1. The most common, formidable and dangerous thing is the development of HYPOGLYCEMIA. This is facilitated by:

Overdose;

Inconsistency between the administered dose and the food taken;

Liver and kidney diseases;

Other (alcohol).

The first clinical symptoms of hypoglycemia (vegetotropic effects of "fast" insulins): irritability, anxiety, muscle weakness, depression, changes in visual acuity, tachycardia, sweating, tremor, pallor of the skin, goose bumps, a feeling of fear. A decrease in body temperature during hypoglycemic coma has diagnostic value.

Long-acting drugs usually cause hypoglycemia at night (nightmares, sweating, anxiety, headache on waking - cerebral symptoms).

When using insulin medications, a patient should always have with him a small amount of sugar and a piece of bread, which, if there are symptoms of hypoglycemia, must be eaten quickly. If the patient is in a coma, then glucose should be injected into a vein. Usually 20-40 ml of a 40% solution is sufficient. You can also inject 0.5 ml of adrenaline under the skin or 1 mg of glucagon (in solution) into the muscle.

Recently, in order to avoid this complication, new advances in the field of technique and technology of insulin therapy have appeared and been put into practice in the West. This is due to the creation and use of technical devices that provide continuous administration of insulin using a closed-type device that regulates the rate of insulin infusion in accordance with the glycemic level, or facilitates the administration of insulin according to a given program using dispensers or micropumps. The introduction of these technologies makes it possible to carry out intensive insulin therapy with the approach, to some extent, of insulin levels during the day to the physiological level. This helps to achieve compensation for diabetes mellitus in a short time and maintain it at a stable level, and normalize other metabolic parameters.

The simplest, most accessible and safe way to carry out intensive insulin therapy is to administer insulin in the form of subcutaneous injections using special pen-type devices (Novopen - Czechoslovakia, Novo - Denmark, etc.). Using these devices, you can easily dose and perform virtually painless injections. Thanks to automatic adjustment, using the pen syringe is very easy, even for patients with reduced vision.

2. Allergic reactions in the form of itching, hyperemia, pain at the injection site; urticaria, lymphadenopathy.

An allergy can be not only to insulin, but also to protamine, since the latter is also a protein. Therefore, it is better to use drugs that do not contain protein, for example, insulin tape. If you are allergic to bovine insulin, it is replaced with pork, whose antigenic properties are less pronounced (since this insulin differs from human insulin by one amino acid). Currently, in connection with this complication of insulin therapy, highly purified insulin preparations have been created: monopeak and monocomponent insulins. The high purity of monocomponent drugs ensures a decrease in the production of antibodies to insulin, and therefore, transferring a patient to monocomponent insulin helps to reduce the concentration of antibodies to insulin in the blood, increases the concentration of free insulin, and therefore helps reduce the dose of insulin.

Species-specific human insulin obtained by DNA recombinant method, that is, by genetic engineering, has even greater advantages. This insulin has even less antigenic properties, although it is not completely exempt from this. Therefore, recombinant monocomponent insulin is used for allergies to insulin, insulin resistance, as well as in patients with newly diagnosed diabetes mellitus, especially young people and children.

3. Development of insulin resistance. This fact is associated with the production of antibodies to insulin. In this case, the dose must be increased, and human or porcine monocomponent insulin must be used.

4. Lipodystrophy at the injection site. In this case, the site of administration of the drug should be changed.

5. Decreased potassium concentration in the blood, which must be regulated through diet.

Despite the presence in the world of well-developed technologies for producing highly purified insulins (monocomponent and human, obtained using DNA recombinant technology), a dramatic situation has developed in our country with domestic insulins. After a serious analysis of their quality, including international examination, production was stopped. Technology is currently being modernized. This is a forced measure and the resulting deficit is compensated by purchases abroad, mainly from Novo, Pliva, Eli Lilly and Hoechst.

1. Insulin resistance is a condition characterized by an increase in the dose of insulin as a result of a weakening of its hypoglycemic effect in response to the necessary physiological needs of the body.

According to severity, insulin resistance is divided into:

Light (insulin dose 80-120 units/day),

Medium (insulin dose up to 200 units/day),

Severe (insulin dose more than 200 units/day).

Insulin resistance can be relative or absolute.

Relative insulin resistance is understood as an increase in the need for insulin associated with inadequate insulin therapy and diet. The insulin dose, as a rule, does not exceed 100 units/day.

Absolute insulin resistance may be due to the following reasons:

Absence or decreased sensitivity of receptors of insulin-dependent tissue cells to the action of insulin;

Products produced by cells of mutant islets (low activity).

The appearance of antibodies to insulin receptors,

Impaired liver function in a number of diseases,

destruction of insulin by proteolytic enzymes during the development of any infectious-inflammatory process,

Increased production of counter-insular hormones - corticotropin, somatotropin, glucagon, etc.,

The presence of excess body weight (mainly with the android (abdominal) type of obesity,

The use of insufficiently purified insulin preparations,

The presence of allergic reactions.

In order to prevent the development of insulin resistance, it is necessary to exclude possible food allergens from the diet; strict adherence by patients to a diet and physical activity regimen, thorough sanitation of foci of infection.

To treat insulin resistance, it is necessary to transfer the patient to a regimen of intensified insulin therapy with monocomponent or short-acting human drugs. For this purpose, you can use insulin microdosers or the Biostator (Artificial Pancreas) device. In addition, part of the daily dose can be administered intravenously, which allows the rapid binding and reduction of circulating anti-insulin antibodies. Normalizing liver function also helps reduce insulin resistance.

Hemosorption, peritoneal dialysis, administration of small doses of glucocorticoids along with insulin, and the administration of immunomodulators can be used to eliminate insulin resistance.

2. Allergy to insulin is most often caused by the presence of protein impurities with pronounced antigenic activity in insulin preparations. With the introduction of monocomponent and human insulin preparations into practice, the frequency of allergic reactions in patients receiving them has significantly decreased.

There are local (local) and general (generalized) allergic reactions to insulin.

Local skin reactions to insulin administration include the following:

1. An immediate reaction develops immediately after insulin administration and is manifested by erythema, burning, swelling and gradual thickening of the skin at the injection site. These phenomena intensify over the next 6-8 hours and persist for several days. This is the most common form of local allergic reaction to insulin administration.

2. Sometimes, with intradermal injection of insulin, the development of so-called local anaphylaxis (Arthus phenomenon) is possible, when swelling and sharp hyperemia of the skin appear at the injection site after 1-8 hours. Over the next few hours, the swelling increases, the inflammatory focus thickens, and the skin in this area becomes black and red in color. Histological examination of the biopsy material reveals exudative-hemorrhagic inflammation. With a small dose of administered insulin, a reverse development begins after a few hours, and with a large dose, after a day or more, the lesion undergoes necrosis with subsequent scarring. This type of false insulin hypersensitivity is extremely rare.

3. A local delayed-type reaction is clinically manifested 6-12 hours after insulin injection by erythema, swelling, burning and hardening of the skin at the injection site, reaching a maximum after 24-48 hours. The cellular basis of the infiltrate consists of lymphocytes, monocytes and macrophages.

Immediate allergic reactions and the Arthus phenomenon are mediated by humoral immunity, namely by circulating antibodies of the JgE and JgG classes. Delayed-type hypersensitivity is characterized by a high degree of specificity to the administered antigen. This type of allergic reaction is not associated with antibodies circulating in the blood, but is mediated by the activation of cellular immunity.

General reactions can include urticaria, angioedema, bronchospasm, gastrointestinal disorders, polyarthralgia, thrombocytopenic purpura, eosinophilia, enlarged lymph nodes, and in the most severe cases, anaphylactic shock.

In the pathogenesis of the development of systemic generalized allergies to insulin, the leading role belongs to the so-called reagents - class E immunoglobulin antibodies to insulin.

Treatment of allergic reactions to insulin:

Prescription of monocomponent porcine or human insulin,

Prescription of desensitizing drugs (fenkarol, diphenhydramine, pipolfen, suprastin, tavegil, claritin, etc.),

Administration of hydrocortisone with microdoses of insulin (less than 1 mg hydrocortisone),

Prescription of prednisolone in severe cases,

If local allergic reactions do not go away for a long time, then specific desensitization is carried out, which consists of successive subcutaneous injections of insulin, soluble in 0.1 ml of isotonic sodium chloride solution in increasing concentrations (0.001 IU, 0.002 IU, 0.004 IU; 0.01 IU, 0 .02 units, 0.04 units; 0.1 units, 0.2 units, 0.5 units, 1 unit) at intervals of 30 minutes. If a local or generalized reaction occurs to the administered dose of insulin, the subsequent dose of hormones is reduced.

3. Lipodystrophy is a focal disorder of lipogenesis and lipolysis that occurs in the subcutaneous tissue at the sites of insulin injection. Lipoatrophy is more common, that is, a significant decrease in subcutaneous tissue in the form of a depression or pit, the diameter of which in some cases can exceed 10 cm. Much less often, the formation of excess subcutaneous fat, reminiscent of lipomatosis, is observed.

Significant importance in the pathogenesis of lipodystrophy is attached to long-term traumatization of tissues and branches of peripheral nerves by mechanical, thermal and physico-chemical agents. A certain role in the pathogenesis of lipodystrophy is assigned to the development of a local allergic reaction to insulin, and given the fact that lipoatrophy can be observed far from the site of insulin administration, also to autoimmune processes.

To prevent the development of lipodystrophy, the following rules must be followed:

Alternate insulin injection sites more often and administer it according to a specific pattern;

Before injecting insulin, the bottle must be held in your hand for 5-10 minutes to warm it to body temperature (under no circumstances should you inject insulin immediately after removing it from the refrigerator!);

After treating the skin with alcohol, you must wait a while for it to completely evaporate to prevent it from getting under the skin;

To administer insulin, use only sharp needles;

After the injection, it is necessary to lightly massage the insulin injection site, and, if possible, apply heat.

Treatment of lipodystrophy consists, first of all, in teaching the patient the technique of insulin therapy, then in prescribing monocomponent porcine or human insulin. V.V. Talantov proposed injecting the area of ​​lipodystrophy for therapeutic purposes, that is, injecting an insulin-novocaine mixture at the border of healthy tissue and lipodystrophy: a 0.5% solution of novocaine in a volume equal to the therapeutic dose of insulin, mixed and administered once every 2-3 day. The effect, as a rule, occurs within a period of 2-3 weeks to 3-4 months from the start of treatment.

The use of glucose-lowering drugs requires a very serious approach. These medications are selected by a doctor who focuses on the patient’s condition, blood sugar levels and its content in urine, the course and form of diabetes and other indicators. The choice of drug and its dosage is strictly individual: what works well for one patient may be contraindicated for another. Therefore, in no case should you use glucose-lowering drugs uncontrollably, because they can cause harm rather than benefit.

Antihyperglycemic drugs are not used in the treatment of insulin-dependent diabetes mellitus in children and are specially selected for pregnant women with diabetes mellitus.

There are three types of tableted hypoglycemic agents. They differ from each other in their chemical composition and characteristics of their effects on the body.

Sulfonamides

These drugs have a multifaceted effect on the body. Firstly, they enhance the formation and release of insulin into the blood. Secondly, they increase the sensitivity of organs and tissues to insulin. Thirdly, they increase the number of insulin receptors on cells. And finally, fourthly, they increase breakdown and reduce the formation of glucose in the liver.

Sulfonamide drugs act for 6-12 hours. In addition to the hypoglycemic effect, sulfonamides have a beneficial effect on blood vessels, improving their blood flow and preventing the development of diabetic damage to small vessels. In addition, second-generation drugs are well excreted by the intestines and do not put a strain on the kidneys, protecting them from diabetic complications.

However, with all the advantages of sulfonamides, they also have their own characteristics, so some people have contraindications to them. These drugs are prescribed with great caution to elderly people, who have a very slow elimination of these drugs from the body, and this leads to a gradual accumulation of drugs in the body and the occurrence of hypoglycemic states and coma. In addition, sulfonamides become addictive over time. The fact is that after 5 years of using these hypoglycemic agents, the sensitivity of tissue receptors to their effects decreases. As a result, they become ineffective or lose their impact altogether.

Indications for the use of sulfonamide drugs:

For non-insulin-dependent diabetes mellitus, when diet does not help reduce sugar, and the patient is not obese;

The same goes for the obese patient;

In insulin-dependent diabetes mellitus, which occurs in a labile form;

In the absence of a pronounced effect of insulin treatment in insulin-dependent type of diabetes mellitus.

Sometimes sulfonamides are combined with insulin therapy. This is done in order to enhance the effect of insulin and convert the labile form of diabetes into a stable form.

Biguanides

This type of hypoglycemic drug has a completely different effect on blood sugar levels. As a result of their use, glucose is better absorbed by muscle tissue. Biguanides influence cell receptors in such a way that insulin works better and normalizes sugar levels. These drugs have many positive properties.

They lower blood sugar; reduce the absorption of glucose in the intestine and its release from the liver; suppress the formation of glucose in the liver; increase the number of insulin-sensitive receptors in tissues; stimulate the breakdown of fats and promote their burning; thin the blood and suppress appetite.

But biguanides also have a significant drawback. They contribute to the accumulation of acidic products in the body and provoke the occurrence of hypoxia of tissues and cells, that is, their oxygen starvation. Although the use of biguanides rarely leads to the development of hypoglycemic conditions, they should be taken with great caution by the elderly and those who have concomitant chronic diseases of the liver, lungs and heart. In this case, side effects such as nausea, vomiting, abdominal pain, diarrhea, various allergic reactions and even the development of diabetic polyneuropathy are possible. Biguanides are mainly indicated for those people who have insulin-dependent diabetes with a stable course, as well as for patients with normal body weight and no tendency to ketoacidosis. Biguanides are also prescribed to patients with diabetes mellitus who are intolerant to sulfonamides or are addicted to them with no effect from treatment.

