When insulin is prescribed for diabetes mellitus, sugar indicators for prescribing injections. Insulin therapy for diabetes mellitus: complications, schemes (regimes), rules for conducting Drawing up an insulin therapy regimen

Type 1 diabetes is chronic illness, which requires constant treatment and monitoring of the patient's health. It is equally important to adhere to the principles proper nutrition and in general healthy lifestyle life. But it is insulin in type 1 diabetes that is the main medicine, without which it is almost impossible to help the patient.

general information

To date, the only way to treat type 1 diabetes and keep the patient in good condition is insulin injections. All over the world, scientists are constantly conducting research on alternative ways help such patients. For example, doctors talk about the theoretical possibility of artificially synthesizing healthy pancreatic beta cells. Then they plan to transplant patients to get rid of diabetes. But so far this method has not passed clinical trials, and it is impossible to obtain such a treatment even as part of an experiment.

Trying to treat type 1 diabetes without insulin is pointless and very dangerous. Often such attempts lead to early disability or even death. A person may fall into a coma, have a stroke, and so on. All this can be avoided if the disease is diagnosed in time and treated.

Not all patients psychologically can accept the diagnosis immediately, some of them think that over time, sugar returns to normal without treatment. But, unfortunately, with insulin-requiring diabetes, this cannot happen on its own. Some people start only after the first hospitalization, when the disease has already played out in earnest. It is better not to bring to this, but to start as early as possible proper treatment and slightly adjust the usual way of life.

The discovery of insulin was a revolution in medicine, because previously diabetics lived very short lives, and their quality of life was much worse than that of healthy people. Modern drugs allow patients to lead a normal life and feel good. Young women with this diagnosis, thanks to treatment and diagnosis, in most cases can even become pregnant and give birth to children. Therefore, it is necessary to approach insulin therapy not from the point of view of some restrictions for life, but from the position real opportunity maintain health and well-being for many years.

If you follow the doctor's recommendations regarding insulin treatment, then the risk of side effects of the medication will be minimized. It is important, according to the instructions, to enter the doses prescribed by the doctor and monitor the expiration date. More information about side effect insulin and the rules that will help you avoid it, you can find out.

How to make injections?

From how correct the technique of administering insulin will be, its effectiveness, and hence the well-being of the patient, depends. An example algorithm for administering insulin looks like this:

1. The injection site must be treated with an antiseptic and dried well with gauze wipes so that the alcohol completely evaporates from the skin (with the introduction of some insulins, this step is optional, since they contain special preservative disinfectants).
2. With an insulin syringe, you need to dial the required amount of the hormone. You can initially draw a little more money, then to release air from the syringe to the exact mark.
3. Release the air, making sure that there are no large bubbles in the syringe.
4. With clean hands, you need to form a fold of skin and inject the medicine into it with a quick movement.
5. The needle must be removed, holding the injection site with cotton. It is not necessary to massage the injection site.

One of the main rules for administering insulin is to hit it exactly under the skin, and not into the muscle area. An intramuscular injection can lead to impaired absorption of insulin and to soreness, swelling in this area.

You should never mix different brands of insulin in the same syringe, because this can lead to unpredictable health consequences. It is impossible to predict the interaction of the components, which means that it is impossible to predict their effect on blood sugar levels and the general well-being of patients.

It is advisable to change the area of ​​​​insulin injection: for example, in the morning you can inject insulin into the stomach, at lunchtime - into the thigh, then into the forearm, etc. This must be done so that lipodystrophy does not occur, that is, thinning of the subcutaneous fatty tissue. With lipodystrophy, the mechanism of insulin absorption is disrupted, it may not enter the tissues as quickly as it should. This affects the effectiveness of the medicine and increases the risk of sudden spikes in blood sugar.

Injection therapy for type 2 diabetes

Insulin at diabetes Type 2 is rarely used, since this disease is more associated with metabolic disorders at the cellular level than with insufficient insulin production. Normally, this hormone is produced by the beta cells of the pancreas. And, as a rule, in type 2 diabetes, they function relatively normally. The level of glucose in the blood rises due to insulin resistance, that is, a decrease in the sensitivity of tissues to insulin. As a result, sugar cannot enter the blood cells, instead it accumulates in the blood.

If a most of beta cells are working normally, then one of the tasks of treating a non-insulin-dependent form of the disease is to keep them in the same active state

In severe type 2 diabetes and frequent fluctuations in blood sugar levels, these cells can die or weaken their functional activity. In this case, to normalize the condition, the patient will have to either temporarily or permanently inject insulin.

Also, hormone injections may be needed to maintain the body during periods of infectious diseases, which are a real test for the immunity of a diabetic. The pancreas at this moment may produce an insufficient amount of insulin, since it also suffers due to intoxication of the body.

It is important to understand that in most cases, hormone injections for non-insulin-dependent diabetes are temporary. And if the doctor recommends this type of therapy, you should not try to replace it with something.

