insulinotherapy

August 12, 2017 17:51 | Genetic Diseases

Insulin is a hormone, consisting of amino acids.Pancreatic cells produce proinsulin, which is inactive.As a result of the action of enzymes into active insulin.It enters the bloodstream and enters the liver.The incoming half liver insulin binds to receptors.The remainder of the hormone enters the systemic circulation and then into muscle and fatty tissue.The main share of the hormone, about 80% is processed in the liver and kidneys.The remaining part is processed in muscle and adipose tissue.Isolation of insulin by the pancreas is divided into basal and food.Basal allocation ensures optimal blood glucose between meals.Food insulin release occurs after ingestion, which resulted in blood glucose levels rise.During the day there is also the oscillation of insulin.His greatest amount produced in the early morning hours, the smallest - in the evening.For the treatment of diabetes best human insulin preparation is obtained by a semisynthetic or biosynthetic.Semisynthetic method consists of replacing one amin

o acid for another in pig insulin.Biosynthetic method is that the genetic material in the intestinal bacteria or yeast culture portion inserted human genetic material which is responsible for generation of insulin.As a result of the manipulation of micro-organisms begin to secrete human insulin.

insulin preparations are divided into preparations short and prolonged action.short-acting drugs undergo rapid absorption, providing a greater concentration of insulin in the blood.Short-acting insulins have several routes of administration: subcutaneous, intramuscular, intravenous.Insulins with prolonged action are divided into 2 groups: intermediate-acting and long-acting.the average duration of action drug is slowly absorbed, allowing the start of their activities in about 1 to 1.5 hours after administration.long-acting preparations consist of large crystals, which still provides a slower absorption.Drugs in this group take effect in 4-5 hours after administration.The duration of action of 28-36 hours. The maximum effect is achieved after 8-14 hours after administration.Despite such a prolonged effect of drugs in this group, usually one injection per day is not enough.This is due to the inability to provide an adequate level of data insulin preparations in the blood throughout the day.

There are a number of indications for insulin .These include type I diabetes, removal of the pancreas, the inability to achieve the restoration of metabolic processes in diabetes diet during pregnancy, as well as a number of conditions arising during the course of type II diabetes.Such conditions include: coma, prekomatosnoe condition, progressive weight loss, state of ketosis, blood glucose, fasting more than 15 mmol / l, the inability to achieve a normal metabolism in the background purpose tablet glucose-lowering drugs in the maximum daily dose, the emergence and rapid progression of latecomplications of diabetes, various surgical procedures.

There are several principles of treatment of insulin preparations.The first principle is that the required amount of insulin for administration twice a day provides insulin preparations - in the morning and evening.The second principle is that the replacement of insulin by the pancreas occurs by administration before each meal short-acting drugs.The dose is calculated based on the estimated amount of carbohydrates that a person intends to take.Moreover, it considered in the existing blood glucose level before meal.This blood sugar level is determined separately using the individual meter.

Individuals suffering from Type II diabetes mellitus, in most cases, not require reception of insulin preparations.Yet in some cases, need to take these drugs.These people are divided into two groups.The first group includes young adults (28-40 years) who do not have obesity.The second group consists of people suffering from type II diabetes, which for a long time been used for the treatment of sulfonylurea drugs, against which they have developed resistance to this group of drugs.

There are several tactics insulin treatment.Sometimes insulin treatment is temporary and can last from several weeks to several months.This tactic is used in the absence of true insulin deficiency.Cancel insulin in this case it takes place gradually.

Another treatment strategy is the appointment of insulin in combination with oral saharoponizhayuschimi with drugs from the outset.The dosage of insulin is produced, taking into account the following data: a blood glucose level, time of day, the number of pieces of bread, which is assumed to use, and intensity of physical exercise before and after a meal.The time interval between the administration of insulin and food intake is selected individually.In most cases, this range is from 15 to 30 minutes.One of the goals of treatment is to normalize insulin levels of fasting blood sugar.Evening insulin dose is approximately 22-23 hours, as its effect occurs within 8-9 hours.