Glucobay

This drug slows down the absorption of glucose in the intestines and its entry into the blood. Thus, it reduces blood sugar levels in all types of diabetes. In addition, this drug is good because it reduces the level of triglycerides in the blood - substances that affect the development of insulin dependence in patients with non-insulin-dependent diabetes mellitus. This is a serious cause of the development of atherosclerosis. Glucobay is mainly prescribed for non-insulin-dependent diabetes, both as a single treatment and in combination with sulfonamide drugs. For insulin-dependent diabetes mellitus, glucobay is used in combination with insulin therapy. In this case, the patient reduces the dose of administered insulin.

An important advantage of glucobay is the absence of hypoglycemic reactions, therefore it is actively prescribed to elderly patients. But glucobay, like most glucose-lowering drugs, has side effects, which include diarrhea and bloating. The main contraindications to the use of glucobay are diseases of the gastrointestinal tract, pregnancy, breastfeeding, and age under 18 years. This drug is also not recommended for patients who have gastroparesis caused by diabetic neuropathy.

Treatment of pregnant women with glucose-lowering drugs

For pregnant women, glucose-lowering drugs are contraindicated because they penetrate the placenta and have a harmful effect on the development of the fetus, causing deformities and even death. Therefore, any type of diabetes mellitus in pregnant women is treated only with diet and insulin. But if a pregnant woman has non-insulin-dependent diabetes mellitus and was taking glucose-lowering medications before pregnancy, then she is gently switched to insulin. The transition from one type of treatment to another should be carried out under the control of blood and urine sugar. Usually, the compliance of the glucose-lowering drug with one dose of insulin is calculated, and the amount of the drug that the woman took is converted into the corresponding dose of insulin.

For example, one tablet of maninil corresponds to 7-8 units of simple insulin. And the daily amount of insulin is 6-8 units of insulin for every 2.7 mmol/l of blood sugar exceeding the norm (5.5 mmol/l). To this add 4 to 6 units of insulin in the presence of glucose in the urine.

But the main measures for treating diabetes during pregnancy should be aimed at compliance with nutrition and diet. The daily calorie content of food for a pregnant woman with diabetes should not exceed 35 kcal/kg body weight. Protein can be consumed no more than 1-2 g per kg of weight, carbohydrates can be eaten from 200 to 240 g per day, and fat - only 60-70 g per day. Easily digestible carbohydrates, such as semolina, confectionery, sweets, sugar, baked goods, white bread, should be completely excluded from the diet. And include in it foods rich in vitamins A, C, D, E, group B, as well as minerals and plant fibers.

Insulin therapy

Insulin therapy is the main method of treatment, or more precisely, the normalization of carbohydrate metabolism in insulin-dependent diabetes mellitus. In non-insulin-dependent diabetes mellitus, insulin therapy becomes an auxiliary treatment method, and in advanced stages, the main one. Insulin is used in absolutely all groups of patients - children, adults and pregnant women. However, insulin dosages and treatment regimens are different for everyone, and they depend not only on the category of the patient, but also on many other factors.

Insulin treatment is always used for insulin-dependent diabetes mellitus, and for non-insulin-dependent diabetes mellitus only when the disease is severe with decompensation. Insulin is also indicated for women with any type of diabetes during pregnancy, childbirth and breastfeeding. Insulin therapy is mandatory in case of life-threatening conditions of the patient - ketoacidosis, ketoacidosis, hyperosmolar and lactic acid coma, as well as in the presence of contraindications to the use of glucose-lowering drugs or the lack of effectiveness of the use of glucose-lowering tablets. Insulin is used for any severe complications of diabetes.

Types of insulins

Insulin is naturally produced by pancreatic cells and is a protein hormone that helps transport glucose into tissue cells. Insulin is never taken in tablet form, because it is a protein substance that is easily destroyed by gastric juice. Our task is to bring insulin to the cells. Therefore, this drug is always prescribed by injection.

Depending on their origin, insulins are divided into two types: human and animal.

Homologous human insulin

This type of insulin is produced artificially using genetic engineering methods. The basis is pork insulin, which differs from human insulin in only one amino acid - alanine. As a result of synthesis, this acid is replaced by another amino acid - threonine, and homologous human insulin is obtained.

Heterologous insulin

This type of insulin is obtained from the pancreas of pigs and cattle, which have similar characteristics to human pancreas.

In recent years, the production of heterologous insulin has been declining, and more and more diabetics are using homologous human insulin.

Insulins act on glucose differently, therefore, according to the duration of their effect, they are divided into three types: short-acting, medium-acting and long-acting (prolonged). To achieve a longer-lasting effect in the body, zinc or proteins are added to the composition of the insulin preparation during its manufacture.

Short acting insulins

These drugs can be administered subcutaneously, intravenously, and intramuscularly. Intravenous and intramuscular insulin is administered only when providing emergency care to a patient (in case of coma, etc.). Subcutaneous administration is used in the routine treatment of diabetes mellitus: patients use it independently.

When administered subcutaneously, the drug begins to act in 15–30 minutes, and the time for the greatest effect and the end of the action of insulin depends on the dose of the drug. Thus, with an insulin dose of up to 10 units, the maximum effect (lowering blood sugar) is achieved 1.5–2 hours after injection, and the end of the effect occurs after 4–5 hours. If the dose of insulin is from 11 units to 20 units, then the maximum effect is achieved after 2–2.5 hours, and the effect of insulin ends after 5–6 hours. It is not recommended to administer more than 20 units of insulin.

Short-acting insulins are used before meals, recalculating consumed carbohydrates per grain units. If the patient uses only this type of insulin (short-acting), then injects the drug at least four times a day.

Intermediate duration insulins

This type of insulin is used only for subcutaneous injections in routine therapy. The drug begins to act after 1.5–2 hours, reaching its maximum effect after 4–8 hours, and the total duration of action of insulin is 12–18 hours. Even relatively large doses of insulin continue to act for the same time. Typically, this type of insulin preparation is used 1-2 times a day in combination with short-acting insulin.

Prolongs, or long-acting insulins

This type of insulin is also used only subcutaneously and for routine treatment of diabetes mellitus. Insulin begins to act 4 hours after its administration, reaching its maximum effect after 8-24 hours. The total duration of action of long-acting insulin is 28 hours. Long-acting insulins are administered 1-2 times a day in combination with short-acting insulins. If a patient with diabetes mellitus uses long-acting insulins, he should know that there should be no break between the end of the action of one drug and the beginning of the action of another, otherwise the sugar level may quickly rise and hyperglycemia will occur. Therefore, long-acting insulin injections must overlap each other.

Combination insulin preparations

Combination insulin preparations are a mixture of short- and medium-acting insulins (called “profiles”) and short- and long-acting insulins (“mixtards”). They are designed for the convenience of administering insulin to patients who require two injections of two types of insulin at once. The profiles consist of 10–40% short-acting insulins and 60–90% intermediate-acting insulins. The combination of insulin mixtards is approximately the same. Typically, combined insulins are prescribed to patients twice a day - before breakfast and before dinner.

Various insulin therapy regimens

The purpose of insulin therapy is to imitate the natural production of insulin by the pancreas. Therefore, treatment regimens are selected in such a way as to fill the gap in the body’s functioning, taking into account its normal physiological activity. To do this, you need to know at what hours the pancreas is most active and at what hours it is passive. In a healthy body, the pancreas does not work with constant activity, but in two modes. At night and between meals, little insulin is produced, only 1 unit per hour. This is called basal or background insulin secretion. During meals, the pancreas is activated and increases the production of insulin, the amount of which depends on the nature and quantity of food. This is a nutritional secretion. In cases of diabetes mellitus, as a rule, both modes of operation of the pancreas are disrupted, so they must be imitated by administering insulin.

Long-acting drugs are used to simulate basal insulin secretion. To simulate alimentary insulin secretion, short-acting drugs are used, which are administered immediately before meals.

There are several options for using and combining insulin drugs. Insulin administration regimens are selected by the doctor depending on the type and development of diabetes, the presence of complications, and diet.

Treatment of pregnant women with diabetes with insulin

During pregnancy, taking antihyperglycemic drugs poses a great danger to the fetus, since these drugs enter the child’s blood through the placenta and contribute to the development of deformities and even death. Therefore, regardless of the form of diabetes, all pregnant women are transferred to insulin therapy, carefully selecting the dose of the medication. Pregnant women, even with transient (gestational) diabetes and mild forms of the disease, need to start insulin therapy as early as possible in order to prevent complications in the development of pregnancy.

For pregnant women, it is recommended to use only human insulin. The dosage of insulin administered during the day is 6–8 units for every 2.7 mmol/l blood sugar exceeding the norm of 5.5 mmol/l. If sugar is contained in the urine, then another 4-6 units of the drug are added to this amount of insulin.

Two types of insulin are usually used - short-acting insulin, which is administered intravenously, subcutaneously and intramuscularly, and long-acting insulin, which is administered only subcutaneously.

Insulin treatment of children with diabetes mellitus

For children, it is recommended to use the latest generation insulins of higher purity; they have less effect on the child’s immune system. It is necessary to begin treatment with short-acting insulins, gradually moving to medium- and long-acting insulins, adding them to the insulin therapy regimen. The selection of the insulin dose depends on the child’s well-being and changes in blood sugar levels. The doctor does this for the first time based on laboratory tests - blood glucose levels and loss of sugar in the urine.

Insulin must be injected subcutaneously into the area of ​​the anterior abdominal wall, shoulder, thigh, buttock or under the shoulder blade. For this, a special syringe pen or insulin syringe is used. Immediately before injection, insulin is heated to body temperature and administered only when the alcohol used to wipe the injection site has completely evaporated from the surface of the skin. Insulin is recommended to be injected slowly and deeply. Injection sites must be constantly changed to prevent the development of a complication from injections - lipodystrophy. Read more about the complications of insulin therapy below.

Intensive insulin therapy

Intensive insulin therapy is used to achieve long-term diabetes compensation and to prevent late vascular complications of diabetes.

There are certain rules for insulin therapy. So, before each insulin injection, the blood sugar level should be at least 5.7 mmol/l and no more than 6.7 mmol/l. Since sugar levels in diabetics rise significantly after eating, the administered insulin should reduce it, but only to certain limits: now it should be from 7.8 mmol/l to 10 mmol/l. However, it is not at all necessary to measure your blood sugar level every time after a meal; the main thing is to determine the glucose level before meals and choose the correct dosage of insulin. Although for special categories of patients - pregnant women and people suffering from concomitant pathologies - monitoring of these indicators is mandatory.

If blood sugar levels differ from those given, then an additional corrective dose of insulin must be administered. For this purpose, short-acting insulin is used, the dose of which is calculated so that the sugar level before the next injection corresponds to the given values.

Insulin therapy for morning hypoglycemia, dawn syndrome and Somogyi syndrome

In the morning, patients with diabetes often experience a rise in blood sugar. It happens:

1) due to too small a dose of short- or long-acting insulin used at night;

2) dawn syndrome, which appears around 6–9 am;

3) chronic insulin overdose syndrome (Somogyi syndrome), which manifests itself at 5–9 am.

How to relieve morning hypoglycemia

To relieve morning hyperglycemia caused by the first reason, that is, an insufficient dose of insulin administered at night, you simply need to increase the dose of short-acting insulin and administer it a little later, calculating the effect of insulin so that it is enough until breakfast. In addition or instead, you can increase the dose of long-acting insulin, which is administered before dinner and depends on the last meal.

How to deal with dawn syndrome

With dawn syndrome, there is an unexpected rise in blood sugar, independent of the dose of nighttime insulin, dietary disturbances, and nocturnal drops in blood sugar. This “dawning” syndrome occurs in patients with diabetes of both types quite often - in almost 75% of cases, and it mainly occurs during diet therapy or treatment with glucose-lowering drugs. This syndrome can appear even in healthy people, only their sugar levels rise to small values ​​that do not exceed the upper limit of normal. But this strange phenomenon can be explained quite simply: in the early morning, a person’s sensitivity to insulin decreases, since at this time the body actively produces other hormones - insulin antagonists: glucagon, cortisol and adrenaline. If these hormones are produced too intensively, which is due to the individual characteristics of the body, then this causes a strong jump in blood sugar. In this case, it is necessary to inject short-acting insulin in advance, at 5 am, without waiting for the “dawn” syndrome.

How to prevent Somogyi syndrome

Somogyi syndrome is morning hyperglycemia caused by an overdose of nighttime insulin, which quite often occurs due to errors in calculating the dose of long-acting insulin administered before dinner. At night, the patient’s sugar level drops significantly, and hypoglycemia occurs, which triggers protective mechanisms for regulating blood sugar and releases insulin antagonist hormones into the blood: glucagon, cortisone and adrenaline. And this leads to a sharp increase in blood sugar just in the early morning hours - from 5 to 9 hours.

To establish the presence of Somogyi syndrome, laboratory tests of portioned and daily urine for sugar and acetone are performed. If sugar and acetone are absent in some portions of urine, but are present in other portions, this indicates an increase in blood sugar after hypoglycemia caused by an overdose of evening insulin.

Somogyi syndrome can be eliminated by adjusting the administered insulin before dinner - its dose is reduced by 10-20% or even more. Another way is possible: shift the time of administration of medium-duration insulin to a later time, that is, administer it not before dinner, but at night before bed at 22-23 hours.

General methods for selecting insulin doses for patients with diabetes mellitus

The dose of the drug is calculated on the basis that 1 unit of subcutaneously administered insulin promotes the absorption of 4 g of glucose in compensated diabetes mellitus and 3 g of glucose in decompensated diabetes mellitus. The goal of insulin therapy is not only to maintain normal blood sugar levels, but also to normalize carbohydrate and fat metabolism, normalize body weight, and also prevent diabetic complications. Therefore, there are several ways to select the daily dose of insulin. They are calculated depending on the course and duration of the disease, as well as on the initial blood and urine sugar levels.