With mild type 2 diabetes, patients often manage even without hypoglycemic pills. They control the disease only with a special diet and lungs. physical activity, while not forgetting about regular check-ups with a doctor and measuring blood sugar. But during those periods when insulin is prescribed for temporary deterioration, it is better to adhere to the recommendations in order to maintain the ability to keep the disease under control in the future.

Types of insulin

According to the time of action, all insulins can be conditionally divided into the following groups:

• ultra short action;
• short action;
• medium action;
• prolonged action.

Ultrashort insulin begins to act within 10-15 minutes after the injection. Its effect on the body lasts for 4-5 hours.

Short acting drugs begin to act on average half an hour after the injection. The duration of their influence is 5-6 hours. Ultrashort insulin can be administered both immediately before meals and immediately after it. Short insulin is recommended to be administered only before meals, as it does not begin to act so quickly.

Intermediate acting insulin when ingested, it begins to reduce sugar only after 2 hours, and the time of its total action is up to 16 hours.

Long-acting drugs (extended) begin to affect carbohydrate metabolism after 10–12 hours and are not excreted from the body for 24 hours or more.

All these drugs have different tasks. Some of them are administered immediately before meals to stop postprandial hyperglycemia (increased sugar after eating).

Intermediate and long-acting insulins are administered to maintain the target sugar level constantly throughout the day. Doses and regimen of administration are selected individually for each diabetic, based on his age, weight, characteristics of the course of diabetes and the presence of concomitant diseases. There is a state program for the issuance of insulin to patients suffering from diabetes, which provides free provision of this medicine to all those in need.

The role of diet

With diabetes of any type, except for insulin therapy, it is important for the patient to follow a diet. The principles of therapeutic nutrition are similar for patients with different forms of this disease, but there are still some differences. In patients with insulin-dependent diabetes, the diet may be more extensive, since they receive this hormone from outside.

With optimally selected therapy and well-compensated diabetes, a person can eat almost everything. Of course, we are talking only about healthy and natural products, since semi-finished products and unhealthy food excluded for all patients. At the same time, it is important to correctly administer insulin for diabetics and be able to correctly calculate the amount of medication needed, depending on the volume and composition of the food.

The basis of the diet of a patient diagnosed with a metabolic disorder should be:

• fresh vegetables and fruits with a low or medium glycemic index;
• low-fat dairy products;
• cereals with slow carbohydrates in the composition;
• dietary meat and fish.

Diabetics who are treated with insulin can sometimes afford bread and some natural sweets (if they do not have complications of the disease). Patients with type 2 diabetes should follow a more strict diet, because in their situation it is nutrition that is the basis of treatment.

By adjusting your diet, you can get rid of excess weight and reduce the load on all vital organs

Meat and fish are also very important for a weakened patient's body, because they are a source of protein, which, in fact, is a building material for cells. Dishes from these products are best steamed, baked or boiled, stewed. It is necessary to give preference to low-fat varieties of meat and fish, do not add a lot of salt during the cooking process.

Fatty, fried and smoked foods are not recommended for patients with any type of diabetes, regardless of the type of treatment and the severity of the disease. This is due to the fact that such dishes overload the pancreas and increase the risk of diseases of the cardiovascular system.

A diabetic needs to be able to calculate the number of bread units in food and the right dose of insulin in order to maintain a target blood sugar level. All these subtleties and nuances, as a rule, are explained by the endocrinologist at the consultation. This is also taught in "diabetes schools", which often operate at specialized endocrinological centers and clinics.

What else is important to know about diabetes and insulin?

Probably, all patients who were once diagnosed with this disease are concerned about how long they live with diabetes and how the disease affects the quality of life. There is no single answer to this question, since everything depends on the severity of the disease and the person's attitude to his illness, as well as on the stage at which it was discovered. The sooner a patient with type 1 diabetes begins insulin therapy, the more chances they have to maintain a normal life for many years.

In order for diabetes to be well compensated, it is important to choose the right dose of insulin and not skip injections.

The choice of medicine should be handled by a doctor, any attempts at self-treatment can end in failure. Usually, at first, the patient is selected for extended insulin, which he will inject at night or in the morning (but sometimes it is recommended to inject it twice a day). Then they proceed to the calculation of the amount of short or ultra-short insulin.

It is advisable for the patient to buy a kitchen scale in order to know the exact weight, calorie content and chemical composition of the dish (the amount of proteins, fats and carbohydrates in it). To choose the right dose of short insulin, the patient needs to measure blood sugar for three days each time before meals, as well as 2.5 hours after it, and record these values ​​in an individual diary. It is important that on these days of selecting the dose of the medicine, the energy value of the dishes that a person eats for breakfast, lunch and dinner is the same. It can be a variety of food, but it must contain the same amount of fat, protein and carbohydrates.

