1. Insulin resistance– 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 (aEDominal) 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 most often due to the presence in insulin preparations of protein impurities with pronounced antigenic activity. 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.

Allergic reactions of the immediate type and the Arthus phenomenon are mediated by humoral immunity, namely by circulating antibodies of the classes JgE And JgG. 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.

Lipodystrophy– these are focal disorders of lipogenesis and lipolysis that occur 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.

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.

This article contains information about the side effects and complications of insulin therapy, which in most cases develop at the very beginning of the transition to injections of this hormone, which is why many patients begin to worry and mistakenly believe that this method of treatment is not suitable in their case.

Side effects and complications of insulin therapy

1. Veil before the eyes. One of the most commonly observed complications of insulin therapy is the appearance of blurred vision, which causes significant discomfort in patients, especially when trying to read something. Being uninformed on this issue, people begin to sound the alarm, and some even believe that this symptom marks the development of something called retinopathy, that is, eye damage due to diabetes.

In fact, the appearance of the veil is the result of a change in the refraction of the lens, and it spontaneously disappears from view 2 or 3 weeks after the start of insulin therapy. Therefore, there is no need to stop taking insulin injections when blurry vision appears.

2. Insulin swelling of the legs. This symptom, like the blurred vision, is transitory. The appearance of edema is associated with sodium and water retention in the body as a result of the initiation of insulin therapy. Gradually, the patient’s body adapts to the new conditions, and swelling of the legs disappears on its own. For the same reason, at the very beginning of insulin therapy, a transient increase in blood pressure may be observed.

3. Lipohypertrophy. This complication of insulin therapy is not observed as often as the first two. Lipohypertrophy is characterized by the appearance of fatty deposits in the area of ​​subcutaneous insulin injection.

The exact cause of the development of lipohypertrophy has not been established, but there is a significant relationship between the places where fatty deposits appear and the areas of frequent injections of the hormone insulin. That is why you should not constantly inject insulin into the same area of ​​the body; it is important to alternate injection sites correctly.

In general, lipohypertrophy does not lead to a deterioration in the condition of patients with diabetes, unless, of course, they are enormous in size. And do not forget that these compactions lead to a deterioration in the rate of absorption of the hormone from a localized area, so you should try in every possible way to prevent their appearance.

In addition, lipohypertrophy significantly disfigures the human body, that is, it leads to the appearance of a cosmetic defect. Therefore, if they are large in size, they have to be removed surgically, because, unlike the complications of insulin therapy from the first two points, they will not disappear on their own.

4. Lipoatrophy, that is, the disappearance of subcutaneous fat with the formation of a pit in the area of ​​insulin administration. This is an even rarer side effect of insulin therapy, but it is still important to be informed. The cause of lipoatrophy is an immunological reaction in response to injections of low-quality, insufficiently purified preparations of the hormone insulin of animal origin.

To eliminate lipoatrophies, injections around the periphery of small doses of highly purified insulin are used. Lipoatrophy and lipohypertrophy are often referred to collectively as lipodystrophy, despite the fact that they have different etiologies and pathogenesis.

5. Red itchy spots may also occur at insulin injection sites. They can be observed very rarely, plus they tend to disappear on their own soon after their occurrence. However, in some patients with diabetes, they cause extremely unpleasant, almost unbearable itching, which is why it is necessary to take measures to eliminate them. For these purposes, hydrocortisone is first introduced into the bottle with the administered insulin preparation.

6. Allergic reaction can be observed during the first 7-10 days from the start of insulin therapy. This complication resolves on its own, but it takes some time - often from several weeks to several months.

Fortunately, today, when most doctors and patients have switched only to the use of highly purified hormone preparations, the possibility of developing allergic reactions during insulin therapy is gradually erased from people’s memory. Life-threatening allergic reactions include anaphylactic shock and generalized urticaria.

By and large, when using outdated insulin preparations, one can only observe allergic itching, swelling and redness of the skin. To reduce the likelihood of developing allergic reactions, it is necessary to avoid frequent breaks in insulin therapy and use only human insulin.

7. Abscesses at insulin injection sites are practically never encountered today.

8. Hypoglycemia , that is, a decrease in blood sugar.

9. Gaining extra pounds. Most often, this complication is not significant; for example, after switching to insulin injections, a person gains 3-5 kg ​​of excess weight. This is due to the fact that when switching to the hormone, you have to completely reconsider your usual diet, increase the frequency and caloric content of meals.