Devices for administering insulin. Syringe pens and other devices

There are several types of devices for administering insulin. For uncomplicated diabetes mellitus, plastic insulin syringes and special syringe pens are usually used. Of course, using syringe pens is more convenient, but an insulin syringe is also quite easy to use. The syringe has a built-in needle, so insulin dosing can be done quite accurately. However, you need to keep in mind that the syringe must be sterilized after each injection and stored in a protective case. If you follow these simple hygiene rules, you can use a plastic syringe many times until the needle becomes dull.

However, most patients with diabetes prefer to use syringe pens, which are equipped with an insulin cartridge (Penfill) and a sterile needle. They work like ink fountain pens. The needles in the syringe pen are disposable, and the penfills are changed as insulin is used. To administer a specific dose of insulin, a button is used, under the action of which the required amount of the drug enters the needle. The advantage of a syringe pen is that the injections are completely painless.

Microdosers are used for intensive insulin therapy. Using these devices, you can administer short- and long-acting insulins subcutaneously and intravenously at a given rate. Microdosers are special devices that are equipped with a device for monitoring blood sugar, so they are used to stabilize the course of diabetes and select the dose of insulin in the following cases:

For newly diagnosed diabetes mellitus;

In severe cases of diabetes mellitus;

For labile diabetes;

With frequent hypoglycemia;

If there is acetone in the urine;

In case of chronic insulin overdose;

If you are addicted to insulin.

Microdosers allow you to gradually increase the dose of insulin under the control of sugar levels in the blood and urine until a lasting effect is achieved in reducing sugar to normal levels. After this, the patient can switch to using syringe pens or insulin syringes.

In very serious cases and only in a hospital, a special device is used - a biostator. It allows you not only to quickly determine your blood sugar level, calculate and adjust the rate of insulin administration, but also injects glucose and insulin itself. This device is a pancreas simulator. The biostattor is used in the following cases:

For newly diagnosed diabetes;

For labile diabetes;

To remove the patient from a state of ketoacidosis and diabetic coma;

During childbirth and surgery.

Rules for administering insulin

Patients with diabetes and parents of sick children have to independently master the technique of administering insulin. This is not particularly difficult, but you need to know well the injection rules, as well as the places where insulin can be injected.

Areas for subcutaneous insulin injection: the front wall of the abdomen, under the shoulder blades, outer thighs, buttocks, shoulder. Since even during the day you have to give several injections, the injection sites for insulin need to be alternated, and according to a certain pattern. If the previous injection was made in the anterior wall of the abdomen, then the next injection should be made in the same area, but 2-3 cm higher, then move the insulin injection site 2-3 cm lower, then to the left and finally to the right of the previous injection site. After this, insulin can be injected into the thigh, and the injection sites there also need to be changed. Then - to another area, etc. Then, by the time the insulin is injected again into the front wall of the abdomen, the injection marks will have time to heal.

Different areas respond slightly differently to insulin. Thus, insulin is absorbed most quickly from the anterior wall of the abdomen. And the slowest is from the front of the thigh. Therefore, it is recommended to inject at certain places at the same hours. For example, if you injected insulin into the thigh in the morning, and under the shoulder blade in the evening, then the next day follow the same scheme: in the morning - into the thigh, in the evening - under the shoulder blade. Then the effectiveness of insulin throughout the day will be approximately the same.

Different types of insulin are better absorbed in certain areas. Thus, short-acting insulin is most often recommended to be injected into the anterior wall of the abdomen. Long-acting insulin is usually injected into the buttocks, the front of the thigh, under the shoulder blades, or into the upper arm.

Injecting insulin into the shoulder should be done very carefully and in the most extreme cases, when other places are too punctured and there is a risk of complications developing. The fact is that the muscles in the shoulder are very close to the skin, and insulin can accidentally get there. In the muscle, it is absorbed into the blood much faster than subcutaneously, as a result, the effect of insulin will manifest itself faster.

Insulin is injected subcutaneously to a depth of 0.5 cm. In this case, it is necessary to get the needle into the subcutaneous layer between the muscles and the skin. To avoid getting into the muscle, you need to know the technique and sequence of the injection.

1. Using the thumb and forefinger of one hand, slightly pull the skin at the injection site so that a fold forms on the skin. But do not squeeze the skin too hard with your fingers.

2. With your other hand, take the syringe as you usually hold a pencil.

3. Holding the syringe vertically, with one movement of your hand, insert the needle along its entire length into the base of the fold.

4. Press the plunger or press the button to inject insulin into the subcutaneous tissue and count to ten.

5. Remove the needle from the skin.

Needles come in lengths of 12 mm and 8 mm. Depending on the patient’s build, the needle size is selected. Thin people are advised to use a shorter 8 mm needle, while others use a standard 12 mm needle. After the injection, a small bruise may appear at the injection site, which will quickly disappear.

Rules for storing insulin

To maintain the activity of insulin, it must be kept in the refrigerator at a temperature of 2–8 ° C, and warmed to body temperature before use. Be sure to read the shelf life of the insulin drug, which is written on the ampoule, as it has a limited time. If the insulin preparation is a suspension, that is, a mixture, then it looks cloudy, so it must be mixed thoroughly by rolling the ampoule between your palms. This way, the insulin solution will become homogeneous and can be injected under the skin. If flakes appear in the insulin, it has changed color or thickened, it means that it is already spoiled and should not be used under any circumstances. Insulin can deteriorate when the temperature is too high or too low, or when exposed to direct sunlight.

Possible complications of insulin therapy

If certain safety measures and rules are not followed, insulin treatment, like any other type of treatment, can cause various complications. The difficulty of insulin therapy lies in the correct selection of insulin dosage and choice of treatment regimen, therefore, a patient with diabetes mellitus must especially carefully monitor the entire treatment process. It seems difficult only at the beginning, and then people usually get used to it and cope well with all the difficulties. Since diabetes is a lifelong diagnosis, they learn to handle a syringe in the same way as a knife and fork. However, unlike other people, patients with diabetes cannot afford even a little relaxation and “rest” from treatment, as this risks complications.

Lipodystrophy

This complication develops at injection sites as a result of disruption of the formation and breakdown of adipose tissue, that is, seals appear at the injection site (when adipose tissue increases) or depressions (when adipose tissue decreases and subcutaneous adipose tissue disappears). Accordingly, this is called hypertrophic and atrophic type of lipodystrophy.

Lipodystrophy develops gradually as a result of prolonged and constant trauma to small peripheral nerves with a syringe needle. But this is only one of the reasons, although the most common. Another cause of complications is the use of insufficiently pure insulin.

Typically, this complication of insulin therapy occurs after several months or even years of insulin administration. The complication is not dangerous for the patient, although it leads to impaired absorption of insulin and also brings a certain discomfort to the person. Firstly, these are cosmetic defects of the skin, and secondly, pain in the areas of complications, which intensifies when the weather changes.

Treatment of atrophic type lipodystrophy involves the use of porcine insulin together with novocaine, which helps restore the trophic function of the nerves. The hypertrophic type of lipodystrophy is treated with physiotherapy: phonophoresis with hydrocortisone ointment.

Using preventive measures, you can protect yourself from this complication.

Prevention of lipodystrophy:

1) alternating injection sites;

2) administration of only insulin heated to body temperature;

3) after treating with alcohol, the injection site should be thoroughly rubbed with a sterile cloth or wait for the alcohol to dry completely;

4) inject insulin slowly and deeply under the skin;

5) use only sharp needles.

Allergic reactions

This complication does not depend on the actions of the patient, but is explained by the presence of foreign proteins in the composition of insulin. There are local allergic reactions that occur in and around the injection sites in the form of skin redness, thickening, swelling, burning and itching. Much more dangerous are general allergic reactions, which manifest themselves in the form of urticaria, angioedema, bronchospasm, gastrointestinal disorders, joint pain, enlarged lymph nodes and even anaphylactic shock.

Life-threatening allergic reactions are treated in a hospital with the administration of the hormone prednisolone; other allergic reactions are relieved with antihistamines, as well as the administration of the hormone hydrocortisone along with insulin. However, in most cases, it is possible to eliminate allergies by switching the patient from pork insulin to human insulin.

Chronic insulin overdose

Chronic insulin overdose occurs when the need for insulin becomes too high, that is, exceeds 1–1.5 units per 1 kg of body weight per day. In this case, the patient's condition deteriorates greatly. If such a patient reduces the dose of insulin, he will feel much better. This is the most characteristic sign of an insulin overdose. Other manifestations of complications:

Severe diabetes;

High fasting blood sugar;

Sharp fluctuations in blood sugar levels during the day;

Large losses of sugar in the urine;

Frequent fluctuations in hypo- and hyperglycemia;

Tendency to ketoacidosis;

Increased appetite and weight gain.

The complication is treated by adjusting insulin doses and selecting the correct drug administration regimen.

Hypoglycemic state and coma

The reasons for this complication are the incorrect selection of the dose of insulin, which turned out to be too high, as well as insufficient intake of carbohydrates. Hypoglycemia develops 2–3 hours after the administration of short-acting insulin and during the period of maximum activity of long-acting insulin. This is a very dangerous complication, because the concentration of glucose in the blood can decrease very sharply and the patient may experience a hypoglycemic coma.

Long-term intensive insulin therapy, accompanied by increased physical activity, often leads to the development of hypoglycemic complications.

If the blood sugar level is allowed to drop below 4 mmol/l, then in response to the lower blood sugar level a sharp rise in sugar may occur, that is, a state of hyperglycemia.

Prevention of this complication is to reduce the dose of insulin, the effect of which occurs when blood sugar drops below 4 mmol/l.

Insulin resistance (insulin resistance)

This complication is caused by getting used to certain doses of insulin, which over time no longer give the desired effect and an increase is required. Insulin resistance can be either temporary or long-term. If the need for insulin reaches more than 100–200 units per day, but the patient does not have attacks of ketoacidosis and does not have other endocrine diseases, then we can talk about the development of insulin resistance.

The reasons for the development of temporary insulin resistance include: obesity, high levels of lipids in the blood, dehydration, stress, acute and chronic infectious diseases, and lack of physical activity. Therefore, you can get rid of this type of complication by eliminating the listed causes.

Long-term or immunological insulin resistance develops due to the production of antibodies to injected insulin, a decrease in the number and sensitivity of insulin receptors, and impaired liver function. Treatment consists of replacing pork insulin with human insulin, as well as using the hormones hydrocortisone or prednisolone and normalizing liver function, including through diet.

Self-monitoring of diabetes

It is impossible to choose an insulin administration regimen and its dosage for life. The amount of insulin and the time of its administration have to be constantly adjusted, because blood sugar levels depend on many factors that cannot be foreseen and excluded. These are unplanned physical activity, emotions, errors in diet, infections, stress. These circumstances make up the life of any person, but for a patient with diabetes mellitus they can be dangerous, since they change too much his physiological indicators, on which his health depends. Therefore, a diabetic patient should be constantly aware of these changes by monitoring their condition and monitoring laboratory values. Self-monitoring is necessary for all patients with diabetes, both insulin-dependent and non-insulin-dependent. The only difference is that with non-insulin-dependent diabetes, blood sugar monitoring is carried out much less frequently, but also constantly, and as health worsens, monitoring blood sugar levels becomes more frequent.

So, self-control of a patient with diabetes includes the following activities:

Determination of blood sugar levels before and after meals;

Comparison of these indicators with physical activity and other unusual (emotional, stressful, painful) situations;

Carrying out a thorough analysis of your subjective feelings;

Evaluation of the data obtained;

Timely adjustment of the dosage of insulin, other medications and diet.

Measuring blood and urine sugar levels using test strips and a glucometer

The use of test strips for self-monitoring of blood and urine sugar levels in the initial diagnosis of diabetes was discussed at the beginning of this chapter. Now let's talk about monitoring these parameters in case of an existing disease.

There are two ways to determine your blood sugar level:

1) using a test strip, comparing the resulting color with a color scale, which can be used to visually determine the blood sugar level;

2) using a glucometer - a device into which a test strip is inserted and the blood sugar level is automatically assessed. The patient can only read the test result on the digital display of the device.

Although using the device, the study is carried out more quickly and conveniently, but with a certain skill, the visual method of determining blood sugar is just as accurate. A minimal error in calculations exists in both cases, but it does not play a role in determining the treatment regimen and insulin dosage.

Measuring sugar levels in urine is carried out with special test strips according to the same scheme. The test strip is immersed in the urine, and the test field changes color depending on the concentration of sugar in the urine. The most accurate test strips are those with a double test field. They are recommended, although a urine sugar test provides less information about the course of diabetes than a blood sugar test.

Urine examination for ketonuria

A patient with diabetes mellitus needs to check the presence of ketone bodies (acetone) in the urine in cases where he has a persistent increase in blood sugar levels and its high concentration in the urine, that is, when several test results in a row show high numbers: above 14 mmol/l in the blood and 3% in the urine. Indications for such a study are deterioration in health (nausea and vomiting) and concomitant diseases with elevated body temperature.

Testing urine for the presence of ketone bodies is necessary in order to prevent an attack of ketonuria and prevent diabetic coma. For this study, there are special test strips that are immersed in urine and change their color depending on the concentration of ketone bodies in the urine. The very presence of ketone bodies in the urine indicates a serious metabolic disorder and requires immediate treatment.

Body weight control

It is necessary to control body weight in order not to miss the first signs of obesity and the associated development of diabetic complications and other related diseases. To control body weight, a special test has been developed that identifies excess body weight. It is called body mass index (BMI) or Kegle index and is measured in kg/sq. m. Therefore, people suffering from diabetes should regularly measure their body weight and height. Based on these data, the Kegle index is calculated.

Calculation of the Kegle index: BMI = weight (kg) / (height (meters)) squared.

The normal Kegle index for men is 20–25, for women 19–24.