When choosing a medication, doctors usually recommend starting with lower doses of insulin and gradually increasing them as needed. The endocrinologist evaluates the level of sugar rise during the day, before and after meals. Not all patients need to inject short insulin every time before meals - for some of them it is enough to do such injections once or several times a day. There is no standard scheme for administering the drug; it is always developed by the doctor individually for each patient, taking into account the characteristics of the course of the disease and laboratory data.

With diabetes, it is important for a patient to find a competent doctor who can help him choose the optimal treatment and tell him how to easily adapt to a new life. Insulin in type 1 diabetes is the only chance for patients to maintain good health for a long time. By following the recommendations of doctors and keeping sugar under control, a person can live full life which is not much different from the life of healthy people.

Last update: October 7, 2019

The doctor's verdict "Diabetes mellitus" and further necessary insulin therapy often frighten the patient.

In this case, doctors unanimously advise not to lose confidence, mobilize strength, follow a diet and follow the doctor's instructions. Only such behavior will help to maintain the quality and fullness of life.

And the rules and tactics of insulin administration (in Latin - Insulinum) can be mastered by everyone. To help the diabetic, special syringe pens and pump devices are currently being produced for comfortable injections.

Type I diabetes mellitus (DM-1) is called insulin dependent for a reason. With it, the beta cells of the pancreas lose their ability to independently synthesize the vital hormone insulin. Initially, this is expressed in a decrease in the production of Insulinum, then its production finally stops.

In this case, it is important to determine the alarming sugar levels in time and prescribe insulin as replacement therapy. Compliance with the rules complex treatment will provide timely assistance to the pancreas and prevent the occurrence of complications sugar disease.

As a rule, with the insulin-dependent type, 2 types of insulin drugs are used:

• long-acting,
• fast (ultra-short and shortened) action.

In the first variant, insulin is more often prescribed for diabetes mellitus twice a day (for example, before breakfast and dinner), as a background protection that ensures the constant presence of the required minimum amount of the hormone in the body. Sometimes a single daily administration of this type is enough for a diabetic. hormonal drug.

Usually prescribed the use of "long" Insulinum with "ultra-short" or "shortened". The main role of the latter in the compensation of carbohydrates from food.

The "ultra-short" biological product acts 10 minutes after entering the body and reaches peak values ​​in an hour.

The effect of the "shortened" version is fixed after 30 minutes and reaches a maximum after 1.5 or 2 hours.

An important point. With a short-acting medicine, additional snacks between main meals are indicated to avoid a drop in blood sugar levels. Conversely, when using Insulinum ultra-short-acting and a heavy meal, an additional injection may be required. This need will disappear only in the case of planned physical activity after eating.

The average daily insulin dose for type I sugar dependence is 0.4-0.9 units / kg of human weight. The appointment of a reduced dosage indicates a state of the disease close to remission.

To assess the content of carbohydrates in food and the subsequent calculation of insulin therapy, bread units are used. 1 bread unit is equal to 10-13 g of carbohydrates.

• for breakfast, one bread unit requires two insulin units,
• for lunch, one bread unit needs one and a half insulin units,
• for dinner, one unit of insulin is enough for one bread unit.

It should be noted that the success of injection treatment depends on the patient's compliance with the time intervals between injections and control of the diet.

Insulin for Type II Diabetes

Type II diabetes mellitus (DM-2), unlike DM-1, is not insulin dependent. With it, the cells of the pancreas synthesize an insufficient amount of the hormone insulin, or the produced Insulinum is rejected by the body for some reason.

Treatment of type II diabetes is comprehensive - using diet, tablet medications and insulin therapy.

Insulin can be prescribed for type 2 diabetes in the following ways:

• at the beginning of the illness
• due to progression of the disease
• as temporary and supportive measures,
• as a permanent therapy,
• in the form of a complex treatment course (with tablets),
• as monotherapy.

Sugar dependence should be diagnosed as early as possible. If a patient with suspected CD-2 does not improve blood glucose levels within a three-month period, elevated glycated hemoglobin persists (more than 6.5%), a diagnosis of diabetes mellitus is made. In the future, this is an indication for the appointment conservative treatment with the use of antidiabetic drugs and insulin injections.

If the patient treated his health without due attention, did not visit the clinic, led a wrong life, became obese, the body does not forgive this. Complications inevitably follow: an increase in the level of glucose in the blood (up to 20 millimoles per liter, the detection of acetone in the urine).

A patient with a sharp deterioration is in the clinic. There are no options here, except for the diagnosis of "Diabetes mellitus" and the transition to insulin injections.

Indications for the temporary use of insulin hormone injections can be serious concomitant diseases (complex pneumonia, heart attack), as well as conditions in which it is impossible to use pills (being in intensive care, postoperative period):

• Hyperglycemia due to severe stress (sugar above 7.8 millimoles per liter) also requires temporary support of the body with Insulinum injections.
• Women with a diagnosis of "DM-2" during fruiting, due to the increased load on the body, may be prescribed a maintenance insulin course.

