-acting insulin. We normalize sugar in the morning on an empty stomach.”

How to complete steps 5-9 - read the articles “Ultra-short insulin Humalog, NovoRapid and Apidra. Human short insulin” and “Insulin injections before meals.

How to lower sugar to normal if it has risen.” You should also first study the article “Treatment of diabetes mellitus with insulin.

What types of insulin are there? Rules for storing insulin."

Let us remind you once again that decisions on the need for long-acting and rapid insulin injections are made independently of each other. Some diabetic patients only need extended-release insulin at night and/or in the morning.

Others are only advised to take rapid insulin injections before meals so that their sugar levels remain normal after meals. Third, long-acting and rapid insulin are needed at the same time.

This is determined by the results of total self-monitoring of blood sugar for 7 consecutive days.

We tried to explain in an accessible and understandable way how to correctly draw up an insulin therapy regimen for type 1 and type 2 diabetes. To decide which insulin to inject, at what time and in what doses, you need to read several long articles, but they are written in the most understandable language. If you still have any questions, ask them in the comments and we will answer quickly.

With an increasing decrease in the secretion of beta cells and the ineffectiveness of tableted hypoglycemic drugs, insulin is recommended in monotherapy or in combination with tableted glucose-lowering drugs.

Absolute indications for prescribing insulin:

• signs of insulin deficiency (eg, weight loss, symptoms of decompensated type 2 diabetes);
• the presence of ketoacidosis and (or) ketosis;
• any acute complications of type 2 diabetes mellitus;
• exacerbations of chronic diseases, acute macrovascular pathologies (stroke, gangrene, heart attack), the need for surgical treatment, severe infections;
• newly diagnosed type 2 diabetes, which is accompanied by high sugar during the day and on an empty stomach, not taking into account body weight, age, or the expected duration of the disease;
• newly diagnosed type 2 diabetes mellitus in the presence of allergies and other contraindications to the use of sugar tablets. Contraindications: hemorrhagic diseases, pathology of kidney and liver functions;
• pregnancy and lactation;
• severe impairment of the kidneys and liver;
• lack of favorable sugar control during treatment with maximum doses of tableted hypoglycemic drugs in acceptable combinations and doses along with sufficient physical activity;
• precoma, coma.

Insulin therapy is prescribed for patients with type 2 diabetes mellitus with the following laboratory parameters:

• fasting blood sugar level above 15 mmol/l in patients with suspected diabetes;
• plasma concentration of C-peptide below 0.2 nmol/l after an intravenous test with 1.0 mg of glucagon;
• despite the use of maximum daily doses of tableted drugs for sugar, the fasting blood glucose level is above 8.0 mmol/l, after meals is above 10.0 mmol/l;
• the level of glycosylated hemoglobin is constantly above 7%.

The main advantage of insulin in the treatment of type 2 diabetes is its effect on all parts of the pathogenesis of this disease. First of all, this helps to compensate for the lack of endogenous production of the hormone insulin, which is observed with a progressive decrease in the functioning of beta cells.

Temporary insulin therapy is prescribed to patients with type 2 diabetes with serious concomitant pathology (severe pneumonia, myocardial infarction, etc.), when very careful control of blood glucose is required for rapid recovery.

Or in situations where the patient is temporarily unable to take pills (acute intestinal infection, during the period before and after surgery, especially in the gastrointestinal tract, etc.).

A serious illness increases the need for insulin in the body of any person. You've probably heard about stress hyperglycemia, when blood glucose increases in a person without diabetes during the flu or other illness accompanied by high fever and/or intoxication.

Doctors speak of stress hyperglycemia when blood glucose levels are above 7.8 mmol/l in patients who are in the hospital for various diseases. According to studies, 31% of patients in therapeutic departments and from 44 to 80% of patients in postoperative departments and intensive care units have elevated blood glucose levels, and 80% of them did not previously have diabetes.

Such patients may be started on insulin intravenously or subcutaneously until the condition is compensated. At the same time, doctors do not immediately diagnose diabetes, but monitor the patient.

If he has additionally high glycated hemoglobin (HbA1c above 6.5%), which indicates an increase in blood glucose in the previous 3 months, and blood glucose does not normalize during recovery, then a diagnosis of “diabetes mellitus” is made and further treatment is prescribed.

In this case, if it is type 2 diabetes, glucose-lowering tablets may be prescribed or insulin administration may be continued - it all depends on concomitant diseases. But this does not mean that the operation or the actions of the doctors caused diabetes, as our patients often express (“they dropped glucose…”, etc.).

d.). It just revealed what I was predisposed to.

But we'll talk about this later.

Thus, if a person with type 2 diabetes develops severe disease, his insulin reserves may not be sufficient to meet the increased need due to stress, and he is immediately transferred to insulin therapy, even if he did not previously need insulin.

Usually, after recovery, the patient starts taking pills again. If, for example, he underwent gastric surgery, he will be advised to continue to administer insulin, even if his own insulin secretion is preserved.

The dose of the drug will be small.

We must remember that type 2 diabetes is a progressive disease, when the ability of pancreatic beta cells to produce insulin gradually decreases. Therefore, the dose of drugs is constantly changing, most often upward, gradually reaching the maximum tolerated, when the side effects of the tablets begin to prevail over their positive (glucose-lowering) effect.

Then you need to switch to insulin treatment, and it will be permanent, only the dose and regimen of insulin therapy may change. Of course, there are patients who can be on a diet or a small dose of drugs for a long time, for years, and have good compensation.

This may be if type 2 diabetes was diagnosed early and beta cell function is well preserved, if the patient has managed to lose weight, watches his diet and moves a lot, which helps improve the functioning of the pancreas - in other words, if his insulin is not wasted. harmful products.

Or maybe the patient did not have obvious diabetes, but had prediabetes or stress hyperglycemia (see above) and the doctors rushed to diagnose “type 2 diabetes.”

And since true diabetes cannot be cured, it is difficult to remove an already made diagnosis. Such a person may have a rise in blood glucose a couple of times a year due to stress or illness, but at other times the sugar is normal.

Also, the dose of glucose-lowering drugs may be reduced in very elderly patients who begin to eat little, lose weight, as some say, “dry out,” their need for insulin decreases, and even diabetes treatment is completely canceled.

But in the vast majority of cases, the dose of drugs is usually gradually increased.

To begin with, it should be noted that the selection of a treatment regimen and dosage of medication should be carried out by an experienced endocrinologist based on many different tests.

The strength and duration of action of insulin directly depends on the state of metabolism in the patient’s body.

An overdose can cause blood sugar levels to drop below 3.3 mmol per liter, causing the patient to fall into a hypoglycemic coma. Therefore, if there is no experienced endocrinologist in your city or region, you should start injections with the most minimal doses.

In addition, it should be remembered that 1 ml of the drug may contain either 40 or 100 international units of insulin (IU). Before injection, it is necessary to take into account the concentration of the active substance.

For the treatment of patients with moderate form of diabetes, 2 treatment regimens are used:

1. Standard.
2. Intense.

With standard therapy, the patient is administered drugs of short or medium duration of action twice a day - at 7 and 19 hours. In this case, the patient should follow a low-carbohydrate diet, have breakfast at 7:30 am, lunch at 1 pm (very light), dinner at 7 pm and go to bed at midnight.

During intensive therapy, the patient is given injections of ultra-short or short-acting drugs three times a day - at 7, 13 and 19 hours. For people with severe diabetes, to normalize night and morning glucose levels, in addition to these three injections, injections of intermediate-acting drugs are also prescribed.

They need to be injected at 7, 14 and 22 hours. They may also prescribe injections of extended-release drugs (Glargine, Detemir) up to 2 times a day (before bedtime and after 12 hours).

To correctly calculate the minimum dose of insulin administered before meals, you should know that 1-1.5 IU of the hormone can neutralize 1 bread unit (XE) of food in the body of a person weighing 64 kg.

With more or less weight, the amount of IU required to neutralize 1 XE increases or decreases proportionally. So, a person weighing 128 kg needs to administer 2-3 IU of the hormone to neutralize 1 XE.

It should be remembered that ultra-short insulin is 1.5-2.5 times more effective than other types; accordingly, less of it is needed. Standard XE contains 10-12 grams of carbohydrates.

In the treatment of type 2 diabetes, the same insulins are used as in the treatment of type 1 diabetes. Usually, short and ultra-short ones (lispro, aspart) are recommended for teasing food; among the extended ones, Lantus and Detemir are preferred, since they allow you to quickly normalize carbohydrate metabolism and are characterized by a mild effect.

Currently, several schemes for administering an external analogue of the pancreas' own hormone are successfully used for diabetes.