Keeping a self-control diary

The patient records the data of all studies in his self-monitoring diary, indicating the date. In addition, he notes in the diary subjective and objective data on general well-being. Namely, it is recommended to measure blood pressure every three days, and if the patient suffers from hypertension, then daily. It is not necessary to calculate body mass index every three days, but weight should be measured, especially for people who are prone to obesity. The diary must be kept carefully so that, based on the entries made, one can easily draw a conclusion about a change in the course of diabetes or its stable condition.

Keeping a self-monitoring diary allows the patient to manage the disease themselves, correct small changes in a timely manner and live with diabetes without feeling any particular inconvenience. Your well-being and health are largely in your own hands and depend on your desire and willingness to help yourself. If a person keeps an excellent self-monitoring diary and, taking into account the results obtained, makes or does not make changes to his treatment, then his diabetes will be invisible to him. You can check how the patient copes with this task and controls his health using another study that is performed in the laboratory. This is an analysis for glycated hemoglobin.

The glycated hemoglobin HbA indicator indicates the general course of diabetes mellitus with all rises and falls in blood sugar, if any. Moreover, it gives an average blood sugar level over 1.5–2 months and thus indicates how well a person manages his disease. Depending on this indicator, one can judge how the patient has adapted to life with diabetes.

If HbA does not exceed 6%, there is no diabetes mellitus or the patient has adapted well.

HbA from 6% to 8% – the patient has adapted well or satisfactorily to the disease.

HbA from 8% to 10% – the patient has unsatisfactorily or poorly adapted to diabetes.

HbA more than 10% - the patient has adapted very poorly to life with diabetes.

It is recommended to check the glycated hemoglobin level 1–2 times every three months for patients with insulin-dependent type of diabetes mellitus and 1–2 times a year for patients with non-insulin-dependent type of diabetes mellitus.

Treatment of complications of diabetes mellitus

Treatment of complications of diabetes mellitus primarily consists of their prevention, that is, constant compensation of the disease. Even with complications that have already begun, normalizing blood sugar levels allows you to reverse the process, that is, not only stop their development, but also reduce the disease to a minimum.

Treatment of angiopathy

The main treatment is stable and long-term compensation of diabetes mellitus. Therefore, the patient is advised to strictly monitor the diet, eat several times a day and gradually eliminate easily digestible carbohydrates from his diet. In addition to diet, the patient should have moderate physical activity, which helps absorb sugar and improves the functioning of the cardiovascular system.

Drug treatment is prescribed by a doctor. Usually these are angioprotectors, anticoagulants and antiplatelet agents that help normalize blood circulation and strengthen blood vessels. In addition, physical therapy methods are used - hyperbaric oxygenation, acupuncture, laser irradiation, magnetic therapy.

Treatment of retinopathy (pathology of the retinal blood vessels)

In this case, the main effort of the patient himself should be aimed at compensating for diabetes. For therapeutic purposes, the patient is prescribed angioprotectors and anticoagulants to stabilize the vascular wall and improve blood circulation, and also undergoes resorption therapy by administering drugs such as trypsin and lidase.

If there is a risk of retinal detachment, then physiotherapeutic procedures are carried out, primarily photocoagulation.

Treatment of nephropathy

If nephropathy occurs with the development of renal failure, then the patient is recommended to include alkaline mineral waters, natural berry and fruit juices in the diet.

In the hospital, special therapy is carried out to detoxify the body, that is, remove toxic substances. In cases of severe nephropathy, blood purification using hemodialysis is used.

Treatment of polyneuropathy

First of all, the patient is faced with the task of fully compensating for diabetes mellitus. Only in this case, treating the complication with medications and other means will give a positive result. To treat polyneuropathy, drugs are used that improve the function of blood vessels and nerve fibers, that is, angioprotectors, anticoagulants, antiplatelet agents, vitamins, lipoic acid. To improve the conduction of nerve impulses along nerve fibers, the drug Proserin is used.

Physiotherapeutic methods for treating complications include the following procedures: electrophoresis, balneotherapy, treatment using paraffin, ozokerite, massage and acupuncture. They help improve the condition of nerve fibers, as well as relieve pain and restore sensitivity in tissues.

Dietary nutrition for diabetes mellitus

Using a simple formula, you can calculate your normal weight.

Normal body weight for women: body weight = height – 110 cm.

Normal body weight for men: body weight = height – 100 cm.

If your values ​​are slightly higher than normal, you should not be alarmed, because in order to have the smallest 1st degree of obesity, you need your body weight to be 25–50% higher than normal. Let's say your height is 165 cm and your weight is 60 kg. Then you should weigh 165–110 = 55 kg. You have an extra 5 kg, but it is not fatal. Now, if you gained 77 kg, it would be almost 50% more than normal. Then the doctor would confidently diagnose you with “1st degree obesity.” But even 67 kg should have alerted you, because this exceeds the norm by just 25% - the lower limit of 1st degree obesity. So, when calculating your weight, evaluate not only the actual numbers you got, but also the period of time during which you managed to gain so much weight. If you have gained 3 kg in a week, then immediately draw a conclusion: reduce the amount of sweets and starchy foods. But if your weight, which is slightly higher than normal, remains at certain numbers for a long time, then you should not change your diet: after all, you are not gaining weight, which means you are not in danger of becoming obese.

Obesity of the 1st degree is a 25–50% increase in weight to the norm, calculated using the given formula.

Obesity of the 2nd degree – 50–70% weight gain to normal body weight.

3rd degree obesity – 75-100% weight gain to normal.

Obesity of the 4th degree – 100% or more weight gain to normal body weight.

Nutrition plays a huge role in the life of a person with diabetes. By making optimal food choices and eating patterns, blood sugar levels can be controlled in patients with non-insulin-dependent diabetes if it occurs without complications. In this case, dietary nutrition is the only method of treating the disease. And for patients with insulin-dependent diabetes, diet is the most important part of the treatment program. In addition to diet, the patient’s life must include physical activity, which is another lever for regulating sugar levels in the body. Physical activity will help the patient reduce the dose of insulin administered. However, physical activity must be properly combined with meals so as not to immediately replenish the amount of “burned” carbohydrates.

The main thing in dietary nutrition is to limit the amount of easily digestible carbohydrates, that is, glucose and sucrose. However, at the same time, the body must receive nutrients that will ensure that it replenishes all energy costs. For a patient with diabetes, the total energy value of food should be slightly below normal, which depends on the age, weight and physical activity of the person.

With normal weight, for every kg of weight of a healthy person, you need from 20 to 25 kcal, and for overweight - from 15 to 17 kcal. If the occupation is associated with light physical activity, then the number of calories is increased by a third of the total. When engaging in heavy physical activity, this figure doubles.

For a healthy person, the ratio of proteins, fats and carbohydrates should be 24%, 16% and 60%, respectively. Patients with diabetes reduce the amount of carbohydrates to 45–50%, while increasing the proportion of other components.

To properly create a diet, you need to know the number of calories that are released during the processing of proteins, fats and carbohydrates. So, when consuming 1 g of protein or carbohydrates, 4 kcal are released, and 1 g of fat provides 9 kcal. But proteins and fats only matter for a person's weight, without affecting blood sugar levels. The main thing for a diabetic is careful control of carbohydrates. For convenience, carbohydrates are usually calculated in bread units - XE. One bread unit corresponds to 25 g of bread or 10 g of sugar (easily digestible carbohydrates). It is especially important to measure the amount of carbohydrates in XE units for patients with insulin-dependent type of diabetes, as well as non-insulin-dependent type of diabetes with an uncompensated form. The amount of carbohydrates a diabetic patient needs per day, calculated in bread units, ranges from 18 to 25 XE.

One unit of bread eaten at breakfast or lunch immediately increases blood sugar levels by 2 mol/l. An ordinary person will not think twice about eating an extra piece of bread, a spoonful of sugar or a cookie, but a patient will immediately feel it. After all, the insulin administered before meals will not be enough for him and the sugar will “creep” up. When allowing yourself excess, you must remember that to compensate for the effect of 1 XE you will need 2 units of short-acting insulin. A diabetic patient who is going on a visit or to a cafe can guess how many units of bread he will eat in excess of the usual norm and inject himself with an increased dose of insulin. But this is an exception to the rule. The patient's usual diet should be calculated so that the amount of insulin administered determines the optimal blood sugar level, which corresponds to that of a healthy person. To do this, you need to eat five, at least four times a day, with light snacks between meals, that is, in total you get 6-7 meals. It is a multiple diet that allows you to control normal glucose levels.

Diet

A strict diet is necessary for insulin-dependent diabetes mellitus, because the frequency and amount of insulin administered depends on food intake. This relationship is reciprocal. The less often insulin is administered, the more strictly the diet should be observed. If injections are given before each meal, then its quantity and energy value can be changed and the diet in this case will be freer. But this is recommended to be done only in exceptional cases - during holidays, trips, etc. In normal times, it is better to adhere to a strict regime and reduce the number of injections.

The frequency of meals allows you to smoothly regulate blood glucose levels. In the short periods of time between meals, there will be no sudden spikes in glucose levels, which can happen when the gaps between meals are too long. They are fraught with a sharp decrease in sugar levels, up to hypoglycemic shock.

In most cases, it is difficult for a working person to maintain a five-meal diet, so you can limit yourself to four meals. Food must be distributed so that not only the nutritional value corresponds to the biological rhythm of a person, but also the consumption of carbohydrates is evenly distributed.

So, with four meals a day, during breakfast the patient should receive 30% of the total daily requirement (4-5 XE), at lunch - 40% (5-6 XE), in the afternoon snack - 10% (1-2 XE), and during dinner time - no more than 20% (4 XE) of the daily diet.

With five meals a day, the first breakfast makes up 25% of the daily ration (3–4 XE), second breakfast – 15% (2–3 XE), lunch – 30% (4–5 XE), afternoon snack – 10% (1–2 XE) and dinner – 20% (4 XE). In addition, between meals, namely two hours after breakfast and two hours before dinner, it is recommended to have light snacks corresponding to 1-2 XE. You should have dinner 2 hours before bedtime, and before going to bed, it is recommended to eat a piece of bread or drink milk to prevent nighttime drops in sugar levels.

For non-insulin-dependent diabetes mellitus, five or four meals a day are also recommended, in which blood sugar levels are kept normal. But the quantity and energy value of food must be strictly calculated in accordance with the characteristics of the patient, so that his weight does not increase and his sugar does not rise. In this case, the greatest attention is paid to the amount of carbohydrates eaten, and not to the eating regimen. If glucose-lowering drugs are used, the amount of carbohydrates may be increased.

Different types of carbohydrates

All carbohydrates are divided into three groups. Easily digestible carbohydrates are glucose, sucrose, fructose, maltose and lactose. Slowly digestible carbohydrates are starch and hard-to-digest carbohydrates are fiber. The first two groups of carbohydrates are absorbed into the blood faster, the third - slowly and difficult. In their diet, patients with diabetes should focus on the third group of carbohydrates. Fast-digesting carbohydrates allow you to quickly raise your blood sugar levels when needed.

Glucose is the simplest carbohydrate that is directly absorbed into the blood. The remaining carbohydrates enter the bloodstream after being converted to glucose. Glucose is the main source of energy for the body. It is grape sugar found in grapes and raisins. Other simple carbohydrates include monosaccharides: fructose (1.5 times sweeter than sugar and 3 times sweeter than glucose), as well as sorbitol and xylitol. Monosaccharides are used as sugar substitutes.

Sugar itself, or sucrose, is cane or beet sugar, which is twice as sweet as glucose. It belongs to disaccharides, which have a simple chemical structure, so they are easily broken down in the intestines. Disaccharides also include malt sugar or maltose, a natural carbohydrate found in sprouted grains of barley and other grain plants. Dairy products (milk, curdled milk, cream) contain milk sugar - lactose.

Starch belongs to complex carbohydrates, that is, polysaccharides, but it is easily digested and has a high calorie content. The most starch is contained in flour - up to 80%, slightly less in potatoes - 50%. Polysaccharides also include glycogen, pectin and fiber. Glycogen is primarily stored in the liver or as fat to provide energy to muscles.

Fiber is not broken down at all in the intestines, but it stimulates its motility, and most importantly for patients with diabetes, fiber slows down the absorption of glucose into the blood. That is why the diet of diabetics should always include fruits and vegetables, among which cabbage plays a vital role.

Rate of carbohydrate absorption

The rate of carbohydrate absorption depends not only on the type of carbohydrate, but on the temperature and structure of the food. For example, finely chopped vegetables are broken down faster in the intestines than coarsely chopped vegetables. Heated food also has a high rate of absorption of carbohydrates, unlike, for example, sweet ice cream, which is absorbed more slowly. In addition, fiber eaten together with easily digestible carbohydrates inhibits their absorption into the blood. They delay the processing of sugars into glucose and fats that are part of food.

Why do you need to know the rate of carbohydrate absorption? The fact is that when sugars processed into glucose quickly enter the blood, its level quickly rises, insulin does not have time to cope, that is, remove glucose from the blood in time and send it to the body’s cells. And “slow” carbohydrates gradually increase blood sugar levels, which are evenly distributed throughout the body with the help of administered insulin (in type 1 diabetes) or hypoglycemic agents (in type 2 diabetes).

Depending on the rate of increase in blood sugar, carbohydrates are also divided into three groups.

1. Carbohydrates, which raise sugar within 1-5 minutes. These include sugar, honey, grapes, sweet carbonated drinks. A patient with insulin-dependent diabetes mellitus should always have some kind of “fast” carbohydrate with him in order to instantly increase the level of glucose in the blood in case of a sharp drop (this can happen during stress, physical activity, skipping meals, etc.). Basically, fast carbohydrates are used precisely for this purpose. Sometimes the patient can indulge in sweets or starchy foods, but first introduce short-acting insulin to neutralize the rapid rise in blood glucose.

2. Carbohydrates that raise blood sugar in 10 minutes. These include white bread and other flour products - cookies, pasta, as well as cakes and chocolate. They can be used as “fast” carbohydrates to relieve an attack of hypoglycemia, which is expected as a result of a diet violation or severe emotional and physical overload, but has not yet begun.