Sugar dependence type 2 is considered a chronic endocrine pathology. With age, concomitant ailments often join, and the underlying disease is exacerbated. An increase in the intake of tablet forms begins to cause complications and adversely affect overall well-being. In this embodiment, the patient is transferred to full insulin therapy.

As non-insulin-dependent diabetes develops, sometimes the use of dietary restrictions and the introduction of a certain regimen to stabilize glucose levels becomes not enough. It is the turn of oral agents and insulin injections.

Antidiabetic drugs in tandem with hormonal injections can minimize the dose of the latter and prevent possible post-insulin complications.

Insulin monotherapy for DM-2 is usually used for severe decompensation of the pancreas, late diagnosis, the development of dangerous complications and the ineffectiveness of oral agents.

In any case, you should not be afraid of hormonal injections, they are not addictive.

At what level of sugar is insulin prescribed

From the foregoing, it becomes clear that the treatment of non-insulin-dependent diabetes, in contrast to insulin-dependent diabetes, can be carried out with oral medications.

However, if the pills are powerless, the medicine-insulin comes into play. Doctors also resort to insulin therapy if the patient's glucose values ​​are more than 7 millimoles per liter before meals or over 11.1 millimoles per liter after a couple of hours after a meal.

It is important to remember that it is impossible to decide on your own at what sugar to inject insulin. The decision to prescribe insulin therapy can only be made by the attending endocrinologist.

The choice of the dose of insulin injections is a serious measure and depends on many factors (the stage of the disease, test results, the patient's condition, etc.). An important role is given to an individual approach to treatment.

To help, there are standard dose selection schemes as general guidelines for prescribing.

"Long" insulin

Long-acting insulin medication is designed to provide normal glucose levels during non-meal times.

You can check the correctness of the prescribed dosage of "long-term" Insulinum empirically:

• on the first day, do not have breakfast and control glycemia every 1-1.5-2 hours,
• on the second day, do not dine and make the same observation,
• on the third day, stay without dinner and check the glucose level every hour or two.

Additionally, such measurements should be made at night. If the glycemic readings have not changed (an error of one or two millimoles per liter is acceptable), the dose is correct.

Long-acting insulin hormone therapy allows for a single injection per day. At what time is it better to give this injection (in the morning or evening hours) - your own body should tell you.

"Short" insulin

A bolus is the introduction of "ultra-short" or "short" bidirectional insulin:

• to maintain a normal glycemic level after the assimilation of food,
• reduction in sugar spike.

A food bolus is a treatment dose that allows you to absorb what you eat, and a correction bolus is a treatment dose that fights the resulting hyperglycemia.

As a result, an injection of an “fast” insulin preparation is a symbiosis of food and correction boluses.

Currently, diverse insulin drugs have been developed. For example, the "shortened" Actrapid is most effective a couple of hours after application and requires a snack during this period. The result of the introduction of "ultra-short" NovoRapid is felt faster and the patient does not need a snack.

Knowing the right dosage will help you know how many insulin units are needed to compensate for one bread unit or 10-13 g of carbohydrates.

When using a standard algorithm, the individual characteristics of the organism are taken into account and changes are made.

Choice of treatment regimen

The general daily scheme, how and when to inject insulin with SD-2, looks like this:

• morning injection of "fast" insulin stabilizes sugar between breakfast and lunch,
• a morning injection of a long-term hormone will provide a glycemic level until dinner (for 12 hours),
• evening administration of a fast-acting insulin drug will replenish hormone deficiency from dinner until bedtime (until 24.00),
• an evening dose of "long-term" Insulinum will provide protection during the night.

The above formula is subject to adjustments in the following cases:

• change in the course of the underlying disease,
• physiological conditions (pregnancy, menstrual cycle, nervous overload, etc.),
• change of seasons,
• individual characteristics of a person.

Life with sugar addiction is definitely changing. A timely visit to an endocrinologist will help determine the treatment, avoid complications and maintain the usual rhythm of life for many years.

If you think about it, at first it is not clear why diabetics should be given hormonal injections. The amount of such a hormone in the body of a sick person basically corresponds to the norm, and often it is significantly exceeded.

But the matter is more complicated - when a person has a “sweet” disease, then the immune system infects beta cells human body, the pancreas, which is responsible for insulin production, suffers. Such complications occur not only in type 2 diabetics, but also in type 1.

As a result, a large number of beta cells die, which significantly weakens the human body.

If we talk about the causes of pathology, obesity is often to blame, when a person does not eat well, moves little and his lifestyle can hardly be called healthy. It is known that a large number of elderly and middle-aged people suffer from excess weight, but the "sweet" disease does not affect everyone.

So why is it that sometimes a person is affected by pathology, and sometimes not? It is largely a matter of genetic predisposition, autoimmune attacks can be so severe that only insulin injections can help.