A complete transition to insulin replacement therapy when diet, glucose-lowering pills, and alternative methods of treating diabetes have failed. The regimen can vary greatly from a single injection once a day to intensive replacement therapy as for type 1 diabetes.

Combined regimen: injections and glucose-lowering drugs are used simultaneously. The combination options here are strictly individual and are selected together with the attending physician.

This approach is considered the most effective. Typically, long-acting insulin (1-2 times a day) is combined with daily oral medications to lower blood sugar.

Sometimes, before breakfast, it is chosen to administer mixed insulin, since the tablets no longer cover the morning need for the hormone.

Temporary switch to injections. As already noted, this approach is mainly justified when carrying out serious medical operations, severe conditions of the body (heart attacks, strokes, injuries), pregnancy, a strong decrease in sensitivity to one’s own insulin, a sharp increase in glycated hemoglobin.

Since the good results of compensating type 2 diabetes with insulin force doctors to actively recommend this approach to treating the disease, many patients, and doctors themselves, find themselves in a difficult choice: “when is it time to prescribe insulin?”

On the one hand, the patient’s understandable fear forces doctors to postpone the moment; on the other hand, progressive health problems do not allow insulin therapy to be postponed for a long time. In each case, the decision is made individually.

Remember, any methods of therapy for endocrine pathologies can only be used after agreement with the attending physician! Self-medication can be dangerous.

Insulin therapy for type 1 diabetes mellitus

Intensified or basal-bolus insulin therapy

Long-acting insulin (LAI) is administered 2 times a day (morning and at night) Short-acting insulin (SAI) is administered 2 times a day (before breakfast and before dinner) or before main meals, but its dose and the amount of XE are strictly fixed ( the patient does not change the insulin dose and the amount of XE on his own) - there is no need to measure glycemia before each meal

Insulin dose calculation

Total daily insulin dose (TDID) = patient weight x 0.5 U/kg*

- 0.3 U/kg for patients with newly diagnosed type 1 diabetes during the period of remission (“honeymoon”)

0.5 U/kg for patients with an average history of the disease

0.7-0.9 U/kg for patients with a long history of the disease

For example, the patient’s weight is 60 kg, the patient has been sick for 10 years, then the SSDI is 60 kg x 0.8 U/kg = 48 U

If the SSDI is 48 units, then the dose of the IPD is 16 units, with 10 units administered before breakfast and 6 units before bedtime

The ICD dose is 2/3 of the SSDI.

However, with an intensified insulin therapy regimen, the specific dose of ICD before each meal is determined by the number of bread units (XE) planned to be taken with food, the level of glycemia before meals, the need for insulin for the first XE at a given time of day (morning, afternoon, evening)

The need for ICD in breakfast is 1.5-2.5 U/1 XE. at lunch - 0.5-1.5 U/1 XE, at dinner 1-2 U/1 XE.

In case of normoglycemia, ICD is administered only for food; in case of hyperglycemia, additional insulin is administered for correction.

For example, in the morning a patient’s sugar level is 5.3 mmol/l, he plans to eat 4 XE, his insulin requirement before breakfast is 2 U/XE. The patient must inject 8 units of insulin.

With traditional insulin therapy, the ICD dose is divided either into 2 parts - 2/3 is administered before breakfast and 1/3 is administered before dinner (If the SSDI is 48 U, then the ICD dose is 32 U, with 22 U administered before breakfast, and 10 U before hive) , or the ICD dose is divided approximately evenly into 3 parts, administered before main meals. The amount of XE in each meal is strictly fixed.

Calculation of the required amount of XE

The diet for type 1 diabetes is physiological isocaloric, its purpose is to ensure normal growth and development of all body systems.

Daily calorie intake - ideal body weight x X

X - amount of energy/kg depending on the patient’s level of physical activity

32 kcal/kg - moderate physical activity

40 kcal/kg - average physical activity

48 kcal/kg - heavy physical activity

Ideal body weight (M) = height (cm) - 100

Ideal body weight (F) = height (cm) - 100 – 10%

For example, a patient works as a cashier in a savings bank. The patient's height is 167 cm. Then her ideal body weight is 167-100-6.7, i.e. about 60 kg, and taking into account moderate physical activity, the daily calorie content of her diet is 60 x 32 = 1900 kcal.

Daily caloric intake is 55 - 60% carbohydrates

Accordingly, carbohydrates account for 1900 x 0.55 = 1045 kcal, which is 261 g of carbohydrates. IХЕ = 12 g of carbohydrates, i.e. Every day the patient can eat 261. 12 = 21 XE.

Those. for breakfast and dinner, our patient can eat 4-5 XE, for lunch 6-7 XE, for snacks 1-2 XE (preferably no more than 1.5 XE). However, with an intensified insulin therapy regimen, such a strict distribution of carbohydrates among meals is not necessary.

The combined method of insulin therapy involves combining all insulins in one injection and is called traditional insulin therapy. The main advantage of this method is to reduce the number of injections to a minimum (1-3 per day).

The disadvantage of traditional insulin therapy is the inability to completely imitate the natural activity of the pancreas. This flaw does not allow one to fully compensate for the carbohydrate metabolism of a patient with type 1 diabetes; insulin therapy does not help in this case.

The combined insulin therapy regimen looks something like this: the patient receives 1-2 injections per day, while at the same time he is injected with insulin preparations (this includes both short-acting and long-acting insulins).

Insulins of medium duration of action make up about 2/3 of the total volume of drugs, short-acting insulins remain 1/3.

It is also necessary to say something about the insulin pump. An insulin pump is a type of electronic device that provides round-the-clock subcutaneous administration of insulin in mini-doses with an ultra-short or short period of action.

This technique is called insulin pump therapy. The insulin pump operates in different modes of drug administration.

Insulin therapy regimens:

1. Continuous delivery of pancreatic hormone in microdoses, simulating physiological rates.
2. Bolus speed – the patient can independently program the dosage and frequency of insulin administration.

When the first regimen is used, background insulin secretion is simulated, which makes it possible, in principle, to replace the use of long-acting drugs. Using the second mode is advisable immediately before meals or at times when the glycemic index rises.

When the bolus administration mode is turned on, insulin pump therapy provides the opportunity to change insulins of different types of action.

Important! When combining the listed modes, the closest possible imitation of the physiological secretion of insulin by a healthy pancreas is achieved. The catheter should be changed at least once every 3 days.

The treatment regimen for patients with type 1 diabetes involves administering a basal drug 1-2 times a day, and a bolus immediately before meals. In type 1 diabetes, insulin therapy should completely replace the physiological production of the hormone produced by the pancreas of a healthy person.

The combination of both regimens is called basal-bolus therapy, or a regimen with multiple injections. One type of this therapy is intensive insulin therapy.

The regimen and dosage, taking into account the individual characteristics of the body and complications, should be selected for the patient by his attending physician. The basal drug usually takes up 30-50% of the total daily dose. Calculation of the required bolus amount of insulin is more individual.

Insulin treatment, like any other, may have contraindications and complications. The appearance of allergic reactions at injection sites is a striking example of a complication of insulin therapy.

Insulin is rarely used for type 2 diabetes mellitus, since this disease is more associated with metabolic disorders at the cellular level rather than with insufficient insulin production. Normally, this hormone is produced by beta cells of the pancreas.

And, as a rule, in type 2 diabetes they function relatively normally. Blood glucose levels increase due to insulin resistance, that is, a decrease in tissue sensitivity to insulin.

As a result, sugar cannot enter the blood cells; instead, it accumulates in the blood.

With severe type 2 diabetes and frequent changes in blood sugar levels, these cells may die or weaken their functional activity. In this case, to normalize the condition, the patient will have to either temporarily or constantly inject insulin.

Hormone injections may also be needed to support the body during periods of infectious diseases, which are a real test for a diabetic’s immunity. The pancreas at this moment may produce insufficient amounts of insulin, since it also suffers due to intoxication of the body.

It is important to understand that in most cases, hormone injections for non-insulin-dependent diabetes are a temporary phenomenon. And if a doctor recommends this type of therapy, you should not try to replace it with anything.

With mild type 2 diabetes, patients often manage even without glucose-lowering pills. They control the disease only with a special diet and light exercise, while not forgetting regular examinations with a doctor and measuring blood sugar.

But during those periods when insulin is prescribed for a temporary deterioration, it is better to adhere to the recommendations in order to maintain the ability to keep the disease under control in the future.

Insulin preparations

The cause of type 2 diabetes is poor sensitivity of body cells to insulin. In many people with this diagnosis, the hormone is produced in large quantities in the body.

If it is determined that sugar increases slightly after eating, you can try replacing insulin with tablets. Metformin is suitable for this.

