Treatment of type 2 diabetes with insulin. Insulin for diabetes mellitus: when is it prescribed, dosage calculation, how to inject? Why do you need to dilute insulin and how to produce it correctly?

Everyone who has type 2 diabetes is afraid of this terrible word - insulin. “They’ll put me on insulin, that’s it, this is the beginning of the end” - such thoughts probably appeared in your head when the endocrinologist told you about your unsatisfactory tests and the need to change treatment. It's not like that at all!

Your future prognosis is determined by your sugar levels, your so-called “compensation” for diabetes. Do you remember what glycated hemoglobin is? This measure reflects what your glucose levels have been over the past 3 months. There are large-scale studies that show the relationship between the incidence of strokes, heart attacks, diabetes complications and the level of glycated hemoglobin. The higher it is, the worse the prognosis. According to the recommendations of the ADA/EASD (American and European Diabetes Associations), as well as the Russian Association of Endocrinologists, HbA1c (glycated hemoglobin) should be less than 7% to reduce the risk of developing diabetes complications. Unfortunately, if you have type 2 diabetes, there may come a time when your own beta cells stop producing enough insulin and the pills cannot help. But this is not the beginning of the end! Insulin, when used correctly, will lower blood sugar levels and prevent the development of complications of diabetes. In the arsenal of treatments, this is the most powerful drug and, moreover, this is the so-called “physiological” method of treatment; we give the body what it lacks. Yes, there are certain inconveniences, since insulin is still administered by injection, but this is not as scary as it seems at first glance. In this article we will look at when insulin therapy is indicated, how to adjust insulin doses and several other key aspects that are worth paying attention to in this matter.

Attention! This article is for informational purposes only and should not be taken as a direct guide to action. Any changes in therapy are possible only after agreement with your attending physician!

What blood sugar and glycated hemoglobin levels should you have?

If your sugars do not fit within these limits, treatment adjustments are required.

BUT : For people who have had severe hypoglycemia in the past, the very elderly, those with severe comorbidities, severe complications of diabetes, and those who are unable to control themselves (due to mental, social or visual impairments), less stringent treatment goals are given, glycated hemoglobin should be no more than 8%. Why? Low blood sugar in this case is more life-threatening than slightly elevated blood sugar numbers.

Why is insulin therapy not always prescribed on time?

Mostly due to the sharp denial of the need for insulin therapy by the patient and due to the inertia of the doctor, too much effort needs to be expended and too much to explain to prescribe such treatment. Considering that it takes 10-15 minutes to see a patient at a clinic doctor, it often ends with the doctor simply prescribing the previous therapy. And diabetes remains decompensated, sugar levels are high, and diabetes complications are approaching faster and faster.

When do you start insulin therapy?

If your treatment - glucose-lowering drugs and lifestyle changes - is ineffective, then it is time to add insulin to your therapy.

Compatibility of oral hypoglycemic drugs and insulin.

Metformin should be continued (of course, in the absence of contraindications, for example, renal failure).

If you use short-acting insulin before meals, then taking secretagogues (drugs that stimulate insulin secretion by the pancreas) is canceled.

If you use only basal insulin, then the dose of sulfonylurea drugs should be reduced, and it is better not to use this class of drugs together with insulin due to the high risk of hypoglycemia (low blood sugar).

Let's look at the different insulin therapy regimens and how you can change the doses.

Basal insulin and hypoglycemic drugs.

As a rule, the starting dose of insulin is 10 units or 0.1-0.2 units/kg of ideal body weight.

Dose adjustment is based on fasting sugar levels. Your blood sugar goal is determined by your healthcare provider. The insulin dose is changed every 3 days. You evaluate the average fasting sugar over these 3 days and, depending on its value, change the insulin dose.

Mixed insulin or biphasic.

Perhaps your endocrinologist will prescribe you a similar insulin, for example Novomix or Humulin M3. The initial dose is 12 units before dinner. You can also start with 2 insulin injections before breakfast and dinner, 6 units each.

It should be noted that it is necessary to discontinue sulfonylurea drugs; metformin can be left in the absence of contraindications.

The insulin dose is changed 1-2 times a week.

If your HbA1c level is unsatisfactory, then your doctor may add a 3rd injection of biphasic insulin before lunch (2-4 units), the effectiveness of this dose will need to be assessed by sugar before dinner.

Basis-bolus insulin therapy.

If, despite prescribing insulin therapy with basal or biphasic insulin, your blood glucose level remains off target, your endocrinologist will most likely offer you a similar treatment option. Basis is basal insulin, bolus is “meal” insulin.

The issue of insulin titration can be solved in two ways, ideal and correct, and the second.

It is ideal to navigate not only by the glucose level before and after meals, but also by the amount of carbohydrates eaten. But for this you will need to have some knowledge and understand how to count grain units. You can see this method in the corresponding section about type 1 diabetes and calculating insulin doses. Moreover, with type 2 diabetes mellitus, all relationships and proportions are usually very simple and do not change depending on the time of day, for example, approximately 1 unit of insulin is required to absorb 1 unit of bread.