Types of insulin by time of action

The vast majority of insulin in the world is produced at pharmaceutical plants using genetic engineering technologies. Compared to obsolete animal products, modern facilities characterized by high purity, minimum side effects, stable, well predictable action. Now, 2 types of the hormone are used to treat diabetes: human and insulin analogues.

The human insulin molecule completely repeats the hormone molecule produced in the body. These are short-acting products, the duration of their work does not exceed 6 hours. This group also includes NPH-insulins of medium duration. They have a longer action time, about 12 hours, due to the addition of protamine protein to the preparation.

Insulin analogs are structurally different from human insulin. Due to the peculiarities of the molecule, these drugs can more effectively compensate for diabetes mellitus. These include ultra-short-acting agents that begin to reduce sugar 10 minutes after injection, long-term and extra-long-acting agents that work from 24 hours to 42 hours.

Insulin therapy in diabetes mellitus, pregnancy and children: complications, indications, regimens

• Indications for the use of insulin
• How to design an insulin therapy regimen for type 1 and type 2 diabetes?
• Injection rules
• Traditional and basal-bolus insulin therapy
• Pump therapy
• Insulin therapy in children
• Insulin treatment during pregnancy
• Possible Complications and their prevention

One of the leading treatments for diabetes is insulin therapy. It can significantly improve the health of a diabetic (including a child), and eliminate the development of complications. In order for such treatment to be correct, you need to learn everything about the indications for use, the nuances of drawing up a treatment regimen, the rules for injecting, and much more.

Indications for the use of insulin

• pregnancy and future childbirth, accompanied by diabetes;
• significant decompensation of type 2 diabetes mellitus;
• the minimum degree of effectiveness in the treatment of the disease by other means;
• a significant decrease in body weight.

How to design an insulin therapy regimen for type 1 and type 2 diabetes?

Drawing up an insulin therapy regimen should take into account many nuances.

It is necessary to skillfully combine insulin therapy regimens, it is important to correctly calculate the dose, based on the age of the diabetic, the absence or presence of complications, the "stage" of the disease.

If we talk about a step-by-step procedure, then it should look like this: it is necessary to determine whether injections of prolonged insulin at night are required, if they are necessary, it makes sense to calculate the initial amount, which will subsequently be adjusted.

In order for insulin therapy in type 2 diabetes to be effective, it is necessary to adjust the dosage of prolonged insulin over the next week until the optimal ratio is reached.

Further, after consulting with an endocrinologist, it is important to determine the need for the use of a hormonal component before eating sessions and the exact dosage. Insulin therapy for type 1 diabetes also includes:

• calculation of the initial amount of short or ultra-short insulin before eating and subsequent adjustment of the ratio;
• experimental determination of how many minutes before eating food, the introduction of a hormonal component will be required;
• correct calculation of short or ultra-short insulin in cases where it is important to normalize elevated blood sugar over a long period of time.

Injection rules

The specific rules for introducing a hormonal component depend on whether a pump is used or, for example, the procedure is carried out manually. The principles of insulin therapy are extremely simple: a predetermined amount of the component is administered at a fixed time of day.

If this is not insulin pump therapy, then we are talking about the fact that the hormone is administered under skin covering into adipose tissue. Otherwise medicine will not have the desired effect.

The introduction can be carried out in the shoulder region or in the peritoneum, the upper front of the thigh or the outer crease of the buttocks.

The injection area is changed daily, otherwise numerous consequences can be observed: a change in the quality of hormone absorption, changes in blood sugar levels. In addition, the rules exclude injections into modified areas, for example, with scars, scars, hematomas.

For direct administration of the drug, a conventional syringe or syringe pen is used. The rules of insulin therapy are as follows:

1. the injection site is treated with two swabs soaked in alcohol. One of them treats a larger surface, the second provides disinfection of the injection area;
2. it is necessary to wait about 30 seconds until the alcohol evaporates;
3. with one hand, a subcutaneous fat fold is formed, with the other hand, a needle is inserted into the base of the fold at an angle of 45 degrees;
4. without releasing the folds, you will need to press the piston all the way and introduce the hormonal component. Only after that, the syringe is pulled out and the skin fold is released.

For type 2 and type 1 diabetics, mixing or diluting different types of insulin can be vital. In this case, for a 10-fold dilution, one part of the drug and nine parts of the “solvent” must be used. For dilution by 20 times, one part of the hormone and 19 parts of the "solvent" are used.

Insulin can be diluted with either saline or distilled water. The use of other fluids is strongly discouraged. It is permissible to dilute the presented liquids directly in the syringe or in a separate vessel before administration.

Traditional and basal-bolus insulin therapy

Traditional and basal-bolus therapy with a hormonal component is envisaged. In the first case, we are talking about the fact that long-acting insulin is administered twice a day (in the morning and at night), and the short-acting component is administered either before breakfast and dinner, or before the main meals.