3. Carbohydrates with a longer reaction time - about 30 minutes.

These are black bread, buckwheat, oatmeal and other cereals, which are called “slow” carbohydrates. They should make up the bulk of carbohydrates in the diet of patients with diabetes.

To correctly calculate the amount of carbohydrates per day, you need to know how many kcal per day you need. This was discussed above. For example, an adult with diabetes mellitus, light weight and not very physically active, needs on average 2000 kcal per day. In this case, the share of carbohydrates should be 45–50%, that is, about 1000 kcal. We already know that 1 g of carbohydrates gives 4 kcal, and we can easily calculate how many carbohydrates you can eat per day: 1000 kcal: 4 kcal = 250 g of carbohydrates.

Now you need to convert this amount of carbohydrates into bread units. Since one unit of bread contains about 15 carbohydrates, let’s perform another simple calculation: 250 g: 15 g = 17 XE (approximately).

So, you can eat 17 bread units per day. This amount should be distributed evenly, taking into account the proportions mentioned above and your diet. And then choose food products containing the required number of bread units. To do this, you can use the following data.

Quantity of product corresponding to 1 XE

Granulated sugar – 1 tbsp. spoon

Lump instant sugar – 3 pieces

Honey – 1 tbsp. spoon

Sweet carbonated drinks – 3/4 cup

Fruit juices – 1/2 cup

Bread – 1 piece (25 g)

Dough – 25 g

Thin pancakes or pancakes – 1 pc.

Porridge – 2 tbsp. spoons of cereal

Vermicelli – 1.5 tbsp. spoons

Sausages – 200 g

Dumplings – 5 pcs.

Milk or curdled milk (kefir) – 1 glass

Ice cream – 60 g

Condensed milk without sugar – 100 g

Boiled potatoes – 100 g

Fried potatoes – 2 tbsp. spoons

Legumes – 5 tbsp. spoons

Apples – 100 g (one medium)

Pears – 90 g (one medium)

Oranges – 100 g (one medium)

Watermelon – 400 g

Melon – 300 g

Kiwi – 150 g

Bananas – 1/2 fruit

Apricots – 3 pcs.

Peaches – 1 pc.

Plums – 4 pcs.

Any berries – 150 g

Dried fruits (dried apricots, raisins, prunes) – 20 g

Many products that we have not mentioned have practically no easily digestible carbohydrates and are not converted into bread units. These include vegetables: beets, carrots, cabbage, radishes, radishes, eggplants, turnips, tomatoes, cucumbers, zucchini, onions and green onions, as well as herbs, mushrooms, soybeans and nuts.

How to make a daily diet

To create a daily diet, it is necessary to take into account not only carbohydrates, but also proteins and fats, and all these substances must be in a certain percentage. Since carbohydrates make up 50% of the diet, proteins and fats make up the remaining 50%, of which 3/5 is allocated to fats, and 2/5 to proteins. If you are obese, the amount of fat should be reduced. The greater the degree of obesity, the less fat. However, fats cannot be completely excluded, because they play an important role in the body, being one of the main sources of energy.

Fats

Both deficiency and excess of fats are extremely harmful for a patient with diabetes. A deficiency of these substances leads to muscle weakness, loss of vitamin D and disruption of many organs and systems. And excess fat has a bad effect on the functioning of the pancreas and leads to the development of atherosclerosis. Fats are divided into saturated and unsaturated. Fats of saturated acids contribute to an increase in cholesterol levels, and fats of unsaturated acids, on the contrary, have a beneficial effect on this process, removing excess cholesterol. This indicator plays a big role in the life of a patient with diabetes. The normal level of cholesterol in the blood is from 3.3 to 5.2 mmol/l, but not higher than 6.4 mmol/l. Cholesterol plays both a negative role (provokes the development of atherosclerosis) and a positive role in the body (synthesizes vitamin D). Therefore, the composition of fats must be optimal. Patients with diabetes should limit the consumption of foods rich in cholesterol - lard, fatty meat and strong meat broth, liver, fatty fish, butter, sour cream, cheese, egg yolk. Dairy products should be consumed low in fat.

Saturated fats include animal fats - meat, fish, butter, etc. Unsaturated fats include vegetable fats, vegetable oils, soy. Dairy products contain saturated and unsaturated acids.

Proteins and fats are calculated in the same way as we calculated the amount of carbohydrates a person needs per day. Knowing that when 1 g of fat is burned, 9 kcal of energy is released, and a person needs 2000 kcal per day, of which 24% should be fat, we calculate using the following formulas: 2000 kcal ґ 0.24 = 480 kcal and 480 kcal: 9 kcal = = 50 g (approx.) This means that the daily requirement for fat is 50 g. Let me remind you that this figure can vary depending on a person’s weight; in case of obesity it is much less.

To create a diet taking into account the body's need for fats, you need to know which foods contain fats and in what quantities.

For example, 1 teaspoon of butter contains 5 g of fat, which is 45 kcal, and 1 teaspoon of mayonnaise contains 2 g of fat, 1 tbsp. A spoonful of full-fat sour cream contains 3 g of fat, and 1 teaspoon of vegetable oil contains 5 g of fat. A detailed table can be found in dietary reference books.

Squirrels

When creating a diet and selecting products, it is necessary to remember that the body needs daily protein intake, which is a building material for cells and muscles. In addition, proteins play a primary role in metabolism. The most biologically complete protein, containing a complete set of amino acids, is chicken egg white. A lack of protein has a negative impact on the functioning of the body. Therefore, it is necessary to cover the body’s need for this substance every day. It is 1–1.5 g of protein per 1 kg of healthy person’s weight.

We calculate the amount of proteins for the daily diet. Knowing that when 1 g of protein is burned, 4 kcal is obtained, and a diabetic patient needs 2000 kcal per day and 16% of protein from the entire daily diet, we calculate: 2000 kcal - 16% = 320 kcal. Then 320 kcal: 4 kcal = 80 g protein. Now let's select products that contain this amount of protein. You can use the following information as a guide.

How much protein is contained in 100 g of product

Dairy products (100 g) – 3–4 g

Bread – 7–8 g

Buckwheat, oatmeal – 10–12 g

Cheese – 25 g

Cottage cheese – 20–25 g

Legumes – 23 g

Eggs – 13 g

Vegetables, fruits – 0.5–3 g

Of course, this information is far from complete and is given only for rough guidance, but detailed information can easily be found in dietary reference books.

Product selection

It is rare to find fats, proteins and carbohydrates in their pure form; most often food products contain all these substances in certain quantities. Therefore, when choosing products, you can successfully combine them.

So, half a glass of milk or curdled milk (1 XE) contains 4 g of fat, 12 g of carbohydrates and 8 g of protein, which corresponds to 75 kcal. One serving of meat, poultry or fish (about 30 g) contains 5 g of fat and 7 g of protein - also 75 kcal. A serving of starch-containing foods (bread, porridge, pasta, potatoes, beets, carrots, pumpkin), taken in the amount of 1 XE, contains 15 g of carbohydrates, 3 g of protein and less than 1 g of fat - a caloric value of 80 kcal. Low-starch vegetables, which include all varieties of cabbage, tomatoes, cucumbers, lettuce, contain 5 g of carbohydrates and 2 g of protein, and the energy value is only 25 kcal. These are the most preferred foods for diabetics of both types. Fruits contain a lot of carbohydrates: one serving of 1 XE contains 15 g of carbohydrates, which is 60 kcal. However, fruits contain a lot of vitamins, so they need to be consumed in sufficient quantities.

The healthiest foods for diabetics

Fruits and berries: apples, pomegranates, cherries, gooseberries, currants, cranberries, lingonberries.

Vegetables: cabbage, rutabaga, turnips, cucumbers, tomatoes, onions, lettuce, greens.

Cereals: buckwheat and oats.

Meat: lean meat, fish, mushrooms.

Dairy: kefir, yogurt, low-fat cottage cheese, low-fat cheeses.

Prohibited and unwanted foods for diabetics

Fruits and berries: grapes, raisins, fruit juices, limited pineapple, persimmon, dried apricots, prunes, bananas, dates, figs.

Vegetables: limited potatoes and Jerusalem artichoke.

Cereals: semolina, limited corn and rice, white bread, baked goods.

Meat: smoked meats, sausages, sausage, fatty meats, pork.

Dairy products: limit butter, cheese, fatty cottage cheese, cream, chicken eggs.

Diabetes insipidus

Diabetes insipidus refers to a group of diseases associated with excessive secretion of urine from the human body. Diabetes insipidus is also a disease of the endocrine system, but it is not associated with changes in blood sugar levels, since its causes are completely different. With this disease, the process of urinary regulation is disrupted, and the disorder itself is caused by the absence or reduced content of the antidiuretic hormone, vasopressin, in the blood. Vasopressin is a substance that is synthesized in the hypothalamus and released into the blood and cerebrospinal fluid. Vasopressin is the main hormone in the body that regulates the water balance and osmotic composition of all body fluids - blood and extracellular fluid. It is this hormone that maintains fluid balance, when disturbed, the body stops working normally and diabetes insipidus develops.

In addition, vasopressin is involved in maintaining blood pressure levels, promotes blood clotting and regulates the secretion of several other hormones.

Diabetes insipidus is also called “renal” diabetes, since the kidneys excrete a huge amount of urine with a low specific gravity, that is, with a minimal salt content. A large loss of water in the body causes a person to be constantly thirsty. Diabetes insipidus creates great problems for patients who constantly experience the urge to urinate. But they are strictly forbidden to limit their fluid intake, because this can lead to severe dehydration, loss of consciousness, and coma.

Symptoms of diabetes insipidus

The disease develops rapidly and is manifested by acute symptoms characteristic of any diabetes: unquenchable thirst and increased urination. A sick person drinks from 5 to 20 liters of liquid per day! Despite the fact that normally this figure is 1.5–2 liters. All this fluid then leaves the body, and the patient experiences a constant urge to urinate, visiting the toilet every 10 minutes. But the body immediately strives to replenish the loss of water, and the patient quenches his thirst again and again. A vicious circle arises, exhausting the patient not only psychologically, but also physically.

Since the water-electrolyte balance in the body is disturbed, a person begins to experience severe weakness, loses weight, loses appetite and sleep, and his performance deteriorates significantly. The main symptoms of diabetes insipidus in adults include:

Weakness;

Headache;

Weight loss;

Dry skin;

Decreased salivation;

Distension and prolapse of the stomach.

Children, especially newborns, suffer the development of the disease even more severely. Primary symptoms in children:

Unexplained vomiting;

Increased body temperature;

Neurological disorders;

Enuresis (urinary incontinence).

Causes of diabetes insipidus

The causes of diabetes insipidus can be very diverse. First of all, this is a pathology of the hypothalamus, the part of the brain in which antidiuretic hormone is synthesized. These include tumors and inflammatory diseases of the brain, as well as traumatic brain injuries. Inflammatory diseases of the hypothalamus, in turn, can be caused by serious infectious diseases: influenza, tonsillitis, scarlet fever, tuberculosis, sexually transmitted diseases, especially syphilis, which mostly occur in a chronic form. The impetus for the development of diabetes insipidus is often autoimmune diseases and vascular disorders. Even a difficult birth can cause complications in the pituitary gland and the development of diabetes insipidus.

There are factors that aggravate the course of the disease, further reducing the release of antidiuretic hormone. These include hypertension or isolated cases of increased blood pressure, as well as a decrease in body temperature. In addition, alcohol and some medications have a negative effect: beta-blockers, clonidine, haloperidol and carbamazepine.

Diagnosis of diabetes insipidus

Despite the similar early signs of diabetes mellitus and diabetes insipidus, these diseases are very easy to distinguish one from the other. The main difference is that increased blood sugar levels are typical only for diabetes. With diabetes insipidus, the concentration of glucose in the blood is normal, since sugar is regulated by insulin, which is normally synthesized in the body. Therefore, in patients with diabetes insipidus, there is completely no sugar in the urine.

In people suffering from diabetes mellitus, the specific gravity of urine is increased, and it contains glucose, and in cases of diabetes insipidus, the density of urine is always lower than normal, and the level of glucose in the blood is normal.

All this can be easily checked using home diagnostic tools - tests and glucometers. In order to obtain an accurate picture of the disease, special tests are carried out in the hospital. Limit fluid intake with careful monitoring of all its parameters and monitor changes in blood characteristics. Modern diagnostic methods allow doctors to easily distinguish diabetes mellitus from diabetes insipidus.

When diagnosing diabetes insipidus, it is especially important to determine the cause of the disease, since the choice of treatment depends on this.

Treatment of diabetes insipidus

Treatment of patients with diabetes insipidus depends on the cause of the disease. It consists of drug treatment and adherence to nutrition and diet. If it is a brain tumor, then surgery, radiation and chemotherapy are necessary. For inflammatory diseases of brain structures, antibiotics and other anti-inflammatory drugs are prescribed. For neurogenic diabetes insipidus, desmopressin preparations (tablets or drops) are also used. For nephrogenic diabetes insipidus, thiazide and potassium-sparing drugs are used. In both cases, the flow of water into the patient’s body is reduced.

And antidiuretic hormone deficiency associated with dysfunction of the hypothalamus or pituitary gland is treated medicinally with the help of drugs containing vasopressin. To compensate for this missing hormone, its synthetic analogs are used - adiuretin or desmopressin. These medications are given as a spray or drops through the nose twice a day. In addition to them, another drug is used - Pitressin Tanate. This remedy has a longer lasting effect and is used once every 3-5 days. To increase the secretion of antidiuretic hormone, tablet drugs are used - tegretol, chlorpropamide, clofibrate and carbamazepine. For nephrogenic diabetes insipidus, thiazide diuretics and lithium preparations are prescribed.