The second method requires that you eat a certain, stable amount of carbohydrates for breakfast, lunch and dinner.

Dose titration is based on postmeal blood glucose levels, meaning if you want to change your insulin dose for breakfast, you should assess your blood glucose before lunch. Insulin doses are changed once every 3 days until the target glucose values ​​are reached. Based on fasting glucose levels, the dose of basal insulin is adjusted.

If your glucose level is high or low, you should change your basal (long-acting) insulin dose before breakfast rather than injecting bolus insulin at dinner.

Remember, based on your morning fasting glucose level, you will change your basal insulin dose.

Evaluation of treatment effectiveness.

It is necessary to monitor your blood glucose levels at least 4 times a day to achieve target blood glucose levels and reduce the likelihood of hypoglycemia (low blood sugar).

And in conclusion, I would like to say that, at first glance, everything probably seems very complicated and confusing to you. Understanding comes gradually; it would be better if you worked closely with your endocrinologist, and would be “more than one warrior in the field.” Remember, you can and should ask questions; if some prescriptions seem illogical and confusing to you, ask your endocrinologist.

If you have type 2 diabetes, it is important to remember your diet and nutritional rules to stabilize your sugar levels. Violation of the amount of carbohydrates, incorrect accounting of bread units, cooking in violation of recommendations, consumption of prohibited foods can lead to sharp jumps in glucose and provoke dangerous complications.

At what sugar level do you start taking insulin? This question worries patients who have confirmed endocrine pathology. Will the concentration of glucose and glycated hemoglobin remain at an acceptable level? When will you need hormone therapy? The answers largely depend on proper nutrition. Features of the diet for type 2 diabetes and the nuances associated with the use of insulin are reflected in the article.

Causes and symptoms of type 2 diabetes

Endocrine pathology develops against the background of metabolic disorders and hormonal imbalance. In the second type of diabetes, the pancreas produces insulin in sufficient quantities or the secretion of the hormone is slightly reduced, but the tissues are insensitive to the influence of the hormone. A consequence of the pathological process is problems with glucose absorption.

Due to a lack of energy, the balance in the body and the course of many processes are disrupted. To correct pancreatic abnormalities, you need to produce more insulin all the time so that at least a small part of the hormone affects the absorption of glucose. An unbearable load against the background of insulin resistance quickly wears out the gland, especially with poor nutrition, overeating, and frequent consumption of spicy, smoked, fatty foods, baked goods, and sweets.

Factors provoking the development of endocrine pathology:

• genetic predisposition,
• obesity,
• disturbance of metabolic processes,
• fatigue, decreased immunity,
• life under stress,
• lack of rest and sleep,
• hormonal disorders,
• pathological processes and tumors of the pancreas.

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Symptoms:

• dry mucous membranes,
• I'm constantly thirsty
• skin itching,
• urinating more often than usual
• blurred vision,
• poor wound healing,
• fluctuations in appetite and weight,
• nervousness or apathy,
• vaginal candidiasis (in women),
• decreased libido, erectile dysfunction (in men),
• hearing loss,
• increase in pressure.

At what sugar level do you start taking insulin?

Treatment of type 2 diabetes mellitus should take into account the age and individual characteristics of the person, work schedule, diet, the presence of other chronic pathologies, the degree of damage to the pancreas, and sugar levels.

Important details:

• An experienced endocrinologist explains to the patient that he needs to calmly accept the transition to insulin injections and not panic: many diabetics face this stage of therapy. The only difference is that some are prescribed daily injections after diagnosis, while others need injections 510 years after the start of treatment,
• administration of insulin is not a punishment for poor nutrition or failure to follow recommendations, but a vital measure to maintain the optimal course of physiological processes and reduce the risk of hypoglycemic coma,
• delay in switching to storage hormone injections can lead to a sharp increase in glucose concentration. You should not wait if the pancreas cannot cope with its functions, diet, pills of sugar-lowering drugs, physical activity do not allow you to maintain good sugar levels.

When will you need insulin injections? Most often, diabetics with type 2 pathology begin insulin therapy after a long period after diagnosis. It is important to consider at what stage the doctor diagnosed diabetes.

When prescribing storage hormone injections, take into account:

• glycated hemoglobin indicators do not exceed 77.5%, glucose from 8 to 10 mmol/l, pancreatic functions are preserved. The patient can maintain sugar levels for a long time with the help of oral medications,
• glycohemoglobin levels are increased to 8% or more, glucose levels exceed 10 mmol/l. In most cases, switching to insulin injections will be needed sooner than after 5 years.

Insulin therapy for type 2 diabetes is:

• constant,
• temporary.

The patient can receive:

• insulin injections. Antihyperglycemic drugs are ineffective,
• combination of tablets with insulin injections. The number of injections varies from one to two or three or more per day. The dosage is also selected individually.