However, the dosage of the latter should be fixed, that is, the diabetic cannot change the ratio of insulin and the amount of XE on his own. The advantage of this technique is that there is no need to determine glycemia before eating.

Indications for insulin therapy for type 2 diabetes

Each endocrinologist, from the moment of diagnosis of type 2 diabetes, should inform his patients that insulin therapy is one of the highly effective methods of treatment today. Moreover, in some cases, insulin therapy may be the only possible, adequate method for achieving normoglycemia, that is, compensating for the disease.

The main role in deciding on the appointment of insulin therapy should be played by information about the reserve capacity of the beta-cells of the gland. Gradually, as type 2 diabetes mellitus progresses, depletion of beta cells develops, requiring an immediate transition to hormonal therapy. Often only with the help of insulin therapy it is possible to achieve and maintain the required level of glycemia.

In addition, insulin therapy in type 2 diabetes may be required temporarily in some pathological and physiological conditions. The following are situations where insulin therapy for type 2 diabetes is required.

1. Pregnancy;
2. Acute macrovascular complications such as myocardial infarction and stroke;
3. A clear lack of insulin, manifested as progressive weight loss with normal appetite, the development of ketoacidosis;
4. Surgical interventions;
5. Various infectious diseases and, first of all, purulent-septic character;
6. Unsatisfactory performance of various diagnostic research methods, for example:

• fixation of a low level of C-peptide and / or insulin in the blood on an empty stomach.
• repeatedly determined fasting hyperglycemia in cases where the patient takes oral hypoglycemic drugs, observes the regime of physical activity and diet.
• glycosylated hemoglobin more than 9.0%.

Items 1, 2, 4 and 5 require a temporary switch to insulin. After stabilization of the condition or delivery, insulin can be canceled.

In the case of glycosylated hemoglobin, its control should be repeated after 6 months. If during this period of time its level decreases by more than 1.5%, you can return the patient to taking hypoglycemic tablets and refuse insulin.

If there is no noticeable decrease in the indicator, insulin therapy will have to be continued.

Therapy strategy for the progression of type 2 diabetes mellitus natural development Type 2 diabetes mellitus (DM) develops progressive insufficiency of pancreatic beta cells, so insulin remains the only treatment that can control blood glucose in this situation.

About 30-40% of patients with type 2 diabetes need long-term insulin therapy for constant glycemic control, but it is often not prescribed due to certain concerns of both patients and doctors.

Early insulin administration, when indicated, is very important in reducing the incidence of microvascular complications of diabetes, including retinopathy, neuropathy, and nephropathy. Neuropathy is the main cause of non-traumatic amputations in adult patients, retinopathy is the leading cause of blindness, and nephropathy is the main factor leading to ESRD.

The UK Diabetes Prospective Study (UKPDS) and the Kumamoto study showed a positive effect of insulin therapy in reducing microvascular complications, as well as a clear trend towards improved prognosis in terms of macrovascular complications.

The DECODE study evaluated the relationship between overall mortality and glycemia, especially postprandial. The Control of Diabetes and its Complications Study (DCCT) in type 1 diabetes defined stringent standards for glycemic control.

The American Association of Clinical Endocrinology (AACE) and the American College of Endocrinology (ACE) set HbA1c targets of 6.5% or less, and fasting glucose targets of 5.5 and 7.8 mmol/L for postprandial glycemia (via 2 hours after eating).

Quite often, these goals are difficult to achieve with oral monotherapy, so insulin therapy becomes necessary. Consider prescribing insulin as initial therapy for all patients with type 2 diabetes.

It is well known that glucose toxicity can be a factor in the difficulty of achieving adequate glycemic control. Insulin therapy almost always controls glucose toxicity.

As soon as the toxic effect of glucose levels out, the patient can either continue motor therapy with insulin, or switch to combination therapy with insulin in combination with oral antidiabetic drugs, or to oral monotherapy.

Failure to strictly control diabetes mellitus leads to an increased risk of complications in the future, in addition, there are assumptions and evidence that timely and early control ensures the effectiveness of therapy in the future in terms of achieving better control.

There are two modes of insulin therapy: traditional and intensive. The first involves constant doses of insulin calculated by the doctor. The second includes 1-2 injections of a pre-selected amount of a long hormone and several of a short one, which is calculated each time before meals. The choice of regimen depends on the severity of the disease and the patient's readiness for self-control of blood sugar.

Traditional Mode

Calculated daily dose The hormone is divided into 2 parts: morning (2/3 of the total) and evening (1/3). Short insulin is 30-40%. You can use ready-made mixtures in which short and basal insulin are related as 30:70.

The advantages of the traditional regimen are the absence of the need to use daily dose calculation algorithms, rare glucose measurements, once every 1-2 days. It can be used for patients who are unable or unwilling to constantly control their sugar.