In addition, insulin therapy stimulates the process of lipogenesis (fat formation), and also increases the sense of appetite, which patients themselves mention a few days after switching to a new diabetes treatment regimen.

Leave a comment and receive a GIFT!

Complications with insulin therapy are not uncommon.

In some cases, they do not cause serious health changes and are easily corrected, but in others they can be life-threatening.

Let's look at the most common complications and how to eliminate them. How to prevent the condition from getting worse.

When is insulin treatment prescribed for patients with diabetes mellitus?

So, the reasons for insulin therapy are the following conditions:

• first type;
• hyperlactic acidemic coma;
• and childbirth in women with diabetes;
• large-scale and ineffectiveness of other treatment methods for type 2 diabetes mellitus;
• rapid loss of body weight in diabetics;
• caused by carbohydrate metabolism disorders.

The type of drug, dosage and route of administration are determined by the treating endocrinologist.

Possible patient problems associated with insulin therapy

Any therapy, under certain conditions, can cause a deterioration in conditions and well-being. This is due to both side effects and errors in the selection of the drug and dosage.

A sharp drop in blood sugar (hypoglycemia)

• hypertrophic;
• atrophic.

It appears against the background of a long course of hypertrophic pathology.

The mechanism of development of these manifestations is not fully understood.

However, there are suggestions that the reason is systematic injury to peripheral nerve processes, followed by local neurotrophic changes. The problem may also be that:

• insulin is not sufficiently purified;
• the injection of the drug was carried out incorrectly, for example, it was injected into a hypothermic area of ​​the body or it itself had a temperature lower than the required one.

When diabetics have hereditary prerequisites for lipodystrophy, it is worth strictly following the rules of insulin therapy, alternating every day. One of the preventive measures is diluting the hormone with an equal amount of Novocaine (0.5%) immediately before administration.

Other complications in diabetics

In addition to the above, insulin injections can cause other complications and side effects:

• A cloudy veil before the eyes. It appears periodically and causes significant discomfort. The reason is problems with the refraction of the lens. Sometimes diabetics mistake it for retinopathy. Special treatment, which is carried out against the background of insulin therapy, helps to get rid of discomfort.
• . This is a temporary phenomenon that goes away on its own. With the start of insulin therapy, water is less cleared from the body, but over time the metabolism is restored to its previous volume.
• . The cause is also considered to be fluid retention in the body, which may occur at the beginning of insulin treatment.
• Rapid weight gain. On average, weight may increase by 3-5 kilograms. This is due to the fact that the use of hormones increases appetite and promotes the formation of fat. To avoid extra pounds, it is worth revising the menu in the direction of reducing the number of calories and adhering to a strict eating regimen.
• Decreased potassium concentration in the blood. A special diet containing a lot of cabbage vegetables, citrus fruits, and greens will help prevent the development of hypokalemia.

Insulin overdose and development of coma

Insulin overdose manifests itself:

• decreased muscle tone;
• feeling of numbness in the tongue;
• trembling in hands;
• constant thirst;
• cold, sticky sweat;
• "fog" of consciousness.

All of the above are signs of hypoglycemic syndrome, which occurs due to a sharp deficiency of sugar in the blood.

It is important to stop it quickly to avoid transformation into a coma, because it poses a threat to life.

Hypoglycemic coma is an extremely dangerous condition. There are 4 stages of its manifestation classified. Each of them has its own set of symptoms:

1. with the first, hypoxia of brain structures develops. This is expressed by the phenomena discussed above;
2. in the second, the hypothalamic-pituitary system is affected, which is manifested by behavioral disorder and hyperhidrosis;
3. with the third, the functionality of the midbrain suffers. Convulsions occur, pupils enlarge, as during an epileptic seizure;
4. the fourth stage is a critical condition. It is characterized by loss of consciousness, increased heart rate and other disturbances. Failure to provide medical care is dangerous due to cerebral edema and death.

The consequences of being in a coma will be felt in any case. Even if a person was provided with timely and correct assistance, he will become extremely dependent on insulin injections.

If in normal situations a diabetic’s well-being worsens after 2 hours, if the injection is not given on time, then after a coma within an hour the person experiences alarming symptoms.