This drug is able to restore the functioning of cells, and they will be able to perceive the insulin that the body produces.

Many patients resort to this method of treatment in order to avoid having to take daily insulin injections. But this transition is possible provided that a sufficient portion of beta cells are preserved that could adequately maintain glycemia against the background of glucose-lowering drugs, which happens with short-term administration of insulin in preparation for surgery or during pregnancy.

In the event that when taking pills the sugar level still increases, then injections cannot be avoided.

As is known, the main cause of type 2 diabetes is decreased sensitivity of cells to the action of insulin (insulin resistance). In most patients with this diagnosis, the pancreas continues to produce its own insulin, sometimes even more than in healthy people.

If your blood sugar jumps after a meal, but not too much, then you can try replacing rapid insulin injections before meals with metformin tablets.

Insulin is a hormone that performs several functions at once - it breaks down glucose in the blood and delivers it to the cells and tissues of the body, thereby saturating them with the energy necessary for normal functioning.

When there is a deficiency of this hormone in the body, the cells stop receiving energy in the required amount, despite the fact that the blood sugar level is much higher than normal. And when such disorders are detected in a person, he is prescribed insulin drugs.

They have several varieties, and to understand which insulin is better, you should take a closer look at its types and the degree of effect on the body.

General information

The first insulin preparations were of animal origin. They were obtained from the pancreas of pigs and cattle.

In recent years, human insulin preparations have mainly been used. The latter are obtained by genetic engineering, forcing bacteria to synthesize insulin with absolutely the same chemical composition as natural human insulin (i.e., it is not a substance foreign to the body).

Now human genetically engineered insulins are the drugs of choice in the treatment of all patients with diabetes mellitus, including type 2.

Based on the duration of action, insulins are divided into short-acting and long-acting (long-acting) insulins.

Figure 7. Short-acting insulin profile

Short-acting insulin preparations (also called simple insulin) are always transparent. The action profile of short-acting insulin preparations is as follows: onset within 15-30 minutes.

Peak after 2-4 hours, end after 6 hours, although the time parameters of action largely depend on the dose: the lower the dose, the shorter the effect (see Fig.

7). Knowing these parameters, we can say that short-acting insulin must be administered within 30 minutes.

before meals so that its action better coincides with the rise in blood sugar.

Recently, ultra-short-acting drugs have also appeared, the so-called insulin analogues, for example Humalog or Novorapid. Their action profile is somewhat different from conventional short-acting insulins.

They begin to act almost immediately after administration (5-15 minutes), which gives the patient the opportunity not to observe the usual interval between injection and food intake, but to administer it immediately before meals (see.

rice. 8).

The peak of action occurs after 1-2 hours, and the concentration of insulin at this moment is higher compared to regular insulin.

Figure 8. Rapid-acting insulin profile

This increases the possibility of having satisfactory blood sugar after eating. Finally, their effect lasts for 4-5 hours, which allows, if desired, to refuse intermediate meals without the risk of hypoglycemia. Thus, a person’s daily routine becomes more flexible.

Figure 9. Intermediate-acting insulin profile.

Long-acting (long-acting) insulin preparations are obtained by adding special substances to insulin that slow down the absorption of insulin from under the skin. From this group, drugs with an intermediate duration of action are currently mainly used. Their action profile is as follows: beginning - after 2 hours, peak - after 6-10 hours, end - after 12-16 hours, depending on the dose (see Fig. 9).

Long-acting insulin analogues are produced by changing the chemical structure of insulin. They are transparent, so they do not require stirring before injection. Among them, there are analogs with an average duration of action, the action profile of which is similar to the action profile of NPH insulins. These include Levemir, which has a very high predictability of action.

Figure 10. Profile of a mixed insulin containing 30% short-acting insulin and 70% intermediate-acting insulin.

Long-acting analogues include Lantus, which acts for 24 hours, so it can be administered as basal insulin once a day. It does not have a peak of action, so the likelihood of hypoglycemia at night and between meals is reduced.

Finally, there are combination (mixed) preparations that contain both short- or ultra-short-acting insulin and intermediate-acting insulin. Moreover, such insulins are produced with different ratios of “short” and “long” parts: from 10/90% to 50/50%.

Figure 11. Normal insulin secretion

Thus, the action profile of such insulins actually consists of the corresponding profiles of the individual insulins included in their composition, and the severity of the effect depends on their ratio (see Fig. 10).

The rate at which insulin is absorbed depends on which layer of the body the needle enters. Insulin injections should always be given into subcutaneous fat, but not intradermally or intramuscularly (see

Fig. 16). In order to reduce the likelihood of getting into the muscle, patients with normal weight are recommended to use syringes and syringe pens with short needles - 8 mm long (a traditional needle is about 12-13 mm long).

In addition, these needles are somewhat thinner, which reduces pain during injection.

Figure 16. Insulin injection with needles of different lengths (for needles: 8-10 mm and 12-13 mm)

Figure 17. Correctly and incorrectly formed skin fold (for insulin injection)

1. Clear a place on the skin where insulin will be injected.

There is no need to wipe the injection site with alcohol. 2

Using your thumb and forefinger, take the skin into a fold (see fig.

17). This is also done to reduce the likelihood of getting into the muscle.

3. Insert the needle at the base of the skin fold perpendicular to the surface or at an angle of 45 degrees.

4. Without releasing the fold, press the syringe plunger all the way.

5. Wait a few seconds after injecting insulin, then remove the needle.

Syringe pens

Insulin injection is greatly facilitated by the use of so-called syringe pens. They allow the patient to achieve a certain level of convenience in life, since there is no need to carry a bottle of insulin and draw it with a syringe. A special bottle of insulin, Penfill, is pre-inserted into the syringe pen.

In order to mix long-acting insulin before injection, you need to make 10-12 turns of the syringe pen 180° (then the ball located in the penfill will mix the insulin evenly). The dial ring sets the required dose in the housing window. Having inserted the needle under the skin as described above, you need to press the button all the way. After 7-10 seconds, remove the needle.

Insulin injection sites

the anterior surface of the abdomen, the anterior outer surface of the thighs, the outer surface of the shoulders, buttocks (see Fig. 18). It is not recommended to inject yourself into the shoulder, since it is impossible to collect the fold, which means the risk of intramuscular injury increases.

You should know that insulin is absorbed from different areas of the body at different rates: in particular, the fastest from the abdominal area. Therefore, it is recommended to inject short-acting insulin into this area before meals.

Long-acting insulin injections can be given in the thighs or buttocks. Rotating injection sites should be the same every day, otherwise it may cause fluctuations in blood sugar levels.

Figure 18. Insulin injection sites

You should also ensure that no seals appear at the injection sites, which impair the absorption of insulin. To do this, it is necessary to alternate injection sites, and also to retreat from the previous injection site by at least 2 cm. For the same purpose, it is necessary to change syringes or needles for syringe pens more often (preferably after at least 5 injections).

I.I. Dedov, E.V. Surkova, A.Yu. Mayorov

There are several options for insulin injections, each of which has a number of nuances.

Table No. 1. Types of insulin injections

Before answering this question, you need to know which pills are not suitable for diabetics and which pose an immediate danger. If they are dangerous, then they should not be taken and the sugar level is not taken into account.

It is necessary to use injections; if everything is done correctly, then a person’s life can be significantly extended. When consuming harmful pills, a person’s condition worsens, although the glucose level decreases for a short time.

Some patients first go on a strict diet with low carbohydrate intake. And many consume the drug metamorphine.

With hormonal injections, it happens that the sugar level sometimes exceeds the permissible value, although the person does not violate a strict diet and does not violate the administered insulin doses. This means that it is difficult for the pancreas to cope with such a large load, then you need to carefully increase insulin doses so that diabetic complications do not develop.

Such negative sugar levels are often observed in the morning, on an empty stomach. To normalize the condition, you need to have dinner early, no later than 19.

00, and before going to bed inject a small amount of the substance. After each meal, you need to change your glucose level after a couple of hours.

If at this time it is slightly elevated, then this is not critical. Ultra-short injections between meals will help.

Once again, it should be said about the order - first of all, the sick person goes on a strict diet with a low amount of carbohydrates, then moderate consumption of metamorphine begins. If your sugar levels go up, you should not hesitate, but use hormonal injections.

If a person has started injections, the diet should also be strictly followed, and special attention should be paid to the glucose level, it should be the same as in healthy people.

Insulin is destroyed in the body under the influence of gastrointestinal juice; hydrochloric acid and digestive enzymes are to blame for this. Despite the high level of development of modern pharmacology, there are currently no tablets that have the most positive effect. And even active scientific research in this area is not conducted by pharmaceutical companies.