The patient receives injections:

• immediately after identifying hyperglycemia, confirming the diagnosis,
• during therapy, at different stages of treatment, against the background of progression of endocrine pathology, if taking pills does not reduce sugar to optimal values. Many people switch to injections after 710 years.

Prescription of temporary insulin therapy:

• in case of stress hyperglycemia (an increase in glucose concentration during a serious illness with intoxication, an increase in temperature) against the background of type 2 diabetes, insulin injections are prescribed for a certain period. With an active form of pathology, doctors detect sugar levels of more than 7.8 mmol/l. Recovery occurs more quickly if diabetes is closely monitored for glucose concentrations.
• switching to temporary insulin therapy is needed in conditions when the patient cannot take pills: in the pre- and postoperative period during surgical intervention in the gastrointestinal tract, in acute intestinal infections.

Diet rules

Table No. 9 is the best option for maintaining sugar levels within acceptable limits. The diet for type 2 diabetes mellitus is quite strict, but with the non-insulin-dependent type of the disease, it is nutrition that comes to the fore. Injections or insulin tablets and sugar-lowering drugs are additional measures.

Note! In most cases, diabetics learn to do without the hormone while the pancreas copes with insulin production. Only with a severe stage of the pathology, a significant increase in sugar concentration, it is necessary to urgently begin hormonal therapy. The more accurately the patient adheres to the rules of nutrition, the longer the start of daily insulin intake can be delayed.

General principles of nutrition

For type 2 diabetes, it is important to strictly follow the instructions and follow the food preparation rules:

• exclude items with sugar from the diet,
• To give a pleasant taste to compotes, tea, fruit puree, jelly, use sweeteners: sorbitol, xylitol, fructose, stevia. Dosage as directed by the doctor,
• steam, boil, bake,
• replace animal fats and margarine with vegetable oils. Salted lard and cracklings, which many people love, are forbidden. Use unsalted butter sparingly and in small quantities.
• adhere to the diet: sit down at the table at the same time, do not skip the next meal,
• You need to get at least one and a half liters of fluid per day,
• give up fried, smoked foods, baked goods, marinades and pickles, excess salt, canned vegetables and fruits,
• the optimal energy value of the daily diet is from 2400 to 2600 kilocalories,
• Be sure to count bread units, eat types of food with low glycemic and insulin indexes. On the website you can find tables for diabetics, the use of which allows you to avoid increasing glucose concentrations,
• get slow carbohydrates (bran, cereals, pasta made from durum wheat, oatmeal, fruits). Avoid low-use, fast carbohydrates. Diabetics are harmed by halva, cookies, sugar, pies, cakes, dumplings, jam, jam. You cannot eat sweets, bars, milk or white chocolate. The dark variety of chocolate with 72% cocoa is rarely allowed, in small quantities: GI is only 22 units,
• Eat fruits and vegetables more often without heat treatment. In baked and boiled foods, GI values ​​increase, which negatively affects sugar levels. For example, raw carrots: Gl 35, boiled already 85, fresh apricots 20, canned fruits with sugar 91 units,
• eat potatoes in their jackets: GI is 65. If a diabetic decides to eat chips or French fries, then sugar increases more actively: the glycemic index when frying increases to 95 units.

Authorized Products

For diabetes, it is useful to eat the following names and dishes:

• vegetable soups,
• kefir, cottage cheese, yogurt (low-fat types, in moderation),
• seafood,
• cereals, with the exception of rice and semolina porridge,
• chicken egg white, yolk once a week. The best option for a protein omelette is
• vegetables for diabetes: zucchini, pumpkin, tomatoes, cucumbers, eggplants, peppers, all types of cabbage. Vegetables with a high glycemic index (potatoes, boiled carrots and beets) are allowed in small quantities, no more than three times a week,
• a weak broth in the second water (drain the liquid with extractive substances the first time after boiling) based on lean fish, turkey, chicken fillet, beef can be obtained twice a week,
• bran little by little, several times a week, wholemeal bread, grain bread, pumpkin bread, rye bread, no more than 300 g per day. Avoid crackers, baked goods, pizza, pastries, pies, cheap pasta, gingerbread, and dumplings. White bread and loaf sharply limit the glycemic index to 100 units,
• berries and fruits for type 2 diabetes mellitus with a low sugar content, low GI: cherries, plums, currants, green apples, pears, chokeberries, citrus fruits. Severely limit bananas. Freshly squeezed juices are prohibited: there is a sharp jump in glucose levels,
• desserts without sugar. Fruit and berry jelly with fructose, compotes with sweeteners, jelly, sugar-free marmalade, fresh fruit and berry salad,
• hard cheese (little by little, two to three times a week),
• lean fish, turkey meat, rabbit, chicken, veal, beef,
• seaweed,
• vegetable oils little by little, add to salads and ready-made first courses, frying fish and meat is prohibited,
• mushrooms, little by little, boiled or baked,
• nuts (in small quantities), three to four times a week,
• greens: dill, cilantro, green onions, parsley, lettuce,
• chicory-based coffee drink, green tea, weak coffee with milk (necessarily low-fat), mineral water (least warm, still).