The main drawback of the traditional regimen is that the volume and time of insulin intake in injections absolutely does not correspond to the synthesis of insulin in a healthy person. If the natural hormone is secreted for the intake of sugar, then everything happens the other way around: in order to achieve normal glycemia, you have to adjust your diet to the amount of insulin injected.

As a result, patients are faced with a rigid diet, each deviation from which can result in hypoglycemic or hyperglycemic coma.

Intensive mode

Intensive insulin therapy is generally recognized worldwide as the most advanced mode of insulin administration. It is also called basal bolus, as it is able to imitate both constant, basal, secretion of the hormone, and bolus insulin, released in response to an increase in blood glucose.

The undoubted advantage of this regime is the absence of a diet. If a patient with diabetes has mastered the principles of correct dosage calculation and correction of glycemia, he can eat as anyone healthy man.

In this case, there is no specific daily dose of insulin, it changes daily depending on the diet, level of physical activity or exacerbation of concomitant diseases. There is no upper limit on the amount of insulin, the main criterion for the correct use of the drug is glycemia numbers.

Patients with diabetes mellitus using an intensive regimen should use the glucometer many times a day (about 7) and, based on the measurement data, change the subsequent dose of insulin.

Numerous studies have shown that normoglycemia in diabetes mellitus can only be achieved with intensive use of insulin. In patients, glycated hemoglobin decreases (7% versus 9% on the traditional regimen), the likelihood of retinopathy and neuropathy decreases by 60%, and nephropathy and heart problems are approximately 40% less common.

Is it permissible to replace pills with injections

There are several options for insulin injections, each of which has a number of nuances.

Table number 1. Types of means for insulin injections

Before answering this question, you need to know which pills are not suitable for diabetics and which carry an immediate danger. If they are dangerous, then they cannot be taken and the sugar level is not taken into account.

It is necessary to use injections, if everything is done correctly, then a person’s life can be significantly extended. When consuming harmful pills, a person's condition worsens, although the glucose level is at a short time decreases.

Some patients first go on a rigid diet, with a low carbohydrate intake. And many consume the drug metamorphine.

With hormonal injections, it happens that the sugar level sometimes exceeds permissible value, although the person does not violate a strict diet and does not violate the doses of insulin administered. This means that it is difficult for the pancreas to cope with such a large load, then you need to carefully increase insulin doses so that diabetic complications do not develop.

Such negative indicators of sugar content are often observed in the morning, on an empty stomach. To normalize the condition, you need to have dinner early, no later than 19.

00, and before going to bed, inject a small amount of the substance. After each meal, after a couple of hours, it is necessary to change the glucose level.

If at this time it is slightly elevated, then this is not critical. Ultrashort injections between meals will help.

Once again, it should be said about the order - first of all, a sick person sits on a strict diet with a low amount of carbohydrates, then moderate consumption of metamorphine begins. If sugar indicators go up, you should not hesitate, but use hormonal injections.

If a person has started injections, the diet should also be strictly observed, and special attention should be paid to the glucose level, it should be the same as in healthy people.

Insulin under the influence of gastrointestinal juice in the body is destroyed, hydrochloric acid and digestive enzymes are to blame. Despite high level development of modern pharmacology, tablet preparations with the maximum positive effect, currently not. And even active scientific research in this area by pharmaceutical companies is not conducted.

The pharmaceutical market offers the use of an inhalation type aerosol, but its consumption is associated with certain difficulties - the dosage is difficult to calculate, so its use is not recommended.

If a diabetic consumes a large amount of carbohydrates, then he needs in large numbers insulin, which also entails danger, so once again it must be said about the obligatory observance of a low-carbohydrate diet.

In type 2 diabetes, it is important to remember about diet and nutrition rules to stabilize sugar values. Violation of the amount of carbohydrates, incorrect accounting of bread units, cooking in violation of the recommendations, the use of prohibited foods can lead to sharp jumps in glucose, provoke dangerous complications.

At what level of sugar are they put on insulin? This question worries patients who have confirmed endocrine pathology. Will the concentration of glucose and glycated hemoglobin be kept at an acceptable level? When is hormone therapy needed? The answers largely depend on proper nutrition. Features of the diet for type 2 diabetes and the nuances associated with the use of insulin are reflected in the article.

Causes and symptoms of type 2 diabetes

Endocrine pathology develops against the background of metabolic disorders and. When the pancreas produces in sufficient quantities, or the secretion of the hormone is slightly reduced, but the tissues are insensitive to the influence of the hormone. The consequence of the pathological process is problems with the absorption of glucose.

Due to the lack of energy, the balance in the body and the course of many processes are disturbed. To correct pancreatic deviations, more insulin must be produced all the time so that at least a small part of the hormone affects absorption. An unbearable load against the background quickly wears out the gland, especially with malnutrition, overeating, frequent use of spicy, smoked, fatty foods, muffins, sweets.