What to do if, after administering an insulin injection, the diabetic’s condition suddenly worsens

First, you should make sure that the cause of the deterioration is precisely the overestimation of insulin doses. To do this, they take it and check it. The device will show the results within 5 seconds after the test. The norm is from 5 to 7 mmol/l. The lower the number, the brighter the symptoms of ill health.

Sugar deficiency can be corrected by measures that increase its level:

• give chocolate, candy, sweet tea or glucose tablet;
• administer glucose intravenously. Only a medical professional can do this correctly. In this case, the amount of the drug will depend on the condition of the diabetic, the type of his pathology and other parameters.

When trying to replenish low blood sugar, it is important not to overdo it with carbohydrates. In normal health, excess is stored as glycogen as an energy reserve. Diabetes can cause dehydration.

Insulin formation when blood glucose increases

Insulin is the only hormone that controls blood sugar levels.

It promotes the absorption of glucose into muscle and fat tissue.

The main task of insulin is to maintain a normal and stable amount of glucose (80-100 mg/deciliter).

When it is higher, the pancreas synthesizes insulin, which “takes” excess glucose from the blood and sends it for storage in muscles and fat.

To minimize the risk of negative consequences of insulin therapy, it is important to strictly follow the doctor’s instructions and administer the drug correctly.

If your health worsens, you should definitely contact your treating endocrinologist, and in severe cases, call an ambulance on your own or with outside help.

They appear:

• a) in local form - an erythematous, slightly itchy and hot papule or a limited, moderately painful hardening at the injection site;
• b) in a generalized form, characterized in severe cases by urticaria (appearing earlier and more pronounced on the skin of the face and neck), itching of the skin, erosive lesions of the mucous membranes of the mouth, nose, eyes, nausea, vomiting and abdominal pain, as well as increased body temperature and chills. In rare cases, the development of anaphylactic shock is observed.

To prevent further progression of both local and generalized allergic manifestations, in the vast majority of cases it is enough to replace the insulin used with another type (replace monocomponent pig insulin with human insulin) or replace insulin preparations from one company with similar preparations, but produced by another company. Our experience shows that allergic reactions in patients often occur not to insulin, but to a preservative (manufacturers use various chemical compounds for this purpose) used to stabilize insulin preparations.

If this is not possible, then before receiving another insulin preparation, it is advisable to administer insulin with microdoses (less than 1 mg) of hydrocortisone, mixed in a syringe. Severe forms of allergies require special therapeutic intervention (prescription of hydrocortisone, suprastin, diphenhydramine, calcium chloride).

It should, however, be borne in mind that allergic reactions, especially local ones, often occur as a result of improper administration of insulin: excessive trauma (too thick or blunt needle), administration of a very cool drug, incorrect choice of injection site, etc.

2. Hypoglycemic conditions

If the dose of insulin is incorrectly calculated (it is overestimated), or insufficient intake of carbohydrates soon or 2-3 hours after the injection of simple insulin, the concentration of glucose in the blood sharply decreases and a serious condition occurs, including hypoglycemic coma. When using long-acting insulin preparations, hypoglycemia develops during the hours corresponding to the maximum effect of the drug. In some cases, hypoglycemic conditions can occur due to excessive physical stress or mental shock or anxiety.

The determining factor for the development of hypoglycemia is not so much the level of glucose in the blood as the speed of its decrease. Thus, the first signs of hypoglycemia may appear already at a glucose level of 5.55 mmol/l (100 mg/100 ml), if its decrease was very rapid; in other cases, with a slow decrease in glycemia, the patient may feel relatively well with a blood sugar level of about 2.78 mmol/l (50 mg/100 ml) or even lower.

During the period of hypoglycemia, a pronounced feeling of hunger, sweating, palpitations, trembling of the hands and the whole body appear. Subsequently, inappropriate behavior, convulsions, confusion or complete loss of consciousness are observed. At the initial signs of hypoglycemia, the patient should eat 100 g of bread, 3-4 pieces of sugar or drink a glass of sweet tea. If the condition does not improve or even worsens, then after 4-5 minutes you should eat the same amount of sugar. In case of hypoglycemic coma, the patient must immediately inject 60 ml of 40% glucose solution into a vein. As a rule, after the first injection of glucose, consciousness is restored, but in exceptional cases, if there is no effect, after 5 minutes the same amount of glucose is injected into the vein of the other arm. A rapid effect occurs after subcutaneous administration of 1 mg of glucagon to the patient.