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Prohibited names

You can't eat:

• chocolate bars,
• granulated sugar and refined sugar,
• alcohol,
• salty cheeses,
• fatty dairy products,
• semolina and rice porridge,
• desserts with sugar,
• fatty pork, duck, goose,
• offal,
• canned food,
• sausages,
• animal fats,
• smoked meats,
• mayonnaise, ready-made sauces and ketchups,
• fast food,
• baked goods, especially fried pies,
• cakes and pastries,
• sweet cheese curds in chocolate glaze, curd mass,
• fruits with high GI, including dried: grapes, dates, figs,
• sweet soda,
• halva, jam, pastille, preserves, marmalade, other sweets with sugar, artificial colors, flavors.

Prevention of sugar surges in diabetes will be successful if the patient strictly adheres to the diet, exercises, does not overeat, takes prescribed medications, tries not to overwork, and is less likely to get nervous. Do not be afraid of switching to partial or full insulin therapy: timely administration of pancreatic hormone injections prevents severe complications against the background of critically high levels of glucose and glycated hemoglobin. It is important that a diabetic is supported by loved ones: the correct attitude towards insulin therapy is an important aspect of treatment.

From the following video you can learn more about the rules of nutrition for the disease, as well as recipes for dietary dishes for type 2 diabetes:

Diabetes mellitus of the first and, in some cases, type two requires insulin therapy. Moreover, insulin can only be introduced into the body through injections or a pump; no other methods of getting insulin into the body are effective. The pills prescribed for type 2 diabetes only help the body produce insulin on its own.

Our article will focus on injections, namely how to calculate the dose of insulin.

With type 1 insulin, the human pancreas is not at all capable of independently producing a hormone such as insulin, which is necessary for the breakdown of carbohydrates in the body. In type 2 diabetes, the body cannot cope with the volume of incoming carbohydrates, and then the person either takes medications that stimulate the production of this hormone, or (in later stages of the disease) takes insulin by injection.

First of all, you need to understand that for different types of diabetes, the insulin dose is selected according to similar algorithms, however, if with type 1 insulin is needed every day (and it must be kept in close proximity at all times), then with type 2 the need for insulin is much lower.

What you need to know and do to calculate insulin

First, you need to adhere to a low-carbohydrate diet, that is, try to include more proteins and fats in your diet than carbohydrates. If a diabetic patient does not follow this diet or follows it irregularly, then it is impossible to calculate the dose of insulin for diabetes mellitus that will be periodically introduced into the body, because it will change each time depending on the carbohydrates entering the body. If you do not follow a low-carbohydrate diet, you will need to inject different amounts of insulin each time, which leads to unwanted spikes in blood sugar levels.
Also, you need to learn to eat approximately the same amount of carbohydrates at each meal.
Check your blood sugar levels often with a glucometer to understand when and why they change. This will help keep it in a normal state (4.5-6.5 mmol/l).
Remember also that sugar behaves differently in the human body depending on physical activity (their type, volume and duration), the amount of food taken, the daily routine and the type of insulin.

Physical exercise

After unplanned or newly introduced physical activity and exercise, sugar levels in the body may change - both rise and fall. It is necessary to take these surges into account, and each body reacts individually, so for the first 3-7 days of sports or other types of exercise, it is worth measuring your blood sugar level with a glucometer before and after exercise; and if they are long-lasting, then during exercise with a frequency of 1 hour/1-1.5 hours. Depending on the recorded changes, it is worth changing the dose of insulin taken.

Insulin dose and body weight

As a rule, the insulin dose is calculated taking into account the main criterion - body weight. The table below shows how many units of insulin are per 1 kilogram of a person’s weight. Depending on the state of the body, these indicators are different. By multiplying this indicator by your weight, you will get the daily insulin dose.

The amount of carbohydrates entering the body

The dose of insulin for diabetes mellitus directly depends on how much and at what time of day you eat. All foods typically contain carbohydrates, proteins and fats. We are interested in carbohydrates. Typically, proteins and fats are not taken into account when calculating your insulin dose. There is its own system for calculating carbohydrates contained in food - the system of bread units (XE). It is approximately known:

• 1 unit of short-acting insulin covers about 8 g of carbohydrates;
• 1 unit of NovoRapid and Apidra insulin - about 12 g of carbohydrates;
• 1 unit of Humalog insulin - about 20 g of carbohydrates;
• 1 unit of short-acting insulin - about 57 g of protein entering the body or approximately 260 g of fish, meat, poultry, eggs, cheese;
• 1 unit of NovoRapid and Apidra insulin covers about 87 g of protein entering the body or approximately 390 g of fish, meat, poultry, eggs, cheese;
• 1 unit of Humalog insulin - about 143 g of protein entering the body or approximately 640 g of fish, meat, poultry, eggs, cheese.