The pharmaceutical market offers the use of an inhalation aerosol, but its consumption is associated with certain difficulties - the dosage is difficult to calculate, so its use is not recommended.

If a diabetic consumes a large amount of carbohydrates, then he needs a large amount of insulin, which also entails danger, so once again it must be said that a low-carbohydrate diet must be followed.

Complications of insulin therapy

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, with a sedentary lifestyle, leads to weight gain, but this can and even must be fought.

Even with such a disease, it is imperative to lead an active lifestyle. 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 there is a tendency to this disease and you cannot relax and allow anything to be added to your diet.

Insulin is a tissue growth stimulator, causing accelerated cell division. With a decrease in insulin sensitivity, the risk of breast tumors increases, and one of the risk factors is concomitant disorders in the form of type 2 diabetes mellitus and high blood fat, and as we know, obesity and diabetes mellitus always go together.

In addition, insulin is responsible for retaining magnesium inside cells. Magnesium has the property of relaxing the vascular wall. When insulin sensitivity is impaired, magnesium begins to be excreted from the body, and sodium, on the contrary, is retained, which causes vasoconstriction.

The role of insulin in the development of a number of diseases has been proven, while it, while not being their cause, creates favorable conditions for progression:

1. Arterial hypertension.
2. Oncological diseases.
3. Chronic inflammatory processes.
4. Alzheimer's disease.
5. Myopia.
6. Arterial hypertension develops due to the action of insulin on the kidneys and nervous system. Normally, under the action of insulin, vasodilation occurs, but in conditions of loss of sensitivity, the sympathetic part of the nervous system is activated and the vessels narrow, which leads to increased blood pressure.
7. Insulin stimulates the production of inflammatory factors - enzymes that support inflammatory processes and inhibits the synthesis of the hormone adiponectin, which has an anti-inflammatory effect.
8. There are studies showing the role of insulin in the development of Alzheimer's disease. According to one theory, the body synthesizes a special protein that protects brain cells from the deposition of amyloid tissue. It is this substance, amyloid, that causes brain cells to lose their functions.

This same protective protein controls insulin levels in the blood. Therefore, when insulin levels increase, all energy is spent on reducing it and the brain is left without protection.

High concentrations of insulin in the blood cause the eyeball to elongate, which reduces the ability to focus normally.

In addition, frequent progression of myopia has been noted in type 2 diabetes mellitus and obesity.

A diabetic patient who has information about the dangers of diabetes should do everything to avoid complications. Diabetes is diagnosed with three types of complications:

• Spicy o.
• Chronic/Late o.
• Severe/Late o.

Prevention of diabetes

More information: nutrition and sports

Having learned what is injected for diabetes mellitus, how the medicine is selected, and when it should be done, we will consider the main points in the treatment of the pathology. Unfortunately, it is impossible to get rid of diabetes forever. Therefore, the only way to increase life expectancy and minimize injection complications.

What harm can insulin cause? There is a negative point in the treatment of type 2 diabetes mellitus by administering the hormone. The fact is that when you inject medicine, it leads to gaining extra pounds.

Type 2 diabetes on insulin is a high risk of obesity, so the patient is recommended to exercise to increase the sensitivity of the soft tissues. For the treatment process to be effective, special attention is paid to nutrition.

If you are overweight, it is important to follow a low-calorie diet, limiting the amount of fats and carbohydrates in the menu. The medication must be taken taking into account your diet; you need to measure your sugar several times a day.

Treatment of type 2 diabetes mellitus is a complex therapy, the basis of which is diet and exercise, even with stabilization of the required glycemia through injections.

Information about type 2 diabetes is provided in the video in this article.

For diabetes of any type, in addition to insulin therapy, it is important for the patient to follow a diet. The principles of therapeutic nutrition are similar for patients with different forms of this disease, but there are still some differences. In patients with insulin-dependent diabetes, the diet may be more extensive, since they receive this hormone from the outside.

With optimally selected therapy and well-compensated diabetes, a person can eat almost anything. Of course, we are talking only about healthy and natural products, since semi-finished products and junk food are excluded for all patients. At the same time, it is important to administer insulin correctly for diabetics and to be able to correctly calculate the amount of medication needed depending on the volume and composition of the food.

The basis of the diet of a patient diagnosed with a metabolic disorder should be:

• fresh vegetables and fruits with a low or medium glycemic index;
• low fat fermented milk products;
• cereals containing slow carbohydrates;
• dietary meat and fish.

Diabetics who are treated with insulin can sometimes afford bread and some natural sweets (if they do not have complications of the disease). Patients with type 2 diabetes must follow a more strict diet, because in their situation nutrition is the basis of treatment.

The doctor’s verdict “diabetes mellitus” and further necessary insulin therapy often frightens the patient.

In this case, doctors unanimously advise not to lose confidence, mobilize strength, follow a diet and follow the doctor’s instructions. Only such behavior will help maintain the quality and fullness of life.

And everyone can master the rules and tactics for administering insulin (in Latin - Insulinum). To help diabetics, special pen syringes and pump devices are currently being produced for comfortable injections.

Diabetes mellitus type I (DM-1) is not called insulin-dependent for nothing. With it, the beta cells of the pancreas lose the ability to independently synthesize the vital hormone insulin. Initially, this is expressed in a decrease in the production of Insulinum, then its production finally stops.

In this case, it is important to identify alarming sugar levels in a timely manner and prescribe insulin as replacement therapy. Compliance with the rules of complex treatment will allow you to provide timely assistance to the pancreas and prevent the occurrence of complications of diabetes mellitus.

As a rule, for the insulin-dependent type, 2 types of insulin medications are used:

• long-acting,
• fast (ultra-short and shortened) action.

In the first option, insulin is often prescribed for diabetes mellitus twice a day (for example, before breakfast and dinner), as background protection, ensuring the constant presence of the required minimum amount of the hormone in the body. Sometimes a single daily administration of this type of hormonal drug is enough for a diabetic.

Usually, the use of “long-term” Insulinum with “ultra-short” or “short” Insulinum is prescribed. The main role of the latter is in compensating for carbohydrates supplied with food.

The “ultra-short” biological product acts 10 minutes after entering the body and reaches peak values ​​after an hour.

The effect of the “shortened” version is recorded after 30 minutes and reaches a maximum after 1.5 or 2 hours.

Important point. With a short-acting medicine, additional snacks between main meals are recommended to avoid a drop in sugar levels. On the contrary, when using ultra-short-acting Insulinum and eating a heavy meal, an additional injection may be required. This need will disappear only if physical activity is planned after meals.

The average daily insulin dose for type I sugar dependence is 0.4-0.9 units/kg of human weight. Prescribing a reduced dosage indicates a state of the disease close to remission.

Bread units are used to assess the carbohydrate content of food and subsequently calculate insulin therapy. 1 bread unit equals 10-13 g of carbohydrates.

• for breakfast, one bread unit requires two insulin units,
• for lunch, one unit of bread requires one and a half units of insulin,
• For dinner, one unit of insulin is enough for one unit of bread.

It is worth noting that the success of injection treatment depends on the patient’s compliance with the time intervals between injections and control of diet.

Insulin for type II diabetes

Diabetes mellitus type II (DM2), unlike diabetes mellitus 1, is not insulin dependent. In this case, the cells of the pancreas synthesize an insufficient amount of the hormone insulin, or the produced Insulinum is rejected by the body for some reason.

Treatment of type II diabetes mellitus is comprehensive - using diet, tablet medications and insulin therapy.

Insulin can be prescribed for type 2 diabetes in the following ways:

• at the beginning of the disease,
• due to progression of the disease,
• as temporary and supportive measures,
• as a permanent therapy
• in the form of a comprehensive treatment course (with tablets),
• as monotherapy.

It is necessary to diagnose sugar addiction as early as possible. If a patient with suspected T2DM does not improve blood glucose levels within three months, elevated glycated hemoglobin remains (more than 6.5%), a diagnosis of diabetes mellitus is made. Subsequently, this is an indication for conservative treatment with the use of antidiabetic medications and insulin injections.

If the patient did not take proper care of his health, did not visit the clinic, led an unhealthy life, became obese, the body does not forgive this. Complications inevitably follow: an increase in blood glucose levels (up to 20 millimoles per liter, detection of acetone in the urine).

A patient with a sharp deterioration ends up in the clinic. There are no options here other than a diagnosis of diabetes mellitus and switching to insulin injections.

Indications for the temporary use of insulin hormone injections may include serious concomitant diseases (complex pneumonia, heart attack), as well as conditions in which it is impossible to use pills (staying in intensive care, postoperative period):

• Hyperglycemia due to severe stress (sugar above 7.8 millimoles per liter) also requires temporary support of the body with Insulinum injections.
• Women diagnosed with T2DM during pregnancy may be prescribed a maintenance insulin course due to the increased load on the body.