The diet of patients with diabetes insipidus is based on the consumption of large amounts of carbohydrates. In this case, frequent, fractional meals are required. The diet of patients with diabetes insipidus should always include meat, fish, dairy products, vegetables, fresh fruits, and herbs. Patients with low weight should eat foods rich in proteins and vitamins.

In any case, the doctor selects the treatment and diet. Diabetes insipidus requires close attention to your lifestyle, just like diabetes, although the prognosis for this disease is much better. The well-being of patients depends entirely on compliance with the regimen and taking medications. Diabetes insipidus allows you to maintain good health and high performance if a person follows the doctor’s requirements and follows a diet.

Complications of diabetes insipidus

If the disease is not treated, complications arise in many organs and systems of the body. First of all, the disease affects the functioning of the bladder, causing it to stretch. The gastrointestinal tract and heart also suffer - the heart rate increases, and blood pressure, on the contrary, drops. In the future, other, even more serious complications arise: the functioning of the kidneys and liver is disrupted, potency decreases in men, menstruation disorders and even infertility are possible in women.

Some patients try to reduce the amount of liquid they drink to avoid frequent trips to the toilet. Doing this is extremely dangerous, because due to dehydration of the body, the patient’s condition sharply worsens: weakness, headache, nausea appear, convulsions develop, mental and motor agitation occurs, blood pressure drops sharply, and the heartbeat quickens.

Diabetes. The most effective treatment methods Yulia Popova

Possible complications of insulin therapy

If certain safety measures and rules are not followed, insulin treatment, like any other type of treatment, can cause various complications. The difficulty of insulin therapy lies in the correct selection of insulin dosage and choice of treatment regimen, therefore, a patient with diabetes mellitus must especially carefully monitor the entire treatment process. It seems difficult only at the beginning, and then people usually get used to it and cope well with all the difficulties. Since diabetes is a lifelong diagnosis, they learn to handle a syringe in the same way as a knife and fork. However, unlike other people, patients with diabetes cannot afford even a little relaxation and “rest” from treatment, as this risks complications.

Lipodystrophy

This complication develops at injection sites as a result of disruption of the formation and breakdown of adipose tissue, that is, seals appear at the injection site (when adipose tissue increases) or depressions (when adipose tissue decreases and subcutaneous adipose tissue disappears). Accordingly, this is called hypertrophic and atrophic type of lipodystrophy.

Lipodystrophy develops gradually as a result of prolonged and constant trauma to small peripheral nerves with a syringe needle. But this is only one of the reasons, although the most common. Another cause of complications is the use of insufficiently pure insulin.

Typically, this complication of insulin therapy occurs after several months or even years of insulin administration. The complication is not dangerous for the patient, although it leads to impaired absorption of insulin and also brings a certain discomfort to the person. Firstly, these are cosmetic defects of the skin, and secondly, pain in the areas of complications, which intensifies when the weather changes.

Treatment of atrophic type lipodystrophy involves the use of porcine insulin together with novocaine, which helps restore the trophic function of the nerves. The hypertrophic type of lipodystrophy is treated with physiotherapy: phonophoresis with hydrocortisone ointment.

Using preventive measures, you can protect yourself from this complication.

Prevention of lipodystrophy:

1) alternating injection sites;

2) administration of only insulin heated to body temperature;

3) after treating with alcohol, the injection site should be thoroughly rubbed with a sterile cloth or wait for the alcohol to dry completely;

4) inject insulin slowly and deeply under the skin;

5) use only sharp needles.

Allergic reactions

This complication does not depend on the actions of the patient, but is explained by the presence of foreign proteins in the composition of insulin. There are local allergic reactions that occur in and around the injection sites in the form of skin redness, thickening, swelling, burning and itching. Much more dangerous are general allergic reactions, which manifest themselves in the form of urticaria, angioedema, bronchospasm, gastrointestinal disorders, joint pain, enlarged lymph nodes and even anaphylactic shock.

Life-threatening allergic reactions are treated in a hospital with the administration of the hormone prednisolone; other allergic reactions are relieved with antihistamines, as well as the administration of the hormone hydrocortisone along with insulin. However, in most cases, it is possible to eliminate allergies by switching the patient from pork insulin to human insulin.

Chronic insulin overdose

Chronic insulin overdose occurs when the need for insulin becomes too high, that is, exceeds 1–1.5 units per 1 kg of body weight per day. In this case, the patient's condition deteriorates greatly. If such a patient reduces the dose of insulin, he will feel much better. This is the most characteristic sign of an insulin overdose. Other manifestations of complications:

Severe diabetes;

High fasting blood sugar;

Sharp fluctuations in blood sugar levels during the day;

Large losses of sugar in the urine;

Frequent fluctuations in hypo- and hyperglycemia;

Tendency to ketoacidosis;

Increased appetite and weight gain.

The complication is treated by adjusting insulin doses and selecting the correct drug administration regimen.

Hypoglycemic state and coma

The reasons for this complication are the incorrect selection of the dose of insulin, which turned out to be too high, as well as insufficient intake of carbohydrates. Hypoglycemia develops 2–3 hours after the administration of short-acting insulin and during the period of maximum activity of long-acting insulin. This is a very dangerous complication, because the concentration of glucose in the blood can decrease very sharply and the patient may experience a hypoglycemic coma.

Long-term intensive insulin therapy, accompanied by increased physical activity, often leads to the development of hypoglycemic complications.

If the blood sugar level is allowed to drop below 4 mmol/l, then in response to the lower blood sugar level a sharp rise in sugar may occur, that is, a state of hyperglycemia.

Prevention of this complication is to reduce the dose of insulin, the effect of which occurs when blood sugar drops below 4 mmol/l.

Insulin resistance (insulin resistance)

This complication is caused by getting used to certain doses of insulin, which over time no longer give the desired effect and an increase is required. Insulin resistance can be either temporary or long-term. If the need for insulin reaches more than 100–200 units per day, but the patient does not have attacks of ketoacidosis and does not have other endocrine diseases, then we can talk about the development of insulin resistance.

The reasons for the development of temporary insulin resistance include: obesity, high levels of lipids in the blood, dehydration, stress, acute and chronic infectious diseases, and lack of physical activity. Therefore, you can get rid of this type of complication by eliminating the listed causes.

Long-term or immunological insulin resistance develops due to the production of antibodies to injected insulin, a decrease in the number and sensitivity of insulin receptors, and impaired liver function. Treatment consists of replacing pork insulin with human insulin, as well as using the hormones hydrocortisone or prednisolone and normalizing liver function, including through diet.

This text is an introductory fragment.

Insulin therapy is the leading method of treating type 1 diabetes, in which carbohydrate metabolism fails. But sometimes such treatment is used for the second type of disease, in which the body's cells do not perceive insulin (a hormone that helps convert glucose into energy).

This is necessary when the disease is severe with decompensation.

Insulin administration is also indicated in a number of other cases:

1. diabetic coma;
2. contraindications to the use of sugar-lowering drugs;
3. lack of positive effect after taking antiglycemic drugs;
4. severe diabetic complications.

Insulin is a protein that is always introduced into the body by injection. It can be animal or human in origin. In addition, there are different types of hormone (heterologous, homologous, combined) with different durations of action.

Treatment of diabetes through hormonal therapy requires compliance with certain rules and proper dosage calculations. Otherwise, various complications of insulin therapy may develop, which every diabetic should be aware of.

In case of overdose, lack of carbohydrate food, or some time after the injection, the blood sugar level may drop significantly. As a result, a hypoglycemic state develops.

If a long-acting agent is used, then a similar complication occurs when the concentration of the substance reaches its maximum. Also, a decrease in sugar levels is observed after strong physical activity or emotional shock.

It is noteworthy that in the development of hypoglycemia, the leading place is not the concentration of glucose, but the rate of its decrease. Therefore, the first symptoms of decline may occur at levels of 5.5 mmol/l against the background of a rapid drop in sugar levels. With a slow decrease in glycemia, the patient may feel relatively normal, while glucose levels are 2.78 mmol/l or lower.

A hypoglycemic state is accompanied by a number of symptoms:

• severe hunger;
• rapid heartbeat;
• increased sweating;
• tremor of the limbs.

As the complication progresses, convulsions appear, the patient becomes inadequate and may lose consciousness.

If the sugar level has not dropped too low, then this condition can be eliminated in a simple way, which consists of eating carbohydrate foods (100 g of baked goods, 3-4 lumps of sugar, sweet tea). If there is no improvement over time, the patient needs to eat the same amount of sweets.

With the development of hypoglycemic coma, intravenous administration of 60 ml of glucose solution (40%) is indicated. In most cases, after this the diabetic’s condition stabilizes. If this does not happen, then after 10 minutes. he is again injected with glucose or glucagon (1 ml subcutaneously).

Hypoglycemia is an extremely dangerous diabetic complication because it can cause death. Elderly patients with damage to the heart, brain and blood vessels are at risk.

A constant decrease in sugar can lead to irreversible mental disorders.

The patient’s intellect and memory also deteriorate and retinopathy develops or worsens.

Often with diabetes, the sensitivity of cells to insulin decreases. To compensate for carbohydrate metabolism, 100-200 units of the hormone are needed.

However, this condition occurs not only due to a decrease in the content or affinity of receptors for the protein, but also when antibodies to the receptors or hormone appear. Insulin resistance also develops against the background of protein destruction by certain enzymes or its binding by immune complexes.

In addition, lack of sensitivity appears in case of increased secretion of counter-insulin hormones. This occurs against the background of hypercortinism, diffuse toxic goiter, acromegaly and pheochromocytoma.

The basis of treatment is to identify the nature of the condition. To this end, eliminate the signs of chronic infectious diseases (cholecystitis, sinusitis), diseases of the endocrine glands. The type of insulin is also changed, or insulin therapy is supplemented by taking sugar-lowering tablets.

In some cases, glucocorticoids are indicated. To do this, the daily dosage of the hormone is increased and ten-day treatment with Prednisolone (1 mg/kg) is prescribed.

Sulfated insulin can also be used for insulin resistance. Its advantage is that it does not react with antibodies, has good biological activity and practically does not cause allergic reactions. But when switching to such therapy, patients should be aware that the dose of the sulfated drug, in comparison with the simple form, is reduced to ¼ of the original amount of the usual drug.

When insulin is administered, complications can vary. So, some patients experience allergies, which manifest themselves in two forms:

1. Local. The appearance of a fatty, inflamed, itchy papule or hardening in the injection area.
2. Generalized, which causes urticaria (neck, face), nausea, itching, erosions on the mucous membranes of the mouth, eyes, nose, nausea, abdominal pain, vomiting, chills, fever. Sometimes anaphylactic shock develops.

To prevent the progression of allergies, insulin replacement is often carried out. For this purpose, the animal hormone is replaced with a human one or the manufacturer of the product is changed.

It is worth noting that allergies generally develop not to the hormone itself, but to the preservative used to stabilize it. However, pharmaceutical companies may use different chemical compounds.

If it is not possible to replace the drug, then insulin is combined with the administration of minimal doses (up to 1 mg) of hydrocortisone. For severe allergic reactions, the following medications are used:

• Calcium chloride;
• Hydrocortisone;
• Diphenhydramine;
• Suprastin and others.

It is noteworthy that local manifestations of allergies often appear when the injection is done incorrectly.

For example, in case of incorrect choice of injection site, skin damage (dull, thick needle), or injection of too cold a product.

There are 2 types of lipodystrophy - atrophic and hypertrophic. The atrophic form of pathology develops against the background of a prolonged course of the hypertrophic form.

How exactly such post-injection manifestations occur has not been established. However, many doctors suggest that they appear due to constant injury to peripheral nerves with further neurotrophic disorders of a local nature. Defects can also occur due to the use of insufficiently pure insulin.

But after using monocomponent products, the number of manifestations of lipodystrophy is significantly reduced. Another important factor is incorrect administration of the hormone, for example, hypothermia of the injection site, use of a cold drug, etc.

In some cases, against the background of lipodystrophy, insulin resistance of varying severity occurs.

If diabetes has a predisposition to the appearance of lipodystrophy, it is extremely important to adhere to the rules of insulin therapy, changing injection sites daily. Also, to prevent the appearance of lipodystrophy, the hormone is diluted with an equal volume of Novocaine (0.5%).

In addition, it was found that lipoatrophy disappears after injecting a person with insulin.

Insulin-dependent diabetics often experience blurred vision. This phenomenon causes severe discomfort to a person, so he cannot write and read normally.

Many patients mistake this symptom for diabetic retinopathy. But the veil before the eyes is a consequence of changes in the refraction of the lens.

This consequence goes away on its own within 14-30 days from the start of treatment. Therefore, there is no need to interrupt therapy.

Other complications of insulin therapy are swelling of the lower extremities. But this manifestation, like vision problems, goes away on its own.

Swelling of the legs occurs due to water and salt retention, which develops after insulin injections. However, over time, the body adapts to the treatment, so it stops accumulating fluid.

For similar reasons, during the initial stage of therapy, patients may experience periodic increases in blood pressure.

Also, during insulin therapy, some diabetics gain weight. On average, patients gain 3-5 kilograms. After all, hormonal treatment activates lipogenesis (the process of fat formation) and increases appetite. In this case, the patient needs to change the diet, in particular, its calorie content and frequency of meals.

In addition, constant administration of insulin lowers the potassium level in the blood. This problem can be solved through a special diet.

To this end, the daily menu of a diabetic should be rich in citrus fruits, berries (currants, strawberries), herbs (parsley) and vegetables (cabbage, radishes, onions).

To minimize the risk of the consequences of insulin therapy, every diabetic should master self-control methods. This concept includes compliance with the following rules:

1. Constantly monitoring blood glucose concentrations, especially after meals.
2. Comparison of indicators with atypical conditions (physical, emotional stress, sudden illness, etc.).
3. timely adjustment of the dose of insulin, antidiabetic drugs and diet.