Here we come across names of insulins that you may not be familiar with yet; we’ll talk about them in the following chapters.

Carbohydrate-containing products

• All bakery products;
• Cereals (and dark cereals are lower in carbohydrates than light ones: buckwheat is a cereal with the lowest carbohydrate content, rice has the highest);
• Dairy products;
• Fruits;
• All sweets made without sugar substitutes.

Types of insulin

• Fast-acting (ultra-short exposure);
• Short impact on the body;
• Average duration of exposure to the body;
• Prolonged exposure;
• Combined (pre-mixed).

Of course, your attending physician will determine the type of insulin you need. However, you need to know how they differ. In principle, everything is clear from the names - the difference is in how long it starts working and how long it lasts. The table will help you get an answer to the question of which insulin is better.

Basis-bolus insulin therapy for diabetics

In a healthy person, insulin is produced not only when carbohydrates enter the body, but throughout the day. This is necessary to know in order to avoid sudden jumps in blood sugar, which has negative consequences for blood vessels. Basis-bolus insulin therapy, also called “multiple injection therapy,” precisely involves a method of taking insulin in which both short/ultra-short-acting and long-acting insulin is administered. Long-acting insulin is administered every day at the same time, since its action lasts for 24 hours, the dose of such insulin is always the same, it is calculated either by the attending physician, or after observations by measuring blood sugar every 1.5-2 hours for 3-7 days. Next, the following calculations are made:

1. The amount of the hormone insulin required for the body is calculated (body weight x indicator in the table)
2. The amount of short-acting insulin consumed is subtracted from the resulting value.

The resulting value is the desired result, the number of units of long-acting insulin that you need.

Short-acting insulin is administered 30 minutes before meals, ultra-short-acting insulin 15 minutes. It is possible to administer it after food, but in this case an unwanted jump in sugar levels in the body is possible. In addition to basal-bolus insulin therapy, there is also traditional therapy. In the traditional method, a diabetic rarely measures the sugar level in the body and injects insulin at approximately the same time at a fixed dose, with only minor deviations from the established norm. The basal-bolus system involves measuring sugar before each meal, and depending on blood sugar levels, the required dose of insulin is calculated. Basal-bolus therapy has its pros and cons. For example, the need to adhere to a very strict diet and daily routine disappears, but now, having slightly lost vigilance and not injecting insulin on time, you risk allowing a jump in sugar levels, which negatively affects the blood vessels in the human body.

Insulin for type 1 diabetes

In type 1 diabetes, insulin is not produced by the body at all, so insulin for type 1 diabetics is a vital drug. It must be used at least 4 times every day - 1 time with long-acting insulin and 3 times before each meal (if there are more meals, then insulin injections too). Insulin therapy for type 1 diabetes is very strict and its violation can lead to disastrous consequences.

Insulin for type 2 diabetes

Insulin is not always necessary for type 2 diabetes. In the early stages of the disease, patients take medications that stimulate the human body’s independent production of insulin. Only in the later stages, when the disease is advanced, is insulin indispensable. Insulin therapy for type 2 diabetes is not so strict; injections are necessary only in cases where the pills do not bring the desired results. . When insulin is prescribed for type 2 diabetes, a diabetic patient should think more seriously about diet (observance and non-compliance), lifestyle and daily routine.

Why do you need to dilute insulin and how to produce it correctly?

Diluting insulin is not a process that every diabetic faces. It is necessary for those patients with diabetes whose dose of insulin is very small. Typically, the graduation scale on an insulin injection syringe is 1-2 units of insulin. The dose of insulin in the cases described above does not always reach these volumes; in this case, insulin is diluted using a special liquid. If 1 ml usually contains 100 units of insulin, by diluting it, you can achieve a more accurate result of introducing the drug into the body. So, now you know how to dilute insulin using this knowledge.

Insulin is injected into the base of the skin fold

Proper administration of insulin into the body

Calculating the dose and administering insulin are two of the most important issues that all diabetics should know perfectly.

Injecting insulin involves penetrating the skin with a needle, so this process must be performed according to a special algorithm to prevent anything other than insulin from entering the body.

• It is necessary to carefully clean the needle insertion site with an alcohol-soaked cotton swab;
• Wait a while for the alcohol to evaporate;
• Form a subcutaneous fat fold with a pinch;
• At an angle of 45-60 degrees, insert the needle into the base of the fold;
• Introduce the drug without releasing the folds;
• Unravel the fold and only then slowly pull the needle out of the skin.

Calculating insulin is a basic skill that every diabetic must master perfectly, because it is this that ensures the safety of health and life. Since there are different types of diabetes and different stages of the disease, and diabetics use different types of insulin and other medications, the dose of insulin for diabetics is different. For each individual case, an individual calculation and assistance from your attending physician is required.