Sugar dependence type 2 is considered a chronic endocrine pathology. With age, concomitant ailments often occur, and the underlying disease worsens. Increasing intake of tablet forms begins to cause complications and adversely affect overall well-being. In this option, the patient is transferred to full insulin therapy.

As non-insulin-dependent diabetes develops, sometimes the use of dietary restrictions and the introduction of a certain regimen to stabilize glucose levels becomes insufficient. Now comes the turn of oral medications and insulin injections.

Antidiabetic medications in tandem with hormonal injections can minimize the dose of the latter and prevent possible post-insulin complications.

Insulin monotherapy for T2DM is usually used in cases of severe decompensation of the pancreas, late diagnosis, development of dangerous complications and ineffectiveness of oral agents.

In any case, you should not be afraid of hormonal injections; they are not addictive.

At what sugar level is insulin prescribed?

From the above, it becomes clear that non-insulin-dependent diabetes, unlike insulin-dependent diabetes, can be treated with oral medications.

However, if the pills are powerless, insulin medicine comes into play. Doctors also resort to insulin therapy if the patient's glucose test results are more than 7 millimoles per liter before meals or more than 11.1 millimoles per liter after a couple of hours after a meal.

It is important to remember that you cannot decide on your own at what sugar level to inject insulin. The decision to prescribe insulin therapy can only be made by the attending endocrinologist.

The choice of dose of insulin injections is a serious measure and depends on many factors (stage of the disease, test results, patient’s condition, etc.). An individual approach to treatment plays an important role.

To help, there are standard dosage selection schemes as general guidelines for prescriptions.

"Long-term" insulin

Long-acting insulin is designed to maintain normal glucose levels during non-eating periods.

You can check the correctness of the prescribed dosage of “long-term” Insulinum experimentally:

• on the first day, do not have breakfast and monitor glycemia every 1-1.5-2 hours,
• on the second day, do not have lunch and carry out the same observation,
• on the third day, go without dinner and check your glucose level every hour or two.

Additionally, such measurements should be made at night. If the glycemic readings have not changed (an error of one or two millimoles per liter is acceptable), the dose is chosen correctly.

Therapy with long-acting insulin hormones allows for a single injection per day. At what time is it better to give this injection (in the morning or evening hours) - your own body should tell you.

"Short" insulin

A bolus is the administration of “ultra-short” or “shortened” bidirectional insulin:

• to maintain normal glycemic levels after digestion of food,
• reducing sugar surge.

A food bolus is a therapeutic dose that allows you to absorb what you eat, and a correction bolus is a therapeutic dose that combats the resulting hyperglycemia.

As a result, an injection of an “emergency” insulin drug is a symbiosis of food and correction boluses.

Currently, a variety of rapid-acting insulin medications have been developed. For example, “shortened” Actrapid is most effective a couple of hours after use and requires a snack during this period. The result of the introduction of “ultra-short” NovoRapid is felt faster and the patient does not need a snack.

Knowing how many insulin units are needed to compensate for one unit of bread or 10-13 g of carbohydrates will help you choose the right dosage.

When using a standard algorithm, the individual characteristics of the body are taken into account and changes are made.

Choosing a treatment regimen

The general daily scheme of how and when to inject insulin for T2DM looks like this:

• a morning injection of “rapid” insulin stabilizes sugar between breakfast and lunch,
• a morning injection of a long-acting hormone will ensure the glycemic level before dinner (for 12 hours),
• evening administration of a rapid-acting insulin drug will compensate for hormone deficiency from dinner until bedtime (until 24.00),
• an evening dose of "long-acting" Insulinum will provide protection during the night.

The above formula is subject to adjustments in the following cases:

• change in the course of the underlying disease,
• physiological conditions (pregnancy, menstrual cycle, nervous overload and others),
• change of seasons,
• individual characteristics of a person.

Life with sugar addiction definitely changes. A timely visit to an endocrinologist will help you decide on treatment, avoid complications and maintain your usual rhythm of life for many years.

has been used quite often lately. This article provides information about those situations when insulin therapy for type 2 diabetes mellitus may be required. There are cases when a patient with the second type of disease needs to be urgently transferred to an insulin therapy regimen.

Unfortunately, not only patients with type 1 diabetes have to switch to insulin therapy. Often such a need arises in the second type. It is not for nothing that such terms as “non-insulin-dependent diabetes” and “insulin-dependent diabetes” are excluded from the modern classification of diabetes, since they do not fully reflect the pathogenetic mechanisms of the development of the disease. Dependence (partial or complete) can be observed in both types, and therefore today the terms “type 1 diabetes” and “type 2 diabetes” are used to designate types of the disease.

Sad but true!

All patients, without exception, whose own secretion of the hormone is completely absent, cannot be stimulated, or is insufficient, requires lifelong and immediate insulin therapy. Even a slight delay in the transition to insulin therapy may be accompanied by progression of signs of decompensation of the disease. These include: the development of ketoacidosis, ketosis, weight loss, signs of dehydration (dehydration), adynamia.

The development of diabetic coma is one of the reasons for untimely transition to insulin therapy in type 2 diabetes. In addition, with prolonged decompensation of the disease, complications of diabetes quickly arise and progress, for example, diabetic neuropathy and angiopathy. About 30% of diabetic patients currently require insulin therapy.

Indications for insulin therapy for type 2 diabetes mellitus

Every endocrinologist, from the moment of diagnosis of type 2 diabetes, must inform his patients that insulin therapy is one of the highly effective treatment methods today. Moreover, in some cases, insulin therapy may be the only possible, adequate method of achieving normoglycemia, that is, compensation of the disease.

Information about the reserve capabilities of the beta cells of the gland should play a leading role in making decisions about prescribing insulin therapy. Gradually, as type 2 diabetes mellitus progresses, beta cell depletion develops, requiring immediate transition to hormonal therapy. Often, only with the help of insulin therapy can the required level of glycemia be achieved and maintained.

In addition, insulin therapy for type 2 diabetes may be required temporarily in some pathological and physiological conditions. The following are situations when insulin therapy for type 2 diabetes is required.

1. Pregnancy;
2. Acute macrovascular complications such as myocardial infarction and stroke;
3. A clear lack of insulin, manifested as progressive weight loss with normal appetite, the development of ketoacidosis;
4. Surgical interventions;
5. Various infectious diseases, primarily of a purulent-septic nature;
6. Unsatisfactory performance of various diagnostic research methods, for example:

• fixation of low levels of C-peptide and/or insulin in the blood on an empty stomach.
• repeatedly determined hyperglycemia on an empty stomach in cases where the patient takes oral hypoglycemic drugs, follows a regimen of physical activity and diet.
• glycosylated hemoglobin more than 9.0%.

Points 1, 2, 4 and 5 require a temporary switch to insulin. After stabilization of the condition or delivery, insulin can be discontinued. In the case of glycosylated hemoglobin, its monitoring should be repeated after 6 months. If during this period of time its level decreases by more than 1.5%, you can return the patient to taking glucose-lowering tablets and stop using insulin. If there is no noticeable decrease in the indicator, insulin therapy will have to be continued.

endokrinoloq.ru

Treatment strategy for progression of type 2 diabetes mellitus
In the natural progression of type 2 diabetes mellitus (DM), a progressive failure of pancreatic beta cells develops, leaving insulin as the only treatment that can control blood glucose in this situation.
About 30-40% of patients with type 2 diabetes require long-term insulin therapy for constant glycemic control, but it is often not prescribed due to certain concerns of both patients and doctors.

Problems of early prescription of insulin therapy
Both the patient and the doctor have many concerns before starting insulin therapy. The patient's fear of injection is the main barrier to insulin therapy. The doctor’s main task is to choose the right insulin, its dose, and teach the patient the injection technique. The instructions for performing this manipulation are relatively simple, so it does not take much time to master them. New insulin injection systems and pens make injections easier and even less painful than finger pricking for glycemic monitoring.