The introduction of large amounts of insulin in the evening for 2-3 hours of the night develops a state of hypoglycaemia (excessive reduction of blood sugar).This can manifest sleep disorders with nightmares may begin any unconscious action, in the morning, you can note the appearance of headaches and state weakness.at night development state of hypoglycemia causes the release of the hormone glucagon into the bloodstream, which is influenced by the level of blood sugar in the morning time excessively increases.This phenomenon is called the Somogyi phenomenon.Towards morning decreased insulin action and may cease altogether, which also causes a rise in blood glucose.This phenomenon is called the phenomenon of "dawn".

In diabetes using subcutaneous administration of insulin.Intramuscular and intravenous use in emergency situations.Start effect after the administration of short-acting insulin is dependent on the injection site.The most rapid effect is noted when administered under the skin of the abdomen.The effect is observed after 15-30 minutes, reaching a maximum in 45-60 minutes.The slowest effect is observed when administered under the skin of the thigh.Starting effect observed after 1 - 1.5 hours, and the absorbed only 75% of the injected insulin.An intermediate position is occupied by an injection in the shoulder area.It is recommended to introduce a short-acting insulin under the skin of the abdomen and under the skin of the shoulder or thigh - intermediate-acting insulin.The rate of absorption of insulin is increased by the heating of the injection site.Place administration must constantly change.Distances between injections must be at least 12 cm.

Currently, widespread administration of insulin by means of injection pens.Insulin therapy is accompanied by a number of complications.The most common condition of hypoglycaemia (excessive reduction of blood sugar) and hypoglycemic coma.The latter is the most dangerous complication.In addition, allergic reactions may occur, which may be both local and general.Local allergic reactions are located at the site of insulin and may manifest by itching, redness, or seal.Common allergic reactions are urticaria, angioedema or anaphylactic shock.The last are extremely rare.

Types of insulin

currently used porcine insulin and human insulin.

Insulin varies and the duration.

Short insulin takes effect within 15 to 20 minutes.Maximum effect occurs within 1 to 1.5 hours, and ends its operation after 3-4 hours.

Insulins average duration of its action begin in 1.5-2 hours, with a maximum effect within 4-5 hours and complete the action by 6-8 hours.

long-acting insulins begin to have effect after 3-4 hours. Achieve maximum effect after 6 hours. The duration of action of 12- 14 hours.

In addition, there are extremely long and insulin action.They begin to have effect after 6 to 8 hours. Reaches its maximum effect in 10-16 hours and complete their action through 24-26 hours.

There is also a so-called mnogopikovye insulins when in-one in certain proportions mixed insulins short and long-acting.

usually for breakfast is required 2 units of insulin for lunch - 1.5 units, and for dinner 1 unit.But these figures are strictly individual and can identify them, just constantly monitoring blood sugar.This so-called Intensified insulin therapy (closest to the normal operation of the pancreas and allows life differs little from that of people without diabetes).There is also the so-called conventional therapy when the patient makes a two (sometimes one) injection.Injections of insulin short and long action are made twice a day, before breakfast and before dinner.This type of insulin has a major drawback: the lunch should be eaten at certain times (during the peak action of long-acting insulin that is administered in the morning) and must contain a certain amount of bread units.

Under the rules of storage of insulin should be in the fridge on the bottom shelf.Used vial can be stored at room temperature.In no case can not be allowed to freeze insulin.Prior to injection, the vial of insulin you need to warm it up, down for a few seconds in hot water.

To correctly dial a dose, it is necessary: ​​to dial into the air syringe on many divisions as needed to enter the long-acting insulin, and introduce the air into the vial with the insulin.Without removing the syringe, dial the required number of prolonged action of insulin.The same should be done with the vial containing the short-acting insulin, to release air bubbles from the syringe.Inject insulin under the skin.Injections can be made in the abdomen, thigh, buttocks, under the shoulder blade or arm.

insulin - the most experienced drug used in diabetes mellitus type I all patients and for specific indications - diabetes mellitus type II.Patients with type I diabetes need constant replacement of insulin, the hormone should be administered on a daily basis, because only in this case, the body can metabolize glucose.

Insulin is a protein compound, however, getting in the gastrointestinal tract, it is under the action of gastric juice loses digested and medicinal properties.Therefore, it is administered by injection for directly into the blood.

for insulin syringes and apply special schprits-handle to allow for injection almost painlessly, in any situation, without prior sterilization.

to blood sugar level throughout the day was close to normal, you need to use the maximum injection mimic insulin secretion in a healthy person, that is to ensure its constant level and an increase in the amount of growth after the concentration of blood sugar as a result of eating.The peaks of the therapeutic effect of insulin should as far as possible coincide with the rise of blood sugar peaks (which occurs after meals) that is checked by the level of sugar in the blood at 1 and 2 hours after breakfast or lunch.