Test strips or a glucometer are used to measure glucose levels. Determining the level using test strips is carried out as follows: a piece of paper is immersed in urine, and then look at the test field, the color of which changes depending on the concentration of sugar.

The most accurate results can be obtained when using double field strips. However, a blood test is a more effective method for determining sugar levels.

This is why most diabetics use a glucometer. This device is used as follows: a drop of blood is applied to the indicator plate. Then after a couple of seconds the result appears on the digital display. But it should be borne in mind that glycemia for different devices may be different.

Also, to ensure that insulin therapy does not contribute to the development of complications, a diabetic must carefully monitor his own body weight. You can find out whether you are overweight by determining the Kegle index or body weight.

The side effects of insulin therapy are discussed in the video in this article.

source

TARGET: decreased blood glucose levels

INDICATIONS: diabetes mellitus requiring insulin treatment

CONTRAINDICATIONS: hypoglycemia; insulin hypersensitivity

COMPLICATIONS: post-insulin lipodystrophy, allergic reaction.

EQUIPMENT: sterile gloves; tray, tweezers, disposable insulin syringe 1.0 ml; injection needles 12 mm long; alcohol and dry cotton balls; bottle with insulin solution

THE NECESSARY CONDITIONS: There are several types of insulin:

 by duration of action – short-acting and long-acting;

Short-acting insulin is completely transparent, at the bottom of the bottle with long-acting insulin there is a white sediment, and above it there is a clear liquid - you need to shake before administration!

 by origin – human (genetically engineered) and animal origin.

If the patient is prescribed insulins of different effects at the same time, then the insulins are drawn into different syringes, the injection is made through one needle, changing its direction after the first injection of insulin. If the needle is soldered into the syringe, then the injection is done twice.

Insulin is dosed in insulin units (IU).

Insulin is available in 10 ml and 5 ml bottles or 3 ml cartridges. 1 ml contains 100 IU.

The patient's insulin dose is selected individually depending on diet, level of physical activity and lifestyle.

Insulin is stored at temperatures from +2 0C to +8 0C. Do not freeze! Avoid contact with the walls of the refrigerator.

Before opening, the bottle must be kept for 1-2 hours at room temperature.

After opening, the bottle can be stored at a temperature not exceeding +25 0C for 4 weeks in a place protected from light and heat.

The date the bottle was opened is written on the label.

Insulin can be administered using: an insulin syringe; syringe pens; insulin pump.

The rate of insulin absorption depends on the injection site:

 anterior abdominal wall – very rapid absorption;

 buttock – slow absorption;

 thigh – very slow absorption.

Wear protective clothing and disinfect hands

Place several sterile alcohol cotton balls on a sterile tray.

3. Check the expiration date and tightness of the syringe packaging, open it from the piston side.

4. With your right hand, grab the cylinder at the bottom, and with a rotational movement, insert the needle cannula onto the needle cone of the syringe.

5. Place the assembled syringe on a sterile tray.

6. Take the bottle, read the name, concentration, quantity and expiration date of the solution. Make sure visually that the drug is suitable.

2. Specify the dose of the drug according to the doctor’s prescription sheet.

5. Use another alcohol ball to treat the rubber stopper of the bottle. Compliance with aseptic requirements.

6. Wait until the alcohol evaporates.

7. Take the prepared syringe in your right hand. Hold the bottle with your left hand, and insert the needle with your right hand, piercing the rubber stopper of the bottle.

8. Place the bottle in your left hand, turning it upside down. Pull the piston towards you and draw in the required amount of solution.

9. Place the bottle on the treatment table and remove the syringe, holding the needle cannula.

10. Remove the needle, throw it into the waste tray, replacing it with an injection needle.

11. Holding the syringe vertically, check the patency of the needle by releasing air and a drop of solution from the syringe into the cap.

12. Check that the dosage is correct. Prevention of complications.

13. Make sure there is no air in the syringe. If there are air bubbles on the walls of the cylinder, you should slightly pull back the syringe plunger and “turn” the syringe several times in a horizontal plane.

14. Place the finished syringe in a sterile tray.

15. Sit or lay the patient down on the couch.

16. Inspect and palpate the injection site. .

17. Treat the skin in the upper or middle third of the outer surface of the shoulder sequentially with two sterile alcohol balls. Hand movements from bottom to top. Wait until the alcohol evaporates.

18. Take the syringe in your right hand. Remove the protective cap from the needle. Place the fingers on the syringe:

Read also: Polycystic ovary syndrome diabetes mellitus

I – III – IV – on the syringe barrel.

19. Using the fingers of your left hand, gather the skin at the injection site into a triangular fold, base down.

20. Insert the needle into the base of the fold at an angle of 45 0 to the surface of the skin for 2/3 of its length with the cut up.

21. Release the fold, press the piston handle with the first finger of your left hand and slowly introduce the solution.

22. Apply a dry sterile ball to the injection site. Remove the needle with a quick and gentle movement.

21. The patient should eat within the next 30 minutes after the injection.

22. Disinfect used equipment (syringe, needles, cotton balls)

23. Remove used gloves and disinfect.

25. Make an entry in the procedure log and a note on the medical prescription sheet.

26. Monitor the patient’s condition after the manipulation.

TECHNIQUES FOR CALCULATION AND DILUTION OF ANTIBACTERIAL AGENTS(using the example of penicillin)

PURPOSE: carrying out antibacterial therapy.

EQUIPMENT: sterile gloves, tray, tweezers, 5.0 ml syringe; needles 38 mm long; alcohol balls; a bottle of penicillin; ampoules/bottle with solvent (according to the doctor's prescription sheet);

PREREQUISITES: Penicillin is available in the form of crystalline powder of benzylpenicillin sodium or potassium salt. Dosed in action units (ED). Available in bottles of 250,000, 500,000 and 1,000,000 units.

Before use, penicillin is dissolved, for this you can use the following sterile solutions:

- isotonic sodium chloride solution 0.9%; water for injections; 0.5% solution of novocaine

Penicillin in diluted form can be stored for no more than a day in a cool and dark place. The penicillin solution cannot be heated, because under the influence of high temperature it is destroyed. Typically, penicillin is administered 4-6 times a day every 4 hours.

PROCEDURE FOR BREEDING:

There are 2 rules for diluting penicillin.

Let's consider the calculation using the example of a bottle with 1,000,000 units of penicillin.

1st rule: 1 ml of diluted antibiotic must contain 100,000 units of penicillin

2nd rule: 1 ml of diluted antibiotic should contain 200,000 units of penicillin

This rule applies if the patient’s prescription is no more than

500,000 units, because the volume of solution administered intramuscularly should not exceed 5 ml. This rule applies if the patient’s prescription exceeds 500,000 units

It is necessary to determine the amount of solvent:

release form: (1,000,000 units: 100,000 units =

10 ml solvent). It is necessary to determine the amount of solvent:

release form: (1,000,000 units: 200,000 units =

Note: all other antibiotics are dosed and diluted according to the instructions for the drug.

2. Open the bottle of antibiotic (according to the algorithm).

3. Open the ampoule/bottle with the solvent (according to the algorithm).

4. Draw the required amount of solvent into the syringe (based on the rule).

5. Pierce the rubber stopper of the bottle and introduce the solvent.

6. Remove the bottle along with the needle from the needle cone and shake the bottle until the powder is completely dissolved.

7. Connect the syringe with the needle in the bottle, lift the bottle upside down and draw the required amount of dissolved antibiotic (ml).

8. Disconnect the syringe from the needle in the vial and insert the needle for injection.

9. Check the patency of the needle by releasing air and a drop of solution from the syringe into the cap.

10. Place the finished syringe in a sterile tray.

11. Perform an intramuscular injection (according to the algorithm).

PREVENTION OF POST-INJECTION COMPLICATIONS

INFILTRATE:Injections subcutaneous, intramuscular

Signs of compaction, pain at the injection site, redness

Reasons: 1) insufficient needle length (with IM)

2) introduction of unheated oil solutions

3) multiple injections into the same anatomical areas

Prevention: heat oil solutions to 37-380C; alternate injection sites

Helpful measures: iodine mesh, warm compress, warm heating pad.

ABSCESS: subcutaneous, intramuscular

Signs: purulent inflammation of soft tissues with the formation of a cavity filled with pus and limited from surrounding tissues, pain, compaction, hyperemia, local/general increase in body temperature.

Reasons: violation of aseptic and antiseptic requirements

Prevention: strictly adhere to the requirements of asepsis and antisepsis and the sanitary and anti-epidemic regime of the treatment room.

Help: apply a semi-alcohol compress, refer to a surgeon (on an outpatient basis)

NEEDLE BREAKAGE: subcutaneous, intramuscular

Reasons: insertion of the needle all the way to the cannula, sudden muscle contraction by the patient, defective needle

Prevention: do not insert the needle all the way, leave a few millimeters above the skin level, invite the patient to lie on his stomach, if the patient is standing, invite him to shift his body weight to the other leg.

DAMAGE TO NERVE TRUNKS: intramuscular

Signs: neuritis (inflammation of the nerve), paralysis (loss of function of the lower limb)

Reason: mechanical damage, chemical damage, when a drug depot is created close to the nerve trunk.

Prevention: choose the right injection site

Help: novocaine blockade, consultation with a neurologist.

Signs: dystrophic changes in subcutaneous fat when insulin is administered to the same anatomical areas.

Prevention: alternate anatomical areas of insulin administration.

OIL EMBOLISM: intramuscular, intravenous

Signs: oil trapped in a vessel - an embolus - enters the pulmonary vessels through the bloodstream. An attack of suffocation and cyanosis occurs, which can lead to death.

Cause: accidental penetration of the needle lumen into a vessel during intramuscular injection

Prevention:

It is prohibited to inject oil solutions and suspensions into a vein!

A two-step method of introducing an oil solution - after the puncture, be sure to pull the piston towards you!

It is better to choose subcutaneous injection of an oil solution!

Help measures: call a doctor through an intermediary,

begin providing emergency care, CPR, and carry out medical prescriptions.

NECROSIS: subcutaneous, intramuscular, intravenous

Signs: increasing pain in the injection area, swelling, hyperemia or hyperemia with cyanosis, then the appearance of blisters, necrosis ulcers when a highly irritating solution gets into the tissue.

Cause: accidental exit from the vascular bed and the introduction of a 10% calcium chloride solution into the tissues surrounding the vein, erroneous administration of a 10% calcium chloride solution IM or SC

Prevention 1) watch what you take and where you enter it.

2) It is prohibited to inject a 10% calcium chloride solution into a muscle or under the skin!

3) 10% calcium chloride solution is injected only into a vein, very slowly under the control of the patient’s well-being

Help measures 1) stop administering the solution

2) do not apply a tourniquet to the upper limb (it increases the irritating effect of the solution)

3) with intramuscular injection, try to aspirate the solution of their tissues using a sterile syringe

4) inject the area with sterile distilled water, or physiological sodium chloride solution 0.9%, or novocaine solution 0.5% to reduce the concentration of the previously administered solution

5) apply an ice pack

6) inform your doctor immediately

AIR EMBOLISM: intravenous

Signs: air trapped in the vessel - an embolus - enters the pulmonary vessels with the blood flow. An attack of suffocation and cyanosis occurs. Symptoms develop much more quickly than with oil embolism. May be fatal.

Reason(s) air entering a blood vessel through a needle

Prevention 1) carefully displace the air from the syringe and needle

2) do not inject the solution completely, leaving 0.5-1 ml of solution

3) carefully remove air from the infusion system

Help measures 1) call a doctor through an intermediary

2) begin providing emergency assistance, CPR

3) carry out medical prescriptions

Signs of hemorrhage under the skin and the appearance of a bruise under the skin in the form of a purple spot, pain

Reason(s) 1) puncture of both walls of the vein

2) the patient did not press the alcohol ball to the injection site for 5-7 minutes

Prevention follow the intravenous injection technique (cut, angle and depth of injection)

Help measures 1) stop the injection

2) apply an alcohol cotton ball to the vein

3) apply a semi-alcohol compress

4) follow the doctor’s prescriptions (heparin, troxyvasin ointment)

Signs: inflammation of the vein with the formation of a blood clot: pain, hyperemia, thickening along the vein, there may be a local increase in body temperature

Reason(s) 1) frequent punctures of the same vein

2) administration of concentrated irritating solutions

3) using needles that are not sharp enough

Prevention 1) alternate both the veins and the patient’s arms

2) dilute concentrated irritating solutions before injecting into a vein

3) use sharp needles

Help measures 1) inform the doctor

2) fulfill medical prescriptions

INCORRECT ADMINISTRATION OF DRUG SOLUTION: any injection

Signs may vary: from a pain reaction to the development of anaphylactic shock

Reason(s) inattention during work

Prevention watch what you take:

- check the appearance of the solution

 once again clarify the data on the list of medical prescriptions

Help measures 1) if the injection is made on a limb, apply a tourniquet

2) inject the injection site with 0.9% saline sodium chloride solution

3) apply an ice pack

4) inform the doctor and follow his instructions

INFECTION BY IN-HOSPITAL BLOOD-CONTACT INFECTIONS: (SEPSIS, HIV INFECTION, VIRAL HEPATITIS B, C, D): any injection

Signs correspond to the developed disease

Reason(s) gross violations in compliance with the sanitary and anti-epidemic regime of the treatment room, the requirements of OST 42-21-2-85 (disinfection, pre-sterilization cleaning, sterilization), asepsis and antiseptics in work

ALLERGIC REACTIONS: any injection

Signs: may vary: itching, rash, runny nose, anaphylactic shock

Reason(s) individual intolerance to a drug

Prevention 1) control of notes about allergic reactions on the patient’s medical documentation (medical history, outpatient card, pregnant woman’s exchange card)

2) preliminary collection of an allergic history from the patient

3) monitoring the patient’s condition after the injection

Help measures: if signs of anaphylactic shock develop: 1) call a doctor through an intermediary

2) begin emergency care using an anti-shock kit (adrenaline, prednisolone IV in a stream, saline sodium chloride solution 0.9% IV drip)

3) CPR according to indications, carry out medical prescriptions

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Possible complications of insulin therapy

If certain safety measures and rules are not followed, insulin treatment, like any other type of treatment, can cause various complications. The difficulty of insulin therapy lies in the correct selection of insulin dosage and choice of treatment regimen, therefore, a patient with diabetes mellitus must especially carefully monitor the entire treatment process. It seems difficult only at the beginning, and then people usually get used to it and cope well with all the difficulties. Since diabetes is a lifelong diagnosis, they learn to handle a syringe in the same way as a knife and fork. However, unlike other people, patients with diabetes cannot afford even a little relaxation and “rest” from treatment, as this risks complications.