International Diabetes Federation recommendations
In 2005, the International Diabetes Federation published the World Guidelines for Type 2 Diabetes. We provide recommendations for prescribing insulin therapy in patients with type 2 diabetes.
1. Insulin therapy should be initiated when optimized use of oral hypoglycemic agents and lifestyle measures fails to maintain blood glucose control at target.
Lifestyle measures should continue to be used once insulin therapy is started. The initiation of insulin therapy and each increase in the dose of the drug should be considered as an experimental one, regularly monitoring the response to treatment.
2. Once a diagnosis of diabetes is made, it is necessary to explain to the patient that insulin therapy is one of the possible options that contribute to the treatment of diabetes, and, ultimately, this method of treatment may be the best and necessary for maintaining blood glucose control, especially when treated for a long time .
3. Provide patient education, including lifestyle control and appropriate self-control measures. The patient should be reassured that low initial doses of insulin are used for safety reasons; the required final dose is 50-100 units/day.
Insulin therapy should be initiated before poor glucose control develops, usually when HbA 1c levels (DCCT standard) increase to > 7.5% (if data are confirmed) while taking maximum doses of oral glucose-lowering drugs. Continue treatment with metformin. After starting basic insulin therapy, it is necessary to carry out therapy with sulfonylurea derivatives, as well as alpha-glucosidase inhibitors.
4. Use insulin in the following modes:
basal insulin: insulin detemir, insulin glargine or neutral protamine insulin Hagedorn (NPH) (with the latter there is a higher risk of hypoglycemia) once a day, or
premixed insulin (biphasic) twice daily, especially if HbA 1c levels are higher, or
multiple daily injections (premeal short-acting insulin and basal insulin) when glucose control is suboptimal with other treatment regimens or when a flexible meal schedule is desired.
5. Initiate insulin therapy with a self-titration regimen (increasing the dose by 2 units every 2 days) or with the help of a healthcare professional once a week or more often (with a gradual dose-increasing algorithm). Target glucose level before breakfast and main meal –< 6,0 ммоль/л, если такой уровень не достижим, следует проводить мониторинг в другое время суток для определения причин неудовлетворительного контроля уровня глюкозы в крови.
6. Providers should provide patient care over the telephone until target levels are achieved.
7. Use pens (prefilled or refillable) or syringes/vials of the patient's choice.
8. Encourage subcutaneous injections of insulin into the abdomen (fastest absorption) or thighs (slowest absorption), with the gluteal region and forearm also being possible injection sites.
Evidence-based guidelines for the use of insulin in type 2 diabetes are based on data from the UKPDS study, which examined insulin among antidiabetic agents, considering them together, which led to a reduction in vascular complications compared with conventional therapy. Since this study, the options for insulin therapy methods have expanded significantly, new drugs and methods of their delivery to the body have appeared. A review of the evidence by NICE found a trend towards lower quality ratings for studies of older drugs, as well as an increase in the amount of evidence from studies of newer insulin analogues. A recent meta-analysis found strong evidence of less severe hypoglycemia with insulin glargine compared with NPH insulin. Insulin glargine has been the subject of specific NICE guidance, which provides recommendations for its use in cases where a sufficient effect is observed with a once-daily injection or when the use of NPH insulin leads to hypoglycaemia. More studies of insulin analogues and comparisons of basal insulin analogues and fixed formulas were later published. The findings suggest that basal insulin analogues are superior to NPH insulin for the combined endpoints (HbA1c + hypoglycemia), with similar benefits for biphasic and basal analogues when high HbA1c levels, hypoglycemia and weight gain are considered together. The risk of hypoglycemia is higher with insulin than with any insulin secretagogue.
In type 2 diabetes, intensive insulin therapy has been proven to improve metabolic control, clinical outcomes, and quality of life. There is currently insufficient data on the results of treatment of type 2 diabetes with the use of infusion pumps to recommend this method, although their use is possible in a very limited group of patients subject to a strict individual approach.

Achieving compensation for type 2 diabetes mellitus
Diabetes is a special kind of disease in which the needs of patients are constantly changing. A clear understanding of the progressive nature of type 2 diabetes determines the choice of the most optimal treatment at each stage of its development.
The pathogenesis of type 2 diabetes includes two main components: deficiency of insulin secretion and insulin resistance. Therefore, treatment of the disease should be aimed at correcting these defects. An important feature of type 2 diabetes is the progressive decline in beta cell function over the course of the disease, while the degree of insulin resistance does not change. A large number of patients already have a marked decline in beta cell function by the time diabetes is diagnosed. Data from recent studies show that this decrease is of a very specific nature: while maintaining basal secretion, the postprandial response of beta cells is reduced and delayed in time. This fact dictates the need to choose drugs for the treatment of patients with type 2 diabetes that can restore or imitate the physiological profile of insulin secretion.
The progressive deterioration of beta cell function (over time) requires the initiation of additional therapy immediately after diagnosis (Fig. 1). This is confirmed by the results of the UKPDS study, which showed that with dietary therapy alone, only 16% of newly ill patients achieved optimal control within 3 months, by the end of the first year of the disease this number had decreased to 8%.
Before starting drug therapy, special attention must be paid to diet and lifestyle changes of the patient. In most patients, treatment begins with PSSP monotherapy, which brings positive results only in the first stages of the disease. Then there is a need to prescribe combination therapy aimed at correcting both insulin deficiency and insulin resistance. Most often, two or more oral drugs are prescribed, complementary to each other in their mechanism of action. This strategy ensures glycemic control for a number of years, but approximately 5 years after the diagnosis of diabetes, a progressive decrease in insulin secretion leads to the ineffectiveness of complex therapy for PSSP. Despite the fact that the patient's health may remain relatively satisfactory, indicators of carbohydrate metabolism convincingly prove that it is necessary to prescribe insulin therapy.

When should insulin therapy be started for type 2 diabetes?
1. Insulin therapy is prescribed as soon as PSSP in combination with physical activity can no longer adequately control glycemic levels.
2. In case of pronounced side effects of PSSP, lifestyle features, taking medications for the treatment of concomitant diseases and progression of type 2 diabetes, it is advisable to evaluate the possibility of prescribing insulin therapy.
3. Transfer to insulin therapy should be considered if the HbA1c level is persistently above 7% during PSSP therapy.
4. The combination of oral medications and insulin therapy provides better long-term control and less likelihood of weight gain than insulin monotherapy.

The relevance of timely administration of insulin therapy
Results from the Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) provide convincing evidence that achieving good glycemic control significantly reduces the risk of macro- and microvascular complications. However, strict requirements for carbohydrate metabolism indicators are not an end in themselves for either the doctor or the patient. The International Diabetes Federation, focusing the attention of diabetologists on the prevention of various types of complications, has developed degrees for assessing the risk of developing macro- and microvascular complications. The main parameters for calculating risk include HbA 1c, fasting plasma glucose and, most importantly, the level of postprandial glycemia (PPG). To reliably reduce the risk of developing macrovascular complications, stricter control over the parameters of carbohydrate metabolism is required compared to microvascular risk. At the same time, for patients with type 2 diabetes, it is primarily important to reduce the risk of macrovascular complications, i.e., heart attacks and strokes - the most common causes of premature death. It follows that patients with type 2 diabetes need careful adherence to glycemic control goals, so it is necessary to regularly evaluate cardiovascular and metabolic risk factors that determine the prognosis of diabetes in order to promptly prescribe corrective therapy.
Numerous studies and extensive clinical experience have proven that prescribing insulin analogues to patients with type 2 diabetes provides:
improvement of control of carbohydrate metabolism in case of unsuccessful PSSP therapy;
more effective maintenance of optimal control of carbohydrate metabolism than with PSSP therapy;
the opportunity for patients to lead a more active lifestyle, which increases their motivation to follow the doctor’s recommendations.
It is important for patients to know that after starting insulin therapy to improve glycemic control parameters, the obvious benefit of this therapy is observed within 3-6 months.
Thus, previously existing concerns about a possible increase in cardiovascular risk during insulin therapy are refuted. Weight may increase with insulin therapy, but the combination of metformin and insulin usually reduces the risk of weight gain in obese patients. Psychological barriers to initiating insulin therapy can be partially overcome by trial injections after diagnosis. This will reassure patients that insulin injections using modern thin needles are less invasive and painful than those used for vaccination.

Indications for prescribing insulin for type 2 diabetes
If glycemic control is unsatisfactory, the possibility of prescribing insulin is first considered. Early identification of such patients is possible with regular monitoring of HbA 1c levels. In a fairly wide range of patients, there are restrictions regarding increasing the PSSP dose, contraindications to certain or most PSSPs. These patients primarily include:
with complications due to PSSP;
receiving concomitant therapy with drugs that have side effects similar to PSSP;
with renal and liver failure.
In addition, insulin therapy is prescribed to patients seeking greater freedom from regimen restrictions and at the same time wanting to achieve the best levels of carbohydrate metabolism.
A well-designed insulin regimen eliminates the nutritional restrictions associated with many oral medications.
Short courses of insulin therapy should be prescribed to patients with type 2 diabetes in the event of concomitant diseases, pregnancy, myocardial infarction and corticosteroid therapy. In such situations, blood glucose is a more accurate indicator of glycemic control than HbA1c and should be monitored daily to determine the appropriate insulin dose.