Hypoglycemic conditions are dangerous due to the possibility of sudden death (especially in elderly patients with varying degrees of damage to the blood vessels of the heart or brain). With frequently recurring hypoglycemia, irreversible mental and memory disorders develop, intelligence decreases, and existing retinopathy appears or worsens, especially in the elderly. Based on these considerations, in cases of labile diabetes, it is necessary to allow minimal glucozuria and slight hyperglycemia.

3. Insulin resistance

In some cases, diabetes is accompanied by conditions in which there is a decrease in tissue sensitivity to insulin, and 100-200 units of insulin or more are required to compensate for carbohydrate metabolism. Insulin resistance develops not only as a result of a decrease in the number or affinity of insulin receptors, but also with the appearance of antibodies to the receptors or insulin (immune type of resistance), as well as due to the destruction of insulin by protolytic enzymes or binding by immune complexes. In some cases, insulin resistance develops due to increased secretion of counter-insulin hormones, which is observed in diffuse toxic goiter, pheochromocytoma, acromegaly and hypercortinism.

Medical tactics consist primarily of determining the nature of insulin resistance. Sanitation of foci of chronic infection (otitis, sinusitis, cholecystitis, etc.), replacing one type of insulin with another or using one of the oral hypoglycemic drugs together with insulin, active treatment of existing diseases of the endocrine glands give good results. Sometimes they resort to the use of glucocorticoids: slightly increasing the daily dose of insulin, combining its administration with prednisolone at a dose of about 1 mg per 1 kg of the patient’s body weight per day for at least 10 days. Subsequently, in accordance with the existing glycemia and glucosuria, the doses of prednisolone and insulin are gradually reduced. In some cases, there is a need for longer (up to a month or more) use of small (10-15 mg per day) doses of prednisolone.

Recently, for insulin resistance, sulfated insulin has been used, which is less allergenic, does not react with antibodies to insulin, but has 4 times higher biological activity than simple insulin. When transferring a patient to treatment with sulfated insulin, it must be borne in mind that such insulin requires only 1/4 of the dose of administered simple insulin.

4. Pastipsulip lipodystrophy

From a clinical point of view, lipodystrophies are distinguished between hypertrophic and atrophic. In some cases, atrophic lipodystrophies develop after a more or less long-term existence of hypertrophic lipodystrophies. The mechanism of occurrence of these post-injection defects, which involve the subcutaneous tissue and have several centimeters in diameter, has not yet been fully elucidated. It is believed that they are based on long-term trauma to small branches of peripheral nerves with subsequent local neurotrophic disorders or the use of insufficiently purified insulin for injection. When using monocomponent preparations of pig and human insulin, the incidence of lipodystrophy decreased sharply. Undoubtedly, incorrect administration of insulin (frequent injections into the same areas, administration of cold insulin and subsequent cooling of the area of ​​its administration, insufficient massaging after injection, etc.) has a certain significance in this regard. Sometimes lipodystrophies are accompanied by more or less pronounced insulin resistance.

If you are prone to the formation of lipodystrophy, you should be especially pedantic in following the rules for administering insulin, correctly alternating the sites of its daily injections. The administration of insulin mixed in one syringe with an equal amount of 0.5% novocaine solution can also help prevent the occurrence of lipodystrophy. The use of novocaine is also recommended for the treatment of lipodystrophy that has already occurred. Successful treatment of lipoatrophies with insulin injection in humans has been reported.

As noted above, the autoimmune mechanism of IDD has now been established and confirmed. The insulin therapy we considered is only replacement therapy. Therefore, there is a constant search for means and methods of treating and curing IDD. In this direction, several groups of drugs and various effects have been proposed that are aimed at restoring a normal immune response. Therefore, this direction is called immunotherapy for IDD.

General immunosuppression is aimed at suppressing humoral immunity, i.e. formation of autoantibodies, which include cytoplasmic, cell-surface antibodies, antibodies to glutamate decarboxylase, insulin, proinsulin, etc. For this purpose, glucocorticoids, antilymphocyte globulin, azathioprine, cyclosporine A, modern cytostatic drug-RK-506 and irradiation of the pancreas are used glands. According to most researchers, this direction of diabetes has no prospects, because The listed drugs affect only the final phase of the immune response, and not the primary pathogenetic mechanisms leading to the destruction of pancreatic b-cells.