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 administration regimen 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

Type of insulin	International name	Tradename	Action profile (standard large doses)			Action Profile (low carb diet, small doses)
			Start	Peak	Duration	Start	Duration
Ultra-short-acting (analogues of human insulin)	Lizpro	Humalog	After 5-15 minutes	In 1-2 hours	4-5 hours	10 min	5 o'clock
	Aspart	NovoRapid				15 minutes
	Glulisine	Apidra				15 minutes
Short acting	Insulin soluble human genetically engineered	Actrapid NM Humulin Regular Insuman Rapid GT Biosulin R Insuran R Gensulin R Rinsulin R Rosinsulin R Khumodar R	After 20-30 minutes	In 2-4 hours	5-6 hours	After 40-45 minutes	5 o'clock
Intermediate-acting (NPH insulin)	Isophane insulin human genetically engineered	Protafan NM Humulin NPH Insuman Bazal Biosulin N Insuran NPH Gensulin N Rinsulin NPH Rosinsulin S Khumodar B	In 2 hours	After 6-10 hours	12-16 hours	After 1.5-3 hours	12 hours if injected in the morning; 4-6 hours after injection at night
Long-acting analogues of human insulin	Glargine	Lantus	In 1-2 hours	Not expressed	Up to 24 hours	Slowly starts over 4 hours	18 hours if injected in the morning; 6-12 hours after injection at night
	Detemir	Levemir

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 even 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 large. 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 rise, all efforts are 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.

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When is insulin prescribed?

The discovery of insulin in 1921 and its practical use was a revolution in the treatment of diabetes. People stopped dying from diabetic comas. Due to the lack of other drugs at that time, patients with type 2 diabetes were also treated with insulin, and with very good effect. But even now, when a number of glucose-lowering drugs in tablets have been developed and are being used, the use of insulin is necessary in a fairly large category of patients with type 2 diabetes.

In most cases, this is not done for health reasons, but to achieve good blood sugar levels, if such a goal has not been achieved by all of the above means (diet, exercise and sugar-lowering pills).

It should be understood that there can be no harm to the body from treatment with insulin (an example is patients with type 1 diabetes mellitus who have been injecting insulin for decades from the very beginning of the disease).

Insulin preparations

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 after 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 Fig. 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).

Insulin treatment regimens

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 when administering long-acting insulin once or twice a day (see Fig. 12). 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.

The most common scheme for this regimen is the following combination of injections:

1. In the morning (before breakfast) - administration of short and long-acting insulin.
2. During the day (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

When treating with insulin, more frequent self-monitoring of blood sugar is mandatory, in some cases several times a day every day. These indicators are the basis for you and your doctor in making decisions about changing insulin doses, which will be discussed further. A special column appears in the diary regarding the nutrition of a patient on insulin - bread units.

Nutrition during insulin treatment

Unfortunately, the injected insulin “does not know” when and how much you eat. Therefore, you yourself must ensure that the action of insulin corresponds to your diet. Therefore, it is necessary to know which foods increase blood sugar.

As you already know, food products consist of three components: proteins, fats and carbohydrates. They all contain calories, but not all increase blood sugar. Fats and proteins do not have a sugar-raising effect, so they do not need to be taken into account from the point of view of insulin administration. Only carbohydrates have a real sugar-increasing effect, therefore, they must be taken into account in order to administer the appropriate dose of insulin.

What foods contain carbohydrates? This is easy to remember: most of the products are plant-based, and from animals - only liquid dairy products (milk, kefir, yogurt, etc.).

Products that increase blood sugar and require counting can be divided into 5 groups:

1. Cereals (cereals) - bread and bakery products, pasta, cereals, corn.
2. Fruits.
3. Potatoes.
4. Milk and liquid dairy products.
5. Products containing pure sugar, so-called easily digestible carbohydrates.

To eat a varied diet, you need to learn to replace some foods containing carbohydrates with others, but so that your blood sugar fluctuates slightly. This replacement is easy to do using the system bread units (XE). One XE is equal to the amount of a product containing 10-12 grams of carbohydrates, for example, one piece of bread weighing 20-25 g. Although such a unit is called “bread”, they can be used to express not only the amount of bread, but also any other product containing carbohydrates.

For example, 1 XE contains one medium-sized orange, or one glass of milk, or 2 heaping tablespoons of porridge. The convenience of the bread unit system lies in the fact that the patient does not need to weigh food on scales, but rather estimate this amount visually - using easy-to-perceive volumes (piece, glass, piece, spoon, etc.).

As mentioned above, traditional insulin therapy (two insulin injections per day) will require the same diet every day. When using intensive/insulin therapy, you can eat more freely, changing both the timing of meals and the number of bread units.