Currently, there are many types of insulin differ in time of action, so the doctor is able to choose an individual treatment plan for each patient.Determination of the optimal forms of insulin and schemes of their application determined by the endocrinologist, having regard to the severity of diabetes, complications, comorbidities.

Insulin therapy is usually prescribed to patients with type I diabetes, but ketoacidosis, diabetic coma and predkome, infectious complications, and surgical procedures insulin is one of the most important therapeutic agents.

Insulin serum

Reference values ​​of insulin concentration in the blood serum in adults is 3-17 mU / ml (21,5-122 pmol / l).

Insulin - a polypeptide, the monomeric form of which is composed of two chains: A (21 amino acids) and B (30 amino acids).Insulin is produced as a product of proteolytic cleavage of the precursor of insulin, known as proinsulin.In fact insulin is produced after the exit from the cell.Cleavage of the C-chain (C-peptide) from the proinsulin occurs at the cytoplasmic membrane, where appropriate protease concluded.

cells requires insulin for glucose transport, potassium and amino acids in the cytoplasm.It has an inhibitory effect on gluconeogenesis and glycogenolysis.In adipose tissue insulin enhances glucose transport and intensifies glycolysis, increase the rate of fatty acid synthesis and esterification and inhibits lipolysis.With prolonged action of insulin increased synthesis and DNA synthesis enzyme activates growth.

insulin in the blood reduces the concentration of glucose and fatty acids, as well as (although slightly) amino acids.Insulin breaks down relatively quickly in the liver by an enzyme glutationinsulin trans-hydrogenase.The half-life of insulin, the entered intravenously is 5-10 minutes.

cause of diabetes - lack of (absolute or relative) insulin.Determination of the concentration of insulin in blood is necessary for differentiation of various forms of diabetes, therapeutic drug selection, selection of an optimal therapy, establishing the degree of insufficiency of p-cells.In healthy people, during OGTT insulin concentration in blood reaches a maximum at 1 hour after taking the glucose and decreased after 2 hours.

Impaired glucose tolerance is characterized by slowing rise in blood insulin concentration with respect to an increase in blood glucose during the course of the OGTT.The maximum rise in insulin levels in these patients observed in 1.5-2 hours after receiving glucose.blood levels of proinsulin, C-peptide, glucagon in the normal range.

Diabetes mellitus type 1. basal insulin concentration in the blood within the normal or reduced, there are fewer of its rise in all terms of the OGTT.Contents and proinsulin C-peptide is reduced, or glucagon levels in the normal range or slightly increased.

Diabetes mellitus type 2. When mild form of insulin in the blood concentration of fasting somewhat higher.During the OGTT is also higher than normal values ​​in all periods of the study.Blood proinsulin, C-peptide, and glucagon not changed.In the form of medium gravity reveal an increase in insulin concentration in blood on an empty stomach.In the course of the OGTT maximum insulin release is observed for 60 minutes, followed by a very slow decrease in its concentration in the blood, so high levels of insulin observed after 60, 120 and even 180 minutes after the glucose load.The content of proinsulin C-peptide in blood is reduced, glucagon - increased.

Hyperinsulinism. insulinoma is a tumor (adenoma) consisting of p-cells of pancreatic islets.The tumor can develop in people of any age, it usually single, benign nature, but can be multiple, combined with ADEME-tozom, and in rare cases - malignant.When the organic form of hyperinsulinism (insulinoma or islet adenoma) indicated a sudden and inadequate production of insulin, which causes the development of hypoglycemia usually paroxysmal character.Hyperproduction of insulin is independent of glucose (typically above 144 pmol / L).The ratio of insulin / glucose greater than 1: 4.5.Often detected excess proinsulin and C-peptide in the background of hypoglycemia.Diagnosis is no doubt if background hypoglycemia (blood glucose concentration of less than 1.7 mmol / l) in plasma insulin level above 72 pmol / l.As diagnostic tests used load tolbutamide or leucine: in patients with insulin-tumor often there is a high rise in blood insulin concentration and a marked decrease in blood glucose compared to healthy.