Factors provoking the development of endocrine pathology:

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

When prescribing storage hormone injections, consider:

• indicators do not exceed 7-7.5%, glucose - from 8 to 10 mmol / l, pancreatic functions are preserved. The patient can maintain sugar values ​​for a long time with oral preparations;
• indicators of glycohemoglobin are increased to 8% or more, the glucose level exceeds 10 mmol / l. In most cases, a switch to insulin injections will be needed sooner than 5 years.

Insulin therapy for type 2 diabetes is:

• constant;
• temporary.

The patient may receive:

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

The patient receives injections:

• immediately after detection, confirmation of the diagnosis;
• during therapy, different stages treatment, against the background of the progression of endocrine pathology, if taking pills does not reduce sugar to optimal values. Many switch to injections after 7-10 years.

Appointment of temporary insulin therapy:

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

Diet Rules

Table number 9 is the best option to keep the sugar level within acceptable limits. The diet for type 2 diabetes is quite strict, but with an insulin-independent type of illness, it is nutrition that comes to the fore. Injections or insulin tablets and hypoglycemic drugs are additional measures.

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

General principles of nutrition

With type 2 diabetes, it is important to strictly follow the instructions, follow the rules of cooking:

• exclude items with sugar from the diet;
• to give a pleasant taste to compotes, tea, fruit puree, jelly, use sweeteners: sorbitol, xylitol, fructose, stevia. Dosage - as directed by the doctor;
• cook dishes for a couple, cook, bake;
• replace animal fats and margarine vegetable oils. Salted bacon and cracklings, which many people love, are banned. unsalted butter use rarely and little by little;
• adhere to the diet: sit down at the table at the same time, do not skip the next meal;
• per day you need to get at least one and a half liters of fluid;
• refuse fried, smoked types of food, pastries, marinades and pickles, excess salt, canned vegetables and fruits;
• the optimal energy value of the daily diet is from 2400 to 2600 kilocalories;
• be sure to consider, consume types of food with low scores and . On the site you can find tables for diabetics, the use of which allows you to avoid an increase in glucose concentration;
• get slow carbohydrates (bran, cereals, pasta made from durum wheat, oatmeal, fruits). Refuse unhealthy, "fast" carbohydrates. Diabetics are harmed by halva, cookies, sugar, pies, cakes, dumplings, jam, jam. You can not eat sweets, bars, milk and white chocolate. A black variety of chocolate with 72% cocoa is rarely allowed, in small quantities: GI - only 22 units;
• more often eat fruits and vegetables without heat treatment. In baked and boiled foods, GI values ​​\u200b\u200bare increased, which negatively affects sugar levels. For example, raw carrots: Gl - 35, boiled - already 85, fresh apricots - 20, canned fruits with sugar - 91 units;
• use potatoes in "uniforms": GI is 65. If a diabetic decides to eat chips or french fries, then sugar rises more actively: the glycemic index during frying increases to 95 units.

Approved Products

In diabetes, it is useful to use the following names and dishes:

• vegetable soups;
• kefir, cottage cheese, yogurt (low-fat types, in moderation);
• seafood;
• cereals, with the exception of rice and semolina;
• egg white, yolk - 1 time per week. The best option for a dish is a protein omelette;
• : zucchini, pumpkin, tomatoes, cucumbers, eggplants, peppers, all kinds of cabbage. Vegetables with a high glycemic index (potatoes, boiled carrots and beets) are allowed little by little, no more than three times a week;
• weak broth on the “second water” (for the first time after boiling, drain the liquid with extractives) based on low-fat fish, turkey, chicken, beef can be obtained twice a week;
• bran - little by little, several times a week, wholemeal bread, grain, pumpkin, rye - no more than 300 g per day. Crackers, muffins, pizza, cakes, cakes, cheap pasta, gingerbread, dumplings - exclude. Limit white bread and loaf sharply - the glycemic index is 100 units;
• berries and fruits for type 2 diabetes with low sugar content, low GI: cherries, plums, currants, green apples, pears, chokeberry, citrus. Sharply limit bananas. Freshly squeezed juices are prohibited: there is a sharp jump in glucose levels;
• desserts without sugar. Fruit and berry jelly with fructose, compotes with sweeteners, jelly, sugar-free marmalade, fresh fruit and berry salad are useful;
• hard cheese (a little, two to three times a week);
• low-fat varieties of fish, turkey meat, rabbit, chicken, veal, beef;
• seaweed;
• vegetable oils - a little, add to salads and ready-made first courses, fry fish and meat is prohibited;
• mushrooms - a little, boiled or baked;
• nuts (in small quantities), three to four times a week;
• greens: dill, cilantro, green onions, parsley, lettuce;
• coffee drink based on chicory, green tea, weak coffee with milk (required, skimmed), mineral water(slightly warm, no gas).

Go to the address and learn about the norm of knots thyroid gland, as well as about the causes and symptoms of deviations.

Prohibited names

You can not eat:

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

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

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