Rules for changing insulin doses

It is important for a patient on insulin therapy to learn how to independently change insulin doses as needed. But this can only be done if you self-monitor your blood sugar. The only criterion for correct insulin doses is the blood sugar levels measured by the patient himself during the day! Thus, an indicator of the correct dose of long-acting insulin in the evening will be normal fasting blood sugar and the absence of hypoglycemia at night. In this case, a prerequisite for assessment is the presence of normal blood sugar before bedtime, i.e. Long-acting insulin seems to maintain this figure until the morning.

In order to assess the adequacy of the dose of short-term insulin administered before a meal, it is necessary to measure the blood sugar level either 1.5-2 hours after a meal (at the “peak” increase in sugar), or, in extreme cases, just before the next meal (after 5-6 hours).

Measuring blood sugar before dinner will help assess the adequacy of the dose of short-term insulin before lunch with intensified insulin therapy or morning long-acting insulin with traditional one. Blood sugar before bed will reflect the correct dose of short-acting insulin before dinner.

Rules for reducing insulin dosage

The reason for reducing the planned dose of insulin is the occurrence of hypoglycemia if this hypoglycemia was not associated with a patient error (missed a meal or ate fewer grain units, made a technical error with insulin, had a lot of physical activity, or took alcohol).

1. Take sweet foods to relieve hypoglycemia.

3. Think about the cause of hypoglycemia. If one of the main four reasons is found (too much insulin, not enough XE, physical activity, alcohol), then correct the mistake the next day and do not change the insulin dose. If you have not found the cause, then do not change the insulin dose the next day, since this hypoglycemia could be accidental.

4. See if hypoglycemia recurs at the same time the next day. If it recurs, then it is necessary to decide which insulin is most likely to blame. To do this, we need knowledge of the time parameters of insulin action.
5. On the third day, reduce the dose of the appropriate insulin by 10%, rounding to whole numbers (usually 1-2 units). If hypoglycemia recurs again at the same time, the next day further reduce the insulin dose.

Below are examples of what a patient should do to reduce the dose of insulin if hypoglycemia occurs during the day with various insulin treatment regimens:

Patient 2.10 at 16:00 develops hypoglycemia. No obvious cause for hypoglycemia was found. The patient does not change the dose of insulin 3.10. Hypoglycemia repeats at 3 p.m. 4.10 the patient reduces the dose of the insulin that caused the hypoglycemia - long-acting insulin before breakfast - by 10% (from 22 units this will be 2 units), i.e. makes 20 units.

Patient 2.10 at 16:00 develops hypoglycemia. No obvious cause for hypoglycemia was found. The patient does not change the dose of insulin 3.10. Hypoglycemia repeats at 3 p.m. 4.10 the patient reduces the dose of the insulin that caused the hypoglycemia - mixed insulin before breakfast - by 10% (from 34 units this will be 3 units), i.e. makes 31 Units.

3) Before breakfast - short- and medium-acting insulin, before lunch - short-acting insulin, before dinner - short-acting insulin, before bed - medium-acting insulin.

Patient 2.10 at 16:00 develops hypoglycemia. No obvious cause for hypoglycemia was found. The patient does not change the dose of insulin 3.10. Hypoglycemia repeats at 3 p.m. 4.10 the patient reduces the dose of the insulin that caused the hypoglycemia - short-acting insulin before lunch - by 10% (from 10 units this will be 1 unit), i.e. makes 9 units.

Rules for increasing insulin dosage

The reason for increasing the planned insulin dose is the appearance of high blood sugar, which is not associated with any of the following patient errors:

1) little insulin (technical error with dose setting, inconsistency in concentration, injection into another area of ​​the body from which insulin is less absorbed);
2) many grain units (counting error);
3) less physical activity compared to usual;
4) concomitant disease.

The patient's actions should be as follows:

1. Increase the dose of short-acting insulin or mixed insulin at the moment.
2. Determine blood sugar before the next injection. If it remains normal, take the usual dose.
3. Think about the cause of high blood sugar. If one of the main four reasons is found, then the next day correct the mistake and do not change the insulin dose. If you have not found the reason, then do not change the insulin dose the next day, since this high sugar could be accidental.
4. See if the high blood sugar level returns at the same time the next day. If it happens again, then you need to decide which insulin is most likely “to blame” for this, knowing the time parameters of the action of insulin.
5. On the third day, increase the dose of the appropriate insulin by 10%, rounding to whole numbers (usually this will be 1-2 units). If high blood sugar occurs again at the same time, increase the insulin dose the next day.

Below are examples of what a patient should do to increase the dose of insulin when blood sugar is high before dinner with different insulin treatment regimens:

1) Before breakfast and before dinner - short- and medium-acting insulin.

Patient 7.09 has high blood sugar before dinner. No obvious cause for hyperglycemia was found. To quickly reduce this blood sugar, the patient increases the dose of short-acting insulin before dinner from 8 to 10 units. The patient does not change the insulin dose on the morning of September 8. High blood sugar recurs before dinner. The patient again takes 10 units of short-acting insulin before dinner. On September 9, the patient increases the dose of the insulin that caused hyperglycemia - long-acting insulin before breakfast - by 10% (from 22 units this will be 2 units), i.e. makes 24 Units. Before dinner on this day, the patient takes the same dose of short-acting insulin - 8 units.