This complication develops at injection sites as a result of disruption of the formation and breakdown of adipose tissue, that is, seals appear at the injection site (when adipose tissue increases) or depressions (when adipose tissue decreases and subcutaneous adipose tissue disappears). Accordingly, this is called hypertrophic and atrophic type of lipodystrophy.

Lipodystrophy develops gradually as a result of prolonged and constant trauma to small peripheral nerves with a syringe needle. But this is only one of the reasons, although the most common. Another cause of complications is the use of insufficiently pure insulin.

Typically, this complication of insulin therapy occurs after several months or even years of insulin administration. The complication is not dangerous for the patient, although it leads to impaired absorption of insulin and also brings a certain discomfort to the person. Firstly, these are cosmetic defects of the skin, and secondly, pain in the areas of complications, which intensifies when the weather changes.

Treatment of atrophic type lipodystrophy involves the use of porcine insulin together with novocaine, which helps restore the trophic function of the nerves. The hypertrophic type of lipodystrophy is treated with physiotherapy: phonophoresis with hydrocortisone ointment.

Using preventive measures, you can protect yourself from this complication.

1) alternating injection sites;

2) administration of only insulin heated to body temperature;

3) after treating with alcohol, the injection site should be thoroughly rubbed with a sterile cloth or wait for the alcohol to dry completely;

4) inject insulin slowly and deeply under the skin;

5) use only sharp needles.

This complication does not depend on the actions of the patient, but is explained by the presence of foreign proteins in the composition of insulin. There are local allergic reactions that occur in and around the injection sites in the form of skin redness, thickening, swelling, burning and itching. Much more dangerous are general allergic reactions, which manifest themselves in the form of urticaria, angioedema, bronchospasm, gastrointestinal disorders, joint pain, enlarged lymph nodes and even anaphylactic shock.

Life-threatening allergic reactions are treated in a hospital with the administration of the hormone prednisolone; other allergic reactions are relieved with antihistamines, as well as the administration of the hormone hydrocortisone along with insulin. However, in most cases, it is possible to eliminate allergies by switching the patient from pork insulin to human insulin.

Read also: Diabetes mellitus, what happens if you don’t inject insulin for diabetes mellitus

Chronic insulin overdose

Chronic insulin overdose occurs when the need for insulin becomes too high, that is, exceeds 1–1.5 units per 1 kg of body weight per day. In this case, the patient's condition deteriorates greatly. If such a patient reduces the dose of insulin, he will feel much better. This is the most characteristic sign of an insulin overdose. Other manifestations of complications:

High fasting blood sugar;

Sharp fluctuations in blood sugar levels during the day;

Large losses of sugar in the urine;

Frequent fluctuations in hypo- and hyperglycemia;

Increased appetite and weight gain.

The complication is treated by adjusting insulin doses and selecting the correct drug administration regimen.

Hypoglycemic state and coma

The reasons for this complication are the incorrect selection of the dose of insulin, which turned out to be too high, as well as insufficient intake of carbohydrates. Hypoglycemia develops 2–3 hours after the administration of short-acting insulin and during the period of maximum activity of long-acting insulin. This is a very dangerous complication, because the concentration of glucose in the blood can decrease very sharply and the patient may experience a hypoglycemic coma.

Long-term intensive insulin therapy, accompanied by increased physical activity, often leads to the development of hypoglycemic complications.

If the blood sugar level is allowed to drop below 4 mmol/l, then in response to the lower blood sugar level a sharp rise in sugar may occur, that is, a state of hyperglycemia.

Prevention of this complication is to reduce the dose of insulin, the effect of which occurs when blood sugar drops below 4 mmol/l.

Insulin resistance (insulin resistance)

This complication is caused by getting used to certain doses of insulin, which over time no longer give the desired effect and an increase is required. Insulin resistance can be either temporary or long-term. If the need for insulin reaches more than 100–200 units per day, but the patient does not have attacks of ketoacidosis and does not have other endocrine diseases, then we can talk about the development of insulin resistance.

The reasons for the development of temporary insulin resistance include: obesity, high levels of lipids in the blood, dehydration, stress, acute and chronic infectious diseases, and lack of physical activity. Therefore, you can get rid of this type of complication by eliminating the listed causes.

Long-term or immunological insulin resistance develops due to the production of antibodies to injected insulin, a decrease in the number and sensitivity of insulin receptors, and impaired liver function. Treatment consists of replacing pork insulin with human insulin, as well as using the hormones hydrocortisone or prednisolone and normalizing liver function, including through diet.

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Insulin —

Insulin is administered with a special disposable 1 ml insulin syringe.

Target:

Contraindications:

Sterile: a tray with gauze pads or cotton balls, an insulin syringe with a needle, a 2nd needle (if it is possible to change the needle on the syringe), 70% alcohol, insulin preparation, gloves.

Patient and drug preparation:

1. Explain to the patient the need to follow a diet when receiving insulin. Short-acting insulin is administered 15-20 minutes before meals, its hypoglycemic effect begins after 20-30 minutes, reaches its maximum effect after 1.5-2.5 hours, the total duration of action is 5-6 hours.

2. The needle can be inserted into the vial with insulin and subcutaneously only after the stopper of the vial and the injection site have dried from 70% alcohol, because alcohol reduces insulin activity.

3. When drawing an insulin solution into a syringe, draw 2 units more than the dose prescribed by the doctor, because it is necessary to compensate for losses when removing air and checking the second needle (provided that the needle is removable).

4. Vials of insulin are stored in the refrigerator, preventing them from freezing; Avoid exposure to direct sunlight; Warm to room temperature before administration.

5. After opening, the bottle can be stored for 1 month; do not tear off the metal cap, but bend it.

Execution algorithm:

1. Explain the procedure to the patient and obtain his consent.

2. Put on a clean gown, mask, sanitize your hands, and put on gloves.

3. Read the name of insulin, dosage (40,80,100 IU in 1 ml) - must correspond to the doctor’s prescription.

4. Look at the date, the expiration date must match.

5. Check the integrity of the packaging.

6. Open the package with the selected sterile insulin syringe and place it in a sterile tray.

7. Open the aluminum lid, treating it with 70% alcohol twice.

8. Pierce the rubber cap of the bottle after the alcohol has dried

9. Change the needle. Release the air from the syringe (2 units will go into the needle).

10. Place the syringe on a sterile tray, prepare 3 sterile cotton balls (2 moistened with 70% alcohol, the 3rd is dry).

11. Treat the skin first with the 1st, then the 2nd cotton ball (with alcohol), hold the 3rd (dry) in your left hand.

12. Gather the skin into a triangular fold.

13. Insert the needle into the base of the fold at an angle of 45° to a depth of 1-2 cm (2/3 of the needle), holding the syringe in your right hand.

15. Apply pressure to the injection site dry cotton ball.

16. Remove the needle by holding it by the cannula.

17. Place the disposable syringe and needle in a container with 3% chloramine for 60 minutes.

18. Remove gloves and place in a container with a disinfectant solution.

1. Lipodystrophy (disappearance of adipose tissue at the site of numerous injections, scar formation).

2. Allergic reaction (redness, urticaria, Quincke's edema).

3. Hypoglycemic state (in case of overdose). Observed: irritability, sweating, feeling of hunger. (Help for hypoglycemia: give the patient sugar, honey, sweet drinks, cookies).

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Insulin - This is a drug that lowers blood sugar concentrations and is dosed in insulin units (IU). Available in 5 ml bottles, 1 ml of insulin contains 40 IU, 80 IU or 100 IU - look at the bottle label carefully.

Insulin is administered with a special disposable 1 ml insulin syringe.

On one side of the scale on the cylinder there are divisions for ml, on the other - divisions for EI, and use it to set the drug, having previously assessed the division scale. Insulin is administered subcutaneously, intravenously.

Target: therapeutic - reduce blood glucose levels.

Sterile: a tray with gauze pads or cotton balls, an insulin syringe with a needle, a second needle (if you can change the needle on the syringe), 70% alcohol, insulin preparation, gloves.

Non-sterile: scissors, couch or chair, containers for disinfecting needles, syringes, dressings.

Explain to the patient the need to follow a diet when receiving insulin. Short-acting insulin is administered 15-20 minutes before meals, its hypoglycemic effect begins after 20-30 minutes, reaches its maximum effect after 1.5-2.5 hours, the total duration of action is 5-6 hours.

The needle can be inserted into the vial with insulin and subcutaneously only after the stopper of the vial and the injection site have dried from 70% alcohol, because alcohol reduces insulin activity.

When drawing an insulin solution into a syringe, draw 2 units more than the dose prescribed by the doctor, because it is necessary to compensate for losses when removing air and checking the second needle (provided that the needle is removable).

Vials of insulin are stored in the refrigerator, preventing them from freezing; Avoid exposure to direct sunlight; Warm to room temperature before administration.

After opening, the bottle can be stored for 1 month; do not tear off the metal cap, but bend it.

Explain the procedure to the patient and obtain his consent.

Put on a clean gown, mask, sanitize your hands, and put on gloves.

Read the name of insulin, dosage (40,80,100 IU in 1 ml) - must correspond to the doctor’s prescription.

Look at the date, expiration date - it must match.

Check the integrity of the packaging.

Open the package with the selected sterile insulin syringe and place it in a sterile tray.

Open the aluminum lid, treating it with 70% alcohol twice.

Puncture the rubber cap of the bottle after the alcohol has dried, dial insulin (dose prescribed by the doctor plus 2 units).

Change the needle. Release the air from the syringe (2 units will go into the needle).

Place the syringe on a sterile tray, prepare 3 sterile cotton balls (2 moistened with 70% alcohol, 3rd dry).

Treat the skin first with the 1st, then the 2nd cotton ball (with alcohol), hold the 3rd (dry) in your left hand.

Gather the skin into a triangular fold.

Insert the needle into the base of the fold at an angle of 45° to a depth of 1-2 cm (2/3 of the needle), holding the syringe in your right hand.

Apply pressure to the injection site dry cotton ball.

Remove the needle by holding it by the cannula.

Place the disposable syringe and needle in a container with 3% chloramine for 60 minutes.

Remove gloves and place in a container with a disinfectant solution.

Possible complications when administering insulin:

Lipodystrophy (disappearance of adipose tissue at the site of multiple injections, scar formation).

Allergic reaction (redness, urticaria, Quincke's edema).

Hypoglycemic state (in case of overdose). Observed: irritability, sweating, feeling of hunger. (Help for hypoglycemia: give the patient sugar, honey, sweet drinks, cookies).

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1. The most common, formidable and dangerous thing is the development of HYPOGLYCEMIA. This is facilitated by:

— discrepancy between the administered dose and the food taken;

- liver and kidney diseases;

The first clinical symptoms of hypoglycemia (vegetotropic effects of “fast” insulins): irritability, anxiety, muscle weakness, depression, changes in visual acuity, tachycardia, sweating, tremor, pallor of the skin, “goose bumps,” a feeling of fear. A decrease in body temperature during hypoglycemic coma has diagnostic value.

Long-acting drugs usually cause hypoglycemia at night (nightmares, sweating, anxiety, headache on waking - cerebral symptoms).

When using insulin medications, a patient should always have with him a small amount of sugar and a piece of bread, which, if there are symptoms of hypoglycemia, must be eaten quickly. If the patient is in a coma, then glucose should be injected into a vein. Usually 20-40 ml of a 40% solution is sufficient. You can also inject 0.5 ml of adrenaline under the skin or 1 mg of glucagon (in solution) into the muscle.

Recently, in order to avoid this complication, new advances in the field of technique and technology of insulin therapy have appeared and been put into practice in the West. This is due to the creation and use of technical devices that provide continuous administration of insulin using a closed-type device that regulates the rate of insulin infusion in accordance with the glycemic level, or facilitates the administration of insulin according to a given program using dispensers or micropumps. The introduction of these technologies makes it possible to carry out intensive insulin therapy with the approach, to some extent, of insulin levels during the day to the physiological level. This helps to achieve compensation for diabetes mellitus in a short time and maintain it at a stable level, and normalize other metabolic parameters.

The simplest, most accessible and safe way to carry out intensive insulin therapy is to administer insulin in the form of subcutaneous injections using special pen-type devices (Novopen - Czechoslovakia, Novo - Denmark, etc.). Using these devices, you can easily dose and perform virtually painless injections. Thanks to automatic adjustment, using the pen syringe is very easy, even for patients with reduced vision.

2. Allergic reactions in the form of itching, hyperemia, pain at the injection site; urticaria, lymphadenopathy.

An allergy can be not only to insulin, but also to protamine, since the latter is also a protein. Therefore, it is better to use drugs that do not contain protein, for example, insulin tape. If you are allergic to bovine insulin, it is replaced with pork, whose antigenic properties are less pronounced (since this insulin differs from human insulin by one amino acid). Currently, in connection with this complication of insulin therapy, highly purified insulin preparations have been created: monopeak and monocomponent insulins. The high purity of monocomponent drugs ensures a decrease in the production of antibodies to insulin, and therefore, transferring a patient to monocomponent insulin helps to reduce the concentration of antibodies to insulin in the blood, increases the concentration of free insulin, and therefore helps reduce the dose of insulin.