Monday, May 9, 2011

Insulin Therapy in Diabetes Mellitus Type 1

   Basic principles:

    • Intensified insulin therapy (mode "basal bolus"). Such a mode of insulin administration most closely matches the daily profile of insulin in humans without diabetes. Short-acting insulin (ICD) is inserted before each meal, insulin is longer-acting (SDI) introduced 1 or 2 times a day, creating a background concentration of insulin between meals (including at night).

    • The patient can and should be independently change the dose of insulin (in the first place, ICD), depending on blood glucose before meals and the amount of carbohydrates eaten (counting on the "bread units (XE), as well as taking into account physical activity, comorbidities, etc.

    • To successfully manage diabetes, the patient must undergo special training (usually a group) on a structured program "Diabetes School" (at least 20-25 hours of training, with the program, divided into training steps, with sufficient attention to the practical activity of patients, etc.).

    • Diet for type 1 diabetes is a "liberalized". Almost any dish can be estimated action with the help of bread units and balance it correctly calculated the short-acting insulin dose. Saved only minor limitations: (1) not more than 7-10 XE for eating, (2) avoid much carbohydrates (fruit juices, lemonade), because increase blood glucose after taking "ahead of" the action of insulin, (3) avoid foods in which it is difficult to calculate the XE and determine the rate of assimilation.

    • Role of the endocrinologist: monitoring the success of diabetes management (blood glucose measurement results, the patient recorded in the diary of self-control, glycated hemoglobin), assistance in making the right decisions on the calculation of doses of insulin (discussion blog), regular screening for early detection or exclusion of diabetic complications (assessment of the "target organs" DM).
    Means of insulin

    • Insulin syringes (with graduation not in ml, and in units of insulin, and a short (6-13 mm) needle for subcutaneous injection)

    • Syringe-pen (automatic syringe with a cartridge of insulin for several days). Injections and the addition of antimicrobial agents in the insulin eliminates the risk of inflammation and infection at the injection site, even if its holding through a thin layer of clothing. Treatment of skin with alcohol when insulin injections are required.

    • Bezigolny injector for insulin (sold in Russia, but has no great advantages over the syringe-pen)

    • dosing of insulin (insulin pump): portable and small device on his belt, which continuously delivers insulin short-acting subcutaneously injected through the catheter. Background (basal) of insulin similar to longer-acting insulin, and served during the meal boluses - short-acting drug. Dose of insulin (as in the background flow, and during the meal) is determined by the patient on the basis of the doctor's recommendations and the results of self-control (ie, pump does not regulate blood sugar automatically, on the basis of feedback). The pump is not removed at night, but can be switched off for a short time (up to 1-2 hours - on the shower, swimming, etc.).
The advantages of the pump before injection with a pen or a syringe - insulin in the lung at any number of carbohydrates taken even in small "bite" (the usual treatment of ICD is introduced, usually 2-4 times a day) and the ability to fine tune the speed of the background flow insulin at different times of day (important when the phenomenon of "dawn"). Disadvantages - the need for a permanent location on the pump body (even during sleep) and the high cost of equipment and consumables. Insulin pump to fully disclose its advantages in well-trained patients are able to successfully manage their glucose levels with conventional insulin. In this case, the transition to pump therapy treatment leads to some improvement in the diabet (reduction of glycated hemoglobin HbA1c by an average of 1%). 

Technology insulin

The correctness of insulin (both patients and medical staff) is very important, because if not properly introduce undesirable effect of insulin is attenuated or amplified, as is often unpredictable, ie, the strength of insulin action may not completely match the number of input units. If unexpectedly weak effect of insulin or "chaotic behavior" of glycemia during the day checking equipment injections - the first and necessary step in finding the causes of decompensation. This can be done with a special leaflet

No comments:

Post a Comment