2) Before breakfast and before dinner - mixed insulin.

Patient 7.09 has high blood sugar before dinner. No obvious cause for hyperglycemia was found. To quickly reduce this blood sugar, the patient increases the dose of mixed insulin before dinner from 22 to 24 units. The patient does not change the insulin dose on the morning of September 8. High blood sugar recurs before dinner. The patient again takes 24 units of mixed insulin before dinner. On September 9, the patient increases the dose of the insulin that caused hyperglycemia - mixed insulin before breakfast - by 10% (from 34 units this will be 3 units), i.e. makes 37 Units. Before dinner on this day, the patient takes the same dose of mixed insulin - 22 units.

3) Before breakfast - short- and medium-acting insulin, before lunch - short-acting insulin, before dinner - short-acting insulin, before bed - medium-acting insulin.

Patient 7.09 has high blood sugar before dinner. No obvious cause for hyperglycemia was found. To quickly reduce this blood sugar, the patient increases the dose of short-acting insulin before dinner from 8 to 10 units. The patient does not change the dose of insulin in the morning and before lunch on September 8. High blood sugar recurs before dinner. The patient again takes 10 units of short-acting insulin before dinner. 9.09 the patient increases the dose of the insulin that caused hyperglycemia - short-acting insulin before lunch - by 10% (from 10 units this will be 1 unit), i.e. makes 11 units. Before dinner on this day, the patient takes the same dose of short-acting insulin - 8 units.

You should be aware that any disease (especially of an inflammatory nature) may require more active action on the part of the patient to increase insulin doses. In this case, you will almost always need to take short-acting insulin in multiple injections.

Insulin storage

Like any medicine, insulin has a limited shelf life. Each bottle must indicate the expiration date of the drug.

The insulin supply must be stored in the refrigerator at a temperature of 2-8 degrees Celsius (under no circumstances should it be frozen). Insulin vials or pens used for daily injections can be stored at room temperature for 1 month. Also, do not allow the insulin to overheat (do not leave it in the sun or in a closed car in the summer).

Be sure to put your insulin in paper packaging after injection, as insulin is destroyed by light. If you are carrying a supply of insulin with you (vacation, business trip, etc.), you cannot check it in your luggage (it can get lost, crash, and freeze on the plane).

Insulin concentration

Currently, two concentrations of insulin are used in Russia: 40 units in 1 ml of the drug (U-40) and 100 units in 1 ml of the drug (U-100). The concentration is indicated on each vial of insulin. In the same way, syringes are available for different insulin concentrations, and they are marked accordingly. Therefore, whenever you receive a new batch of insulin or new syringes, you should check that the insulin concentration on the vials and syringes matches.

If there is a discrepancy, a very serious dosage error may occur, for example: 1) with a syringe designed for an insulin concentration of 40 U/ml, insulin is drawn from a bottle where the concentration is 100 U/ml - in this case, 2.5 times more insulin will be collected; 2) with a syringe designed for an insulin concentration of 100 U/ml, insulin is drawn from a bottle where the concentration is 40 U/ml - in this case, 2.5 times less insulin is collected.

Set of insulin in a syringe

The sequence of actions when collecting insulin using a syringe is as follows:

1. Prepare a bottle of insulin and a syringe.
2. If you need to administer long-acting insulin, mix it well (roll the bottle between your palms until the solution becomes evenly cloudy).
3. Draw as much air into the syringe as the number of units of insulin you will need to draw later.
4. Introduce air into the bottle.
5. First, draw a little more insulin into the syringe than needed. This is done to make it easier to remove air bubbles trapped in the syringe. To do this, lightly tap the body of the syringe and release the excess amount of insulin along with the air back into the bottle.

Is it possible to mix insulins in one syringe? This depends on the type of long-acting insulin. Those insulins that use protein (NPH insulins) can be mixed. The advisability of mixing insulin is to reduce the number of injections.

The sequence of actions when putting two insulins into one syringe is as follows:

1. Introduce air into the vial of extended-release insulin.
2. Inject air into the vial of short-acting insulin.
3. First, dial up short-acting insulin (transparent), as described above.
4. Then dial up long-acting insulin (cloudy). This should be done carefully so that part of the short-acting insulin that has already been collected does not end up in the bottle with the extended-acting insulin.

Since mistakes are still possible when mixing on your own, ready-made insulin mixtures are produced - the same combined insulins that have already been mentioned. Before taking this type of insulin, it must be mixed in the same way as extended-release insulin.

Insulin injection technique

The rate at which insulin is absorbed depends on which layer of the body the needle enters. Insulin injections should always be administered 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)

To give an insulin injection, you must:

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 index finger, 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.

Several areas of the body are used for insulin injections: 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