At what level of HbA 1c can one switch to insulin therapy?
The results of a North American study involving 8 thousand patients with type 2 diabetes suggest that insulin therapy is especially effective in reducing HbA 1c if its level exceeds 10% (normal HbA 1c = 4.5-6%). However, waiting until glycemic control becomes so poor would be inappropriate. International guidelines recommend that clinicians review therapy and consider prescribing insulin (possibly in combination with PSSP) if the patient's HbA 1c level consistently exceeds 7%.

Is it possible to switch a patient from a diet directly to insulin therapy without first prescribing PSSP?
In some cases, in patients with ineffective metabolic control, diet in combination with lifestyle changes can initiate insulin therapy without prescribing a PSSP. This treatment option is considered in patients with underweight, with identified antibodies to glutamate decarboxylase, indicating the likelihood of LADA diabetes (latent autoimmune diabetes of adults), as well as in patients with steroid diabetes. Some doctors, taking into account clinical experience, prefer to immediately transfer patients with severe hyperglycemia to insulin therapy. Research is currently ongoing to evaluate the effectiveness of such a strategy in slowing disease progression (Fig. 2).

Combination therapy is the first step when oral therapy is ineffective
Numerous studies have found that when the effectiveness of PSSP therapy decreases, the first step may be to add one injection of insulin to the existing PSSP regimen: this strategy provides more effective glycemic control compared to switching to insulin monotherapy. This benefit was found in both obese and non-obese patients. In addition, it has been confirmed that the administration of insulin leads to an improvement in the lipid profile in patients with hyperglycemia who are on PSSP therapy. It should be noted that combination therapy has less effect on body weight dynamics and is less likely to cause hypoglycemia compared to insulin monotherapy.
The reduced risk of obesity with combination therapy is due to a lower total dose of insulin compared to insulin monotherapy. In Hong Kong, a study was conducted in 53 patients with ineffective oral therapy who were divided into groups, one of which continued taking PSSP with the addition of one injection of insulin at bedtime, the other was switched to insulin therapy with two injections. As a result, patients in both groups showed equivalent improvements in long-term glycemic control, but weight gain and insulin dosage were significantly lower in the first group receiving combination therapy. The Finnish study, conducted over 3 months, involved 153 patients with type 2 diabetes, who were divided into five groups receiving different combination therapies. In this study, all patients receiving insulin therapy experienced similar improvements in glycemic control. Weight gain was minimal in the group receiving a combination of oral therapy and an evening injection of NPH insulin, compared with patients who were prescribed a combination therapy: a morning injection of NPH insulin or insulin therapy with two or three injections per day.
The advantage of prescribing intermediate-acting insulin in the evening was also proven in an American study of patients with resistance to sulfonylurea derivatives. Patients who received combination therapy with insulin injection in the evening had fewer episodes of hypoglycemia compared to those who used insulin injection in the morning. The recent FINFAT trial confirmed the particular benefit of metformin in preventing weight gain when given in combination with insulin. This study, which included 96 patients with type 2 diabetes and poor control during treatment with maximum doses of sulfonylureas, showed that administration of intermediate-acting insulin at bedtime in combination with metformin once a day provided a more pronounced reduction in HbA 1c levels, less weight gain and fewer episodes of hypoglycemia compared with a combination of insulin with glyburide + metformin or insulin therapy with two injections per day.
It is important to emphasize that the practical aspects of insulin therapy in patients with type 2 diabetes differ from those in patients with type 1 diabetes. Initiating insulin therapy in patients with type 2 diabetes does not mean the need for additional meals and counting bread units, as is recommended for type 1 diabetes. However, limiting calorie intake is very important for all overweight patients. Patients with severe glycosuria should remember the critical importance of dietary restrictions and adherence to physical activity when transferring to insulin therapy. Failure to adhere to strict dietary restrictions and exercise regimens may increase the risk of weight gain due to cessation of calorie loss while glycosuria decreases while glycemic control improves. Concern about possible hypoglycemia forces some patients to take extra food and avoid physical activity, so the doctor needs to explain the situation and ensure that the patient understands all aspects of the prescribed therapy.

How to start insulin therapy for type 2 diabetes?
When starting insulin therapy, it is important to follow the following recommendations.
1. The ongoing oral therapy can be continued by adding one insulin injection per day.
2. The choice of insulin depends on the level of residual insulin secretion, duration of diabetes, body weight and lifestyle of the individual patient.
3. Self-monitoring of glycemia is very important.
Many patients perceive the start of insulin therapy as a failure of the therapy, which causes them great anxiety. It is very important that the doctor explain to the patient the benefits of insulin therapy soon after diagnosis. It is extremely important that the patient understands that decreased pancreatic function is a natural course of type 2 diabetes. Consequently, at a certain stage in the course of type 2 diabetes, insulin therapy is inevitable. And when the maximum doses of PSSP no longer ensure the achievement of target glycemic values, the administration of insulin therapy cannot be postponed. It may improve glycemic control and thus the long-term prognosis of diabetes. Oral medications can be maintained or insulin monotherapy can be chosen.
Most clinicians believe that when initiating insulin therapy, it is necessary to continue therapy with PSSPs, which, in combination with insulin, prevent a sharp drop in glycemic levels, which significantly reduces the risk of hypoglycemia, and also limits significant fluctuations in blood glucose levels during the day. Metformin has particular advantages in limiting weight gain during insulin therapy. As glycemic control stabilizes with combination therapy, the physician should decide whether to continue oral therapy and discuss this with the patient. When transferring a patient to insulin therapy, it is necessary to take into account his individual characteristics.
Once the decision to initiate insulin therapy has been made, the physician must choose a strategy that will achieve the most effective therapeutic goals. There are no fixed dose titration schemes; at the initial stage, insulin doses should be titrated based on glycemic control indicators and the individual characteristics of the patient.
Basal insulin therapy in the mode of one or two insulin injections. There are several options for basal insulin therapy regimens. NPH insulin (isophane insulin) is given as one injection at bedtime or two or more throughout the day. The evening injection is most often combined with oral therapy; long-acting insulin therapy can be used as monotherapy. In patients with BMI< 30 кг/м 2 инсулинотерапию можно начинать с 10 ЕД инсулина НПХ перед сном, не отменяя пероральную терапию. Такая стартовая доза достаточно удобна, так как, не вызывая большого риска развития гипогликемии, обеспечивает быстрое улучшение гликемического контроля у большинства пациентов. Больным с ИМТ >30 kg/m2 prescribe ready-made insulin mixtures. Combination therapy with PSSP in combination with NPH insulin once a day maintains target glycemic control parameters for 1-2 years in most patients.
The development of new basal insulin preparations culminated in the creation of long-acting insulin analogues, insulin detemir and insulin glargine, which provide a more physiological and stable insulin profile than currently used long-acting insulins.
Ready-made insulin mixtures consist of bolus and basal insulin pre-mixed in a fixed proportion by adding a buffer suspension of protaminated insulin to an insulin solution of the same type. When starting insulin therapy, ready-made insulin mixtures are prescribed once or twice a day, both in combination with PSSP and as monotherapy. Therapy with mixed insulins generally results in significant improvements in glycemic control. Ready-made insulin mixtures can be prescribed to patients on PSSP when this therapy becomes ineffective.
For some patients, ready-made insulin mixtures are prescribed immediately after diet therapy. In patients with a BMI > 30 kg/m2, adding 10 units of a ready-mixed insulin 30/70 before dinner to oral therapy has a good effect. The dose is usually titrated by 2-4 units every 3-4 days and even more often. It is important that the use of mixed types of insulin practically does not change the patient’s lifestyle; in addition, it does not require frequent monitoring of glycemia - it is enough to monitor the blood glucose level once a day before breakfast and periodically carry out additional tests at night.
The ability to limit yourself to two insulin injections reduces the invasiveness of therapy compared to an intensive regimen and helps patients overcome the fear of multiple injections. Proportion accuracy is also important for patients who have difficulty mixing insulin on their own. Currently, it is customary to divide the daily dose of mixed insulin equally between morning and evening injections, but some patients achieve better results when prescribed 2/3 of the daily dose before breakfast and 1/3 before dinner.
Typically, 10-15 years after the diagnosis of diabetes, it becomes necessary to replace therapy with ready-made insulin mixtures with more intensive insulin therapy regimens. The decision on this is made by the doctor and the patient during a joint discussion.
Bolus insulin therapy with three injections per day. In some patients with partially preserved basal insulin secretion, bolus insulin injections 3 times daily may provide satisfactory glycemic control for 24 hours. This regimen does not cover the need for basal insulin secretion, so regular glycemic monitoring is necessary to identify patients whose reduced level of endogenous basal insulin secretion does not allow continued bolus insulin therapy. For some patients, the regimen of three prandial insulin injections per day is a transitional stage to its more intensive variants, prescribed for severe deficiency of insulin secretion.
Basis-bolus insulin therapy. A significant decrease in the endogenous secretion of basal insulin leads to the need to prescribe a combination of bolus and basal insulin (intensive insulin therapy). This regimen is prescribed in cases where other treatment options are ineffective. However, the question of when to prescribe intensive therapy remains controversial: some doctors prefer to consider the possibility of prescribing it already in the early stages of the disease.
Thus, the goal of prescribing insulin in patients with type 2 diabetes is to avoid symptoms associated with hyperglycemia and late complications of the disease. The use of insulin for type 2 diabetes can significantly improve the quality of life of patients.

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http://www.thenhf.com/article.php?id=3635

Heidi Stevenson

People with diabetes should inject insulin - this seems intuitive. This is probably true for type 1 diabetics, when the pancreas stops producing insulin. However, modern doctors usually prescribe insulin to people with type 2 diabetes simply because it lowers blood sugar levels.

The reality is that type 2 diabetics who are given insulin injections are twice as likely to die as those who are given non-insulin treatments!

The study, Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyperglycemic Therapies in Type 2 Diabetes, included 84,622 primary patients with type 2 diabetes between 2000 and 2010, and compares the results of the following treatments:

Metformin monotherapy;

Sulfonylurea monotherapy;

Insulin monotherapy;

Metformin and sulfonylurea combination therapy;

Insulin and metformin combination therapy.

These groups were compared on the risks of several severe outcomes: cardiac problems, cancer and mortality. The primary outcome was defined as the occurrence of one of the three events listed above, with each such event counted once and only if the first occurrence of an adverse outcome occurred. Any of these events occurring at any time plus microcapillary complications were considered as a secondary event. The results were dramatic.

Those who received metformin therapy had the lowest mortality rates, so this group was used as a control group.

In terms of the primary outcome, that is, when only the first occurrence of adverse events was considered:

With sulfonylurea monotherapy, patients were 1.4 times more likely to experience one of these outcomes;

The combination of metformin and insulin resulted in a 1.3-fold increase in risk;

Insulin monotherapy resulted in a 1.8-fold increase in risk;

If we consider the occurrence of any of these events, regardless of whether it is a primary event or a secondary one, the results turn out to be even more dramatic.

Insulin monotherapy led to:

Increase in myocardial infarction by 2.0 times;

Increase in cases of serious damage to the cardiovascular system by 1.7 times;

Increase in stroke rate by 1.4 times;

Increase in the number of renal complications by 3.5 times;

Neuropathies by 2.1 times;

Ocular complications 1.2 times;

Increase in cancer cases by 1.4 times;

Mortality rate is 2.2 times.

Medical arrogance

The hubris and arrogance of modern medicine allows it to make claims that are simply not substantiated. Based on these unsubstantiated claims, thousands, and in the case of diabetes, millions of people are put on medications and regimens that have never shown any benefit. As a result, a huge number of people become guinea pigs for medical experiments - experiments that are not even documented or analyzed!

The use of insulin for type 2 diabetes is just one of many similar examples. One of the most striking such cases is the story of the drug Vioxx.

Reorientation to markers

The way in which such treatments are justified is a slight reorientation away from what really matters. The improvement in the quality and life expectancy of patients is significant. But pharmaceuticals are rarely tested to meet these criteria. The usual excuse that is put forward is that such research will take too much time. If this were a true explanation, we would see regulators carefully monitoring the results of new drugs during their first few years of use. But we simply don’t see this. Instead of observing truly significant outcomes, proxies are used. These are called markers and are intermediate results that are considered to indicate improvement. In the case of insulin, the marker is the blood sugar level. Insulin is required to transport glucose (blood sugar) into cells so they can produce energy. So, insulin lowers blood sugar levels. If artificial pharmaceutical insulin brings sugar levels to more “normal” levels, then the medicine is considered effective.

Erroneous markers

As the study demonstrated, markers simply cannot show the effectiveness of treatment. In the case of type 2 diabetes, the problem is not a lack of ability to produce insulin, nor is it a high level of glucose in the blood. The problem is the cells' ability to use insulin to transport glucose from the blood into the cells.

The problem is that the cells' ability to use insulin is impaired. So how can administering additional insulin be beneficial when the cells are unable to use the one already present in the body? It's actually counterproductive.

However, that's exactly what doctors do. They inject insulin to replace insulin when the problem is not a lack of insulin at all! It should therefore not be surprising that insulin therapy does not meet the real needs of people being treated for diabetes.

As this study demonstrated, injecting insulin into the body leads to worse outcomes. How many decades has this treatment method been in fashion? And all this time the excuse was that it lowers blood sugar levels. But significant effects—quality of life and life expectancy—were not taken into account.

Here we should learn the following lesson: health cannot be achieved with the help of pharmaceuticals, even with the help of time-tested reliable drugs.

Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyperglycemic Therapies in Type 2 Diabetes, Journal of Clinical Endocrinology & Metabolism, Craig J. Currie, Chris D. Poole, Marc Evans, John R. Peters and Christopher Ll. Morgan; doi:10.1210/jc.2012-3042

www.liveinternet.ru

When is insulin prescribed?

It is not always the case that a diabetic needs additional injections, but there are situations when insulin is prescribed for periodic or continuous administration. Indications for this are the following conditions:

• Insulin-dependent diabetes (type 1).
• Ketoacidosis.
• Coma – diabetic, hyperlaccidemic, hyperglycemic.
• Carrying a child and childbirth against the background of diabetes mellitus.

If diabetic coma occurs in type 1 diabetes, it is accompanied by ketocidosis and critical dehydration. The second type of disease in this case causes only dehydration, but it can be total.

The list of indications continues:

• If non-insulin-dependent diabetes is not treated in other ways, that is, therapy does not give positive dynamics.
• Greater weight loss is observed in diabetes mellitus.
• The development of diabetic nephropathy, accompanied by a failure of the nitrogen excretory function of the renal nephrons in type 2 diabetes.
• The presence of significant decompensation of type 2 diabetes mellitus, which can occur against the background of various factors - stress, infectious diseases, injuries, surgical procedures, exacerbation of chronic ailments.

According to statistics, 30% of all patients are prescribed insulin for type 2 diabetes.

Basic information about insulin drugs

Modern pharmacological enterprises offer a wide range of insulin preparations, which differ in duration of action (short, medium, long or long-acting) and degree of purification:

• monopeak - with a small admixture (within the normal range);
• monocomponent - preparations of almost perfect purification.

In addition, insulin for diabetics can vary in specificity: some drugs are derived from animal material.

Human insulin, which scientists have learned to synthesize using cloned genes of artificial origin, is also highly effective and hypoallergenic.

Review of means for administering insulin

There are several options for insulin injections, each of which has a number of nuances.

Table No. 1. Types of insulin injections

The use of each remedy has its own nuances, and a specialist should advise the patient on their correct use.

If type 1 diabetes is not treated without insulin injections, then non-insulin-dependent diabetes can be treated without it. Drugs of this type can be included in complex therapy as a temporary measure, or less often as a permanent measure. They are also prescribed for complications.

What types of insulins are there?

There are three types of drugs, differing in how quickly they work.

Table No. 2 Insulins of different speeds of action

Experts warn about the individual effect of insulin on each body, so regular self-monitoring of blood glucose levels is necessary.

How is the dosage calculated?

Like many other medications, the dose of insulin depends on the patient's body weight. It can vary from 0.1 to 1 unit per 1 kg of weight.

The administration of insulin is a kind of imitation of the work of the pancreas. That is, he is injected at those moments when she should secrete this enzyme. The main role of the injection is to utilize the glucose entering the body.

The dose of insulin changes periodically, depending on how much it is able to break down glucose. Moreover, the indicators are not the same at different times of the day. In the morning the indicators are elevated, and in the evening they decrease.

Life and diabetes

It may seem that diabetes is a death sentence. Naturally, upon hearing such a diagnosis, the patient begins to wonder how long people live with diabetes?

In fact, today life expectancy depends on the patient himself. Although medicine has not come up with a cure for this disease, it still offers options on how you can live with this disease.

There are recorded cases where a person suffering from diabetes lived to be 90 years old! This means that everything is in the hands of the patient, and only he can decide whether to live according to the rules or reduce his age.

The life of a diabetic is subject to rules, but it is worth looking at it from the other side. Following a diet improves appearance, gastrointestinal function and normalizes weight. Healthy sleep and exercise keep you healthy longer.

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