Wednesday, June 22, 2011

Insulin Shock Therapy

There are three basic modes of insulin therapy. They each have their advantages and disadvantages.

In a healthy person insulin secretion occurs constantly and is about 1 IU of insulin in 1 h, the so-called basal or background secretion. During the meal, a rapid (bolus) insulin concentrations increase many times over. Stimulated insulin secretion is approximately 1-2 units for every 10 grams of carbohydrates. While maintaining a constant balance between the concentration of insulin and the need for it on the basis of feedback.

A patient with diabetes mellitus type 1 requires insulin replacement, which would mimic insulin secretion under physiological conditions. Need to use different types of insulin at different times. To achieve satisfactory results by a single introduction of insulin in patients with diabetes type 1 is impossible. Injections can be from 2 to 5-6 times a day. The more injections, the treatment of insulin more close to physiological. In patients with diabetes mellitus type 2 with preserved beta cell function rather one-, two-time insulin to maintain the state for compensation.

1. Fixed-dose regime (regular insulin)

Treatment of diabetes in this mode assumes that the number of units of bread (carbohydrate) every day at every meal has remained relatively constant. Accordingly, doses of insulin are also constant (fixed). Before eating, we introduce a short insulin, insulin prolonged shooting up for a night or two times a day.

The total daily dose (short and extended) of insulin may reach 0.6-1.2 U / kg.

Insulin therapy in this mode is ineffective. Blood sugar with this method of treatment varies considerably from high to low values. Obtain compensation for diabetes, using the fixed-dose regime is almost impossible. But this option is included in the treatment of diabetes (especially the elderly), when you have to make compromises.

2. Intensive insulin therapy (base-bolus regime)

To simulate normal daily (basal) secretion of insulin 2 times a day (12 hours), prolonged insulin is introduced, usually a morning dose of insulin is somewhat greater than at bedtime.

To create a nutritional peak, "teasing" short insulin before each meal (3 meals - 3 short-bolus insulin). To calculate the dose of short-insulin is necessary to know their blood glucose before each meal and the planned number of units of grain at the reception.

Intensive insulin therapy simulates the normal functioning of the pancreas and consistent way of life. It is understandable optimistic motto "diabetes - is not a disease but a way of life" when the patient's freedom is not restricted, no restriction in the diet does not exist (as you eat, how much insulin was introduced, if eaten more than the estimated dose, just need to pin insulin).

3. Combined insulin

Combines diet, oral hypoglycemic drugs and insulin injections prolonged for a night or two times a day (usually 12 units in the morning and 8 units at bedtime).

Treatment of type 2 diabetes provides excellent results in most patients, if we use the following combination: insulin glargine (Lantus) once in the morning or evening, sulfonylurea + 3rd generation (MW Diabeton or Amaryl) once in the morning + (with obesity), metformin.

Vials short-acting insulin Actrapid and NovoRapid 10 ml vial at a concentration 100ME/ml.

Insulin therapy has the task of the maximum possible compensation of carbohydrate metabolism, prevention of hypo-and hyperglycemia, and thus prevent complications of diabetes. Insulin treatment is vital for people with diabetes type 1 and can be used in some situations for people with diabetes type 2.

Indications for the use of insulin therapy:

    Diabetes mellitus type 1
    Ketoacidosis, diabetic hyperosmolar.
    Pregnancy and childbirth in diabetes mellitus.
    A significant decompensation of diabetes mellitus type 2.
    Lack of effect of treatment of other ways of diabetes type 2.
    A significant reduction in body weight in diabetes mellitus.
    Diabetic nephropathy.

Currently, there are a lot of insulin, which differ in duration of action (ultrashort, short, medium and extended), the degree of purification (monocomponent), species specificity (human, porcine, bovine, genetically engineered, etc.)

In Russia, the insulin derived from cattle, derived from consumption, it is associated with more side effects when applied. Quite often when they are administered allergic reactions, lipodystrophy, insulin resistance